斯威士兰、莱索托、马拉维和津巴布韦15至19岁青少年艾滋病毒流行控制进展的两轮人群艾滋病毒影响评估证据：一项横断面研究。

Evidence from two rounds of Population HIV Impact Assessments of progress towards HIV epidemic control in adolescents aged 15-19 years in Eswatini, Lesotho, Malawi, and Zimbabwe: a cross-sectional study.

作者信息

Teasdale Chloe A, Zimba Rebecca, Low Andrea, Nuwagaba-Biribonwoha Harriet, Ndagije Felix, Tenthani Lyson, Mugurungi Owen, Kreniske Philip, Abrams Elaine J

机构信息

Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, USA; Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy (SPH), New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.

出版信息

Lancet Glob Health. 2025 May 29. doi: 10.1016/S2214-109X(25)00106-8.

DOI:10.1016/S2214-109X(25)00106-8

PMID:40451228

Abstract

BACKGROUND

There are more than 1 million adolescents aged 15-19 years living with HIV globally. Using two rounds of the Population HIV Impact Assessments (PHIAs), we describe incidence, prevalence, and UNAIDS 95-95-95 testing, treatment, and viral load suppression (VLS) indicators for adolescents living with HIV in four countries in southern Africa over time.

METHODS

In this multinational cross-sectional study, we analysed data from two PHIA rounds in Eswatini (2016-17 and 2021), Lesotho (2016-17 and 2020), Malawi (2015-16 and 2020-21), and Zimbabwe (2015-16 and 2020). PHIAs are surveys distributed to randomly selected households, and participants were eligible if they had slept in the house the night before, were legally competent, and gave consent. Adolescents aged 15-19 years received rapid antibody HIV testing and provided blood samples. HIV incidence was estimated with avidity assays. Adolescents living with HIV were considered to be on antiretroviral therapy (ART) if they had detectable antiretrovirals in their blood or reported taking ART. VLS was defined as viral load of less than 1000 copies per mL. Survey-weighted proportions of adolescents living with HIV with known HIV status, on ART (among those with known HIV status), and VLS (among those on ART) were compared across survey rounds using Rao-Scott χ tests adjusted for study weights with jackknife variance.

FINDINGS

A total of 11 343 adolescents participated in round 1 (5947 [52·4%] were female and 5396 [47·6%] were male; 402 were living with HIV) and 10 849 in round 2 (5754 [53·0%] were female and 5095 [47·0%] were male; 318 were living with HIV). The estimated HIV incidence in round 1 was 1·05% (95% CI 0·27-1·83) in Eswatini, 0·37% (0·00-0·81) in Lesotho, 0·12% (0·00-0·32) in Malawi, and 0·17% (0·00-0·38) in Zimbabwe. The estimated HIV incidence in round 2 was unavailable in Eswatini due to the small sample size, 0·38% (0·00-0·82) in Lesotho, 0·20% (0·00-0·43) in Malawi, and 0·42% (0·03-0·81) in Zimbabwe. The round 2 PHIA surveys in Lesotho, Malawi, and Zimbabwe showed that approximately 12 000 new HIV infections occurred annually in adolescents aged 15-19 years. Across all four countries, there was an increase between round 1 and round 2 in HIV status knowledge (63·8% to 81·2%, p<0·0001) and in ART coverage (90·1% to 96·3%, p=0·041), whereas there was no significant change in VLS (79·3% to 85·4%, p=0·15).

INTERPRETATION

Despite improvements in HIV status knowledge and ART coverage among adolescents aged 15-19 years living with HIV in four countries, the estimated HIV incidence did not decline and only 81% of adolescents living with HIV knew their status in 2020-21. Increasing testing in this age group is urgently needed to accelerate progress towards epidemic control.

FUNDING

None.

摘要

背景

全球有超过100万15至19岁的青少年感染了艾滋病毒。通过两轮人口艾滋病毒影响评估（PHIA），我们描述了随着时间推移，南部非洲四个国家感染艾滋病毒青少年的发病率、患病率以及联合国艾滋病规划署95-95-95检测、治疗和病毒载量抑制（VLS）指标。

方法

在这项跨国横断面研究中，我们分析了斯威士兰（2016 - 17年和2021年）、莱索托（2016 - 17年和2020年）、马拉维（2015 - 16年和2020 - 21年）和津巴布韦（2015 - 16年和2020年）两轮PHIA的数据。PHIA是对随机选择的家庭进行的调查，参与者如果前一晚睡在该房屋内、具有法定行为能力并给予同意则符合条件。15至19岁的青少年接受了艾滋病毒快速抗体检测并提供了血样。通过亲和力测定法估计艾滋病毒发病率。如果感染艾滋病毒的青少年血液中可检测到抗逆转录病毒药物或报告正在接受抗逆转录病毒治疗，则被视为正在接受抗逆转录病毒治疗（ART）。VLS定义为病毒载量低于每毫升1000拷贝。使用经刀切方差调整研究权重的Rao - Scott χ检验，比较各轮调查中已知艾滋病毒感染状况、接受ART治疗（在已知感染艾滋病毒者中）以及VLS（在接受ART治疗者中）的感染艾滋病毒青少年的调查加权比例。

结果

共有11343名青少年参与了第一轮调查（5947名[52.4%]为女性，5396名[47.6%]为男性；402名感染艾滋病毒），10849名参与了第二轮调查（5754名[53.0%]为女性，5095名[47.0%]为男性；318名感染艾滋病毒）。第一轮调查中，斯威士兰的估计艾滋病毒发病率为1.05%（95%置信区间0.27 - 1.83），莱索托为0.37%（0.00 - 0.81），马拉维为0.12%（0.00 - 0.32），津巴布韦为0.17%（0.00 - 0.38）。由于样本量小，斯威士兰第二轮调查的估计艾滋病毒发病率无法得出，莱索托为0.38%（0.00 - 0.82），马拉维为0.20%（0.00 - 0.43），津巴布韦为0.42%（0.03 - 0.81）。莱索托、马拉维和津巴布韦的第二轮PHIA调查显示，15至19岁青少年每年约有12000例新的艾滋病毒感染。在所有四个国家，第一轮和第二轮之间艾滋病毒感染状况知晓率（63.8%至81.2%，p<0.0001）和ART覆盖率（90.1%至96.3%，p = 0.041）有所提高，而VLS无显著变化（79.3%至85.4%，p = 0.15）。