MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
UNAIDS, Gaborone, Botswana.
J Acquir Immune Defic Syndr. 2024 Jan 1;95(1S):e24-e33. doi: 10.1097/QAI.0000000000003324. Epub 2024 Jan 4.
Quantifying subnational need for antiretroviral therapy (ART) for HIV is challenging because people living with HIV (PLHIV) access health facilities in areas that may differ from their residence. We defined and demonstrated new indicators for PLHIV treatment needed to guide health system target setting and resource allocation.
Botswana.
We extended Naomi, a Bayesian small-area model for estimating district-level HIV indicators from national household survey and HIV service delivery data. We used model outputs for ART seeking probabilities in neighboring districts to define the "PLHIV (attending)" indicator representing the estimated number of PLHIV who would seek treatment at health facilities in a district, and "Untreated PLHIV attending" representing gaps in ART service provision. Botswana 2021 district HIV estimates were used to demonstrate new outputs and assess the sensitivity to uncertainty in district population sizes.
Across districts of Botswana, estimated adult ART coverage in December 2021 ranged 90%-96%. In the capital city Gaborone, there were 50,400 resident PLHIV and 64,200 receiving ART, of whom 24% (95% CI: 20 to 32) were estimated to reside in neighboring districts. Applying ART attendance probabilities gave a "PLHIV attending" denominator of 68,300 and unmet treatment need of 4100 adults (95% CI: 3000 to 5500) for Gaborone health facilities. The facility-based "PLHIV attending" denominator was less-sensitive to fluctuations in district population size assumptions.
New indicators provided more consistent targets for HIV service provision, but are limited by ART data quality. This challenge will increase as treatment coverage reaches high levels and treatment gaps are smaller.
量化国家以下一级艾滋病毒抗逆转录病毒疗法 (ART) 的需求具有挑战性，因为艾滋病毒感染者 (PLHIV) 在可能与其居住地不同的地区获得卫生设施的服务。我们定义并展示了新的 PLHIV 治疗需求指标，以指导卫生系统目标设定和资源分配。
博茨瓦纳。
我们扩展了 Naomi，这是一种用于从全国住户调查和艾滋病毒服务提供数据估计地区一级艾滋病毒指标的贝叶斯小区域模型。我们使用邻近地区的 ART 寻求概率模型输出来定义“PLHIV（就诊）”指标，该指标代表估计会在一个地区的卫生设施寻求治疗的 PLHIV 人数，而“未接受治疗的 PLHIV 就诊”则代表 ART 服务提供方面的差距。我们使用博茨瓦纳 2021 年的地区艾滋病毒估计数来展示新的产出，并评估对地区人口规模不确定性的敏感性。
在博茨瓦纳的各个地区，2021 年 12 月估计的成人接受 ART 治疗的比例在 90%-96%之间。在首都哈博罗内，有 50400 名常住 PLHIV 和 64200 名接受 ART 的人，其中有 24%（95%置信区间：20 至 32）据估计居住在邻近地区。应用 ART 就诊概率得出了 68300 名“PLHIV 就诊”分母和 4100 名未得到治疗的成年人（95%置信区间：3000 至 5500）的治疗需求，这些都是为哈博罗内的卫生设施设定的。以设施为基础的“PLHIV 就诊”分母对地区人口规模假设的波动不太敏感。
新的指标为艾滋病毒服务提供提供了更一致的目标，但受到 ART 数据质量的限制。随着治疗覆盖率达到高水平和治疗差距缩小，这一挑战将增加。
