Farahani Mansoor, Farley Shannon M, Smart Theodore F, Ndagije Felix, Maile Limpho, Longwe Herbert, Hoos David, El-Sadr Wafaa M
ICAP at Columbia University, New York, NY, USA.
ICAP at Columbia University, New York, NY, USA.
Lancet HIV. 2025 Jan;12(1):e51-e59. doi: 10.1016/S2352-3018(24)00271-6. Epub 2024 Dec 10.
Lesotho has made substantial efforts to control its HIV epidemic. We aimed to assess progress towards UNAIDS 95-95-95 targets in Lesotho by comparing data from the Lesotho Population-based HIV Impact Assessments conducted in 2016-17 (LePHIA 2016) and 2019-20 (LePHIA 2020).
The LePHIA surveys used a cross-sectional, two-stage, stratified cluster sampling design to obtain a nationally representative sample of adults aged 15-59 years (LePHIA 2016) or aged 15 years and older (LePHIA 2020) from all ten districts of Lesotho. From November, 2016 to May, 2017 (LePHIA 2016) and from December, 2019 to March, 2020 (LePHIA 2020), consenting participants from randomly selected households provided demographic and clinical information and blood samples for household HIV testing according to national guidelines. HIV-reactive test results were confirmed by a laboratory assay. We estimated HIV status awareness and antiretroviral therapy (ART) use on the basis of self-reports or detection of antiretroviral drugs in blood samples. Viral load suppression was defined as HIV-1 RNA less than 1000 copies per mL. We applied Poisson regression models using survey weights and estimated variances using the Taylor series linearisation approach.
11 682 participants were enrolled in LePHIA 2016 and 12 718 participants were enrolled in LePHIA 2020. Overall HIV incidence decreased significantly from 1·10% (95% CI 0·68-1·52) in 2016 to 0·50% (0·26-0·74) in 2020 (p=0·026). Among adults who tested positive for HIV, awareness of HIV status improved from 81·0% (79·6-82·3) in 2016 to 89·6% (88·3-90·8) in 2020 (p<0·0001). Furthermore, between the two surveys, the proportion on ART among those aware of their HIV status increased from 91·8% (90·5-93·0) to 96·9% (95·9-97·6; p<0·0001) and the prevalence of viral load suppression among those on ART increased from 87·7% (86·1-89·1) to 90·8% (89·5-91·9; p<0·0020). After adjusting for demographic covariates, adults living with HIV were significantly more likely in 2020 than in 2016 to know their HIV status (adjusted prevalence ratio 1·09, 95% CI 1·07-1·12, p<0·0001), to be on ART if aware of their status (1·05, 1·03-1·07, p<0·0001), and to be virally suppressed if on ART (1·03, 1·01-1·06, p=0·0045).
Between 2016 and 2020, Lesotho made significant progress towards the UNAIDS 95-95-95 targets, surpassing the second target (ART coverage) and showing improvements in HIV status awareness and viral load suppression (the first and third targets) as well as declines in HIV prevalence and incidence. Lesotho's experience provides valuable insights for other countries working to control their HIV epidemics.
The US President's Emergency Plan for AIDS Relief.
莱索托已为控制其艾滋病疫情做出了重大努力。我们旨在通过比较2016 - 2017年（莱索托基于人群的艾滋病影响评估，LePHIA 2016）和2019 - 2020年（LePHIA 2020）的数据，评估莱索托在实现联合国艾滋病规划署95 - 95 - 95目标方面取得的进展。
LePHIA调查采用横断面、两阶段、分层整群抽样设计，从莱索托所有十个区中获取具有全国代表性的15 - 59岁成年人样本（LePHIA 2016）或15岁及以上成年人样本（LePHIA 2020）。在2016年11月至2017年5月（LePHIA 2016）以及2019年12月至2020年3月（LePHIA 2020）期间，来自随机抽取家庭的同意参与者根据国家指南提供人口统计学和临床信息以及血液样本用于家庭艾滋病检测。艾滋病病毒反应性检测结果通过实验室检测进行确认。我们根据自我报告或血液样本中抗逆转录病毒药物的检测情况估算艾滋病病毒感染状况知晓率和抗逆转录病毒疗法（ART）的使用情况。病毒载量抑制定义为每毫升艾滋病病毒1型RNA低于1000拷贝。我们使用调查权重应用泊松回归模型，并采用泰勒级数线性化方法估算方差。
LePHIA 2016纳入了11682名参与者，LePHIA 2020纳入了12718名参与者。总体艾滋病病毒发病率从2016年的1.10%（95%置信区间0.68 - 1.52）显著下降至2020年的0.50%（0.26 - 0.74）（p = 0.026）。在检测出艾滋病病毒呈阳性的成年人中，艾滋病病毒感染状况知晓率从2016年的81.0%（79.6 - 82.3）提高到2020年的89.6%（88.3 - 90.8）（p < 0.0001）。此外，在两次调查之间，知晓自身艾滋病病毒感染状况者中接受抗逆转录病毒疗法的比例从91.8%（90.5 - 93.0）增至96.9%（95.9 - 97.6；p < 0.0001），接受抗逆转录病毒疗法者中病毒载量抑制的患病率从87.7%（86.1 - 89.1）增至90.8%（89.5 - 91.9；p < 0.0020）。在对人口统计学协变量进行调整后，2020年感染艾滋病病毒的成年人比2016年更有可能知晓自己的艾滋病病毒感染状况（调整后的患病率比值为1.09，95%置信区间1.07 - 1.12，p < 0.0001），如果知晓自身状况则更有可能接受抗逆转录病毒疗法（1.05，1.03 - 1.07，p < 0.0001），并且如果接受抗逆转录病毒疗法则更有可能实现病毒载量抑制（1.03，1.01 - 1.06，p = 0.0045）。
2016年至2020年期间，莱索托在实现联合国艾滋病规划署95 - 95 - 95目标方面取得了显著进展，超过了第二个目标（抗逆转录病毒疗法覆盖率），并在艾滋病病毒感染状况知晓率和病毒载量抑制方面有所改善（第一个和第三个目标），同时艾滋病病毒流行率和发病率有所下降。莱索托的经验为其他致力于控制其艾滋病疫情的国家提供了宝贵的见解。
美国总统艾滋病紧急救援计划。
