Iwuji Collins C, McMichael Celia, Sibanda Euphemia, Orievulu Kingsley S, Austin Kelly, Ebi Kristie L
Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, Durban, South Africa.
School of Geography, Earth and Atmospheric Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Lancet HIV. 2024 Dec;11(12):e843-e860. doi: 10.1016/S2352-3018(24)00186-3. Epub 2024 Oct 9.
Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.
For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.
Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.
Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.
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极端天气事件对健康构成风险，且对弱势群体（如艾滋病毒感染者）的影响尤为严重。我们旨在调查极端天气事件对艾滋病毒检测接受情况、艾滋病毒治疗与护理以及艾滋病毒传播的影响。
在本系统评价中，我们检索了PubMed、科学网和PsycINFO，以查找在数据库创建至2023年8月31日期间发表的同行评审研究。符合条件的研究为英文定性、定量观察性（回顾性、前瞻性、横断面、纵向、病例对照和队列研究）、混合方法研究以及与艾滋病毒和极端天气事件相关的随机对照试验。我们排除了综述、数学模型和病例报告。导出搜索结果后，两位作者独立筛选已识别文章的标题和摘要，对符合纳入标准的文章全文进行评审。我们运用系统思维来构建一个将极端天气事件与艾滋病毒联系起来的框架，并使用主题叙事综合法总结结果。
在检索到的6126项研究中，27项符合纳入标准并可进行分析，其中19项为定量研究，6项为定性研究，2项为混合方法研究。我们确定了将极端天气事件与艾滋病毒联系起来的五个主要主题：经济和生计状况（12项研究）、心理社会因素（19项研究）、基础设施损坏和运营挑战（17项研究）、移民和流离失所（10项研究）以及相关医疗状况和医疗保健需求（12项研究）。我们展示了这些主题如何以复杂的方式相互作用，导致艾滋病毒检测接受率降低、艾滋病毒护理中断及随后的疾病进展、风险行为改变以及艾滋病毒患病率上升。
极端天气事件与艾滋病毒服务中断有关。由于纳入研究的设计，我们无法确定极端天气事件与艾滋病毒发病率之间的因果关系，这凸显了一个研究空白。有必要制定适当的适应和缓解政策，以在极端天气事件期间及之后保护艾滋病毒感染者的健康和福祉。此类行动对于实现联合国艾滋病规划署到2030年终结艾滋病毒作为公共卫生威胁这一目标至关重要。
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