亲密伴侣暴力对垂直 HIV 传播的影响：对 46 个非洲国家的建模分析。

The contribution of intimate partner violence to vertical HIV transmission: a modelling analysis of 46 African countries.

机构信息

Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada.

MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.

出版信息

Lancet HIV. 2024 Aug;11(8):e542-e551. doi: 10.1016/S2352-3018(24)00148-6. Epub 2024 Jul 23.

DOI:10.1016/S2352-3018(24)00148-6

PMID:39059403

Abstract

BACKGROUND

Addressing gender inequities could be key to the elimination of vertical transmission of HIV. Women experiencing intimate partner violence (IPV) might be at an increased risk of vertical transmission due to their vulnerability to HIV acquisition and barriers to access to and retention in care. Sub-Saharan Africa, where IPV burden is among the highest globally, accounts for most new paediatric HIV infections. We aimed to examine the proportion of excess vertical transmission attributable to IPV in this region.

METHODS

In this modelling analysis, we created a probability tree model of vertical HIV transmission among women aged 15-49 years in 46 African countries. We estimated the proportion of vertical transmission attributable to past-year physical or sexual IPV, or both, as an age-standardised population attributable fraction (PAF) and as excess vertical transmission risk per 1000 births among women experiencing IPV. We incorporated perinatal and postnatal vertical transmission among women who acquired HIV before pregnancy, during pregnancy, and during breastfeeding. Fertility, HIV prevalence, HIV incidence, antiretroviral therapy (ART) uptake, and ART retention varied in the model by women's IPV experience. The model was parameterised using UNAIDS' 2023 Spectrum model data, WHO's Global Database on Violence Against Women, and the peer-reviewed literature. Uncertainty intervals (95% UI) were calculated through 1000 Monte Carlo simulations.

FINDINGS

Across 46 countries 13% (95% UI 6-21) of paediatric HIV infections in 2022 were attributed to IPV, corresponding to over 22 000 paediatric infections. The PAF ranged from 4% (2-7) in Niger to 28% (13-43) in Uganda. The PAF was highest among girls aged 15-19 years (20%, 8-33) and lowest among women aged 45-49 years (6%, 3-9). In southern Africa, where women's HIV prevalence is highest (23%), IPV led to 11 (5-20) additional infections per 1000 births among women affected by IPV.

INTERPRETATION

IPV might be responsible for one in eight paediatric HIV infections in sub-Saharan Africa. Ending IPV could accelerate vertical transmission elimination, especially among young women who bear the highest burden of violence.

FUNDING

Canadian Institutes of Health Research, Canada Research Chair, and Fonds de recherche du Québec-Santé.

TRANSLATIONS

For the French, Georgian and Spanish translations of the abstract see Supplementary Materials section.

摘要

背景

解决性别不平等问题可能是消除艾滋病毒垂直传播的关键。经历亲密伴侣暴力（IPV）的女性由于容易感染艾滋病毒以及获得和维持治疗的障碍，可能面临更高的垂直传播风险。在全球范围内，遭受 IPV 负担最重的撒哈拉以南非洲地区，占大多数新发生的儿科 HIV 感染病例。我们旨在研究该地区归因于 IPV 的垂直传播超额比例。

方法

在这项建模分析中，我们为 46 个非洲国家 15-49 岁的女性创建了一个垂直 HIV 传播概率树模型。我们通过年龄标准化人群归因分数（PAF）和经历 IPV 的女性每 1000 例出生的垂直传播超额风险，来估计过去一年中 IPV 导致的垂直传播比例。我们纳入了在怀孕前、怀孕期间和哺乳期感染 HIV 的女性的围产期和产后垂直传播。模型中，女性的 IPV 经历影响了生育能力、艾滋病毒流行率、艾滋病毒发病率、抗逆转录病毒疗法（ART）的使用和 ART 的保留。该模型使用 UNAIDS 的 2023 年 Spectrum 模型数据、世卫组织的全球暴力侵害妇女数据库和同行评议文献进行参数化。通过 1000 次蒙特卡罗模拟计算不确定区间（95%置信区间）。

结果

在 46 个国家中，2022 年有 13%（95%置信区间 6-21）的儿科 HIV 感染归因于 IPV，相当于超过 22000 例儿科感染。PAF 范围从尼日尔的 4%（2-7）到乌干达的 28%（13-43）。15-19 岁女孩的 PAF 最高（20%，8-33），45-49 岁妇女的 PAF 最低（6%，3-9）。在南部非洲，女性艾滋病毒流行率最高（23%），IPV 导致受 IPV 影响的女性每 1000 例出生增加 11 例（5-20）感染。