Brizzi Andrea, Kagaayi Joseph, Ssekubugu Robert, Abeler-Dörner Lucie, Blenkinsop Alexandra, Bonsall David, Chang Larry W, Fraser Christophe, Galiwango Ronald M, Kigozi Godfrey, Kyle Imogen, Monod Mélodie, Nakigozi Gertrude, Nalugoda Fred, Rosen Joseph G, Laeyendecker Oliver, Quinn Thomas C, Grabowski M Kate, Reynolds Steven J, Ratmann Oliver
Department of Mathematics, Imperial College London, London, United Kingdom.
Rakai Health Sciences Program, Kalisizo, Uganda.
Int J Epidemiol. 2025 Jun 11;54(4). doi: 10.1093/ije/dyaf126.
To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which human immunodeficiency virus (HIV) viraemia is concentrating.
We analysed HIV testing and viral load data collected between 2013 and 2019 from the open, population-based Rakai Community Cohort Study in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, 1-year age bands, and residence in inland and fishing communities. All estimates were standardized to the underlying source population by using census data. We then assessed 95-95-95 targets in their ability to identify the populations in which viraemia is concentrated.
Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%-5.3%) in 2013 to 1.9% (1.7%-2.2%) in 2019 in inland communities and from 19.1% (18.0%-20.4%) in 2013 to 4.7% (4.0%-5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95-95-95 targets. Instead, in both inland and fishing communities, women aged 25-29 years and men aged 30-34 years were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or having already achieved 95-95-95 targets.
The 95-95-95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.
为了确定优先事项并量身定制到2030年在非洲终结艾滋病的干预措施，重要的是对人类免疫缺陷病毒（HIV）病毒血症集中的人群进行特征描述。
我们分析了2013年至2019年期间从乌干达基于人群的开放的拉凯社区队列研究中收集的HIV检测和病毒载量数据，以按性别、1岁年龄组以及在内陆和渔业社区的居住情况估计随时间变化的HIV血清流行率和人群病毒抑制情况。所有估计值均通过使用人口普查数据按基础源人群进行标准化。然后，我们评估了95-95-95目标在识别病毒血症集中人群方面的能力。
在实施普遍检测和治疗之后，内陆社区病毒血症患者的比例从2013年的4.9%（4.6%-5.3%）降至2019年的1.9%（1.7%-2.2%），渔业社区从2013年的19.1%（18.0%-20.4%）降至2019年的4.7%（4.0%-5.5%）。病毒血症并未集中在距离实现95-95-95目标最远的年龄和性别组中。相反，在内陆和渔业社区，25至29岁的女性和30至34岁的男性是2019年对人群水平病毒血症贡献最大的5岁年龄组，尽管这些组已接近或已经实现了95-95-95目标。
95-95-95目标为监测艾滋病流行控制进展提供了有用的基准，但未考虑潜在的人群结构情况，因此可能会将干预措施导向在病毒血症人群中占边缘比例的群体。
