艾滋病防治三个90%策略实施进展分析
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摘要
联合国艾滋病规划署提出了防治艾滋病"三个90%"的目标。各研究在评价该目标实现情况时,采用了不同的方法和标准。文章从三个90%的计算、感染者总人数的估计、检测方法、开始治疗的标准、评价过程中的不确定性等方面,对三个90%的评价方法进行概述。尽管许多国家和地区已经达到或接近"三个90%"的目标,但仍存在检测范围有限、方法不够丰富、药物可及性不足、服药意愿不高、医疗服务质量难以保证、服药依从性差、耐药、服务水平有限影响治疗效果、污名化、歧视仍存在等问题,为加速目标实现,防治艾滋病不能单一地依靠治疗,控制艾滋病依然需要综合防治。
UNAIDS set the ambitious 90-90-90 targets,and different methods and criteria were used in various studies to assess the achievements of the goal.This paper aims to overview of the three 90% evaluation methods from the aspects of estimated number of people with HIV,testing,the standard of starting treatment,and biases in the evaluation process.Although many countries and regions have reached or are close to three 90%targets,there are still challenges in diagnosis,treatment and virus suppression such as limitation of testing scope and method,accessibility to ART or medical care,poor drug compliance and resistance,the stigma and discrimination respectively.In order to accelerate the realization of the goal,the prevention and treatment of AIDS cannot rely on treatment alone,control AIDS still needs comprehensive prevention and treatment.
UNAIDS set the ambitious 90-90-90 targets,and different methods and criteria were used in various studies to assess the achievements of the goal.This paper aims to overview of the three 90% evaluation methods from the aspects of estimated number of people with HIV,testing,the standard of starting treatment,and biases in the evaluation process.Although many countries and regions have reached or are close to three 90%targets,there are still challenges in diagnosis,treatment and virus suppression such as limitation of testing scope and method,accessibility to ART or medical care,poor drug compliance and resistance,the stigma and discrimination respectively.In order to accelerate the realization of the goal,the prevention and treatment of AIDS cannot rely on treatment alone,control AIDS still needs comprehensive prevention and treatment.
引文
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[7]Oldenburg CE,Brnighausen T,Tanser F,et al.Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hyperendemic community in rural South Africa[J].Clin Infect Dis,2016,63(4):548-554.
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[19]Granich R,Williams B,Montaner J,et al.90-90-90and ending AIDS:necessary and feasible[J].The Lancet,2017,390(10092):341-343.
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[21]Insight Start Study Group.Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection[J].N Engl J Med,2015,373(9):795-807.
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[26]Saksena NK,Rodes B,Wang B,et al.Elite HIV controllers:myth or reality[J].AIDS Rev,2007,9(4):195-207.
[27]Marks G,Crepaz N,Senterfitt J W,et al.Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States:implications for HIV prevention programs[J].JAIDS Journal of Acquired Immune Deficiency Syndromes,2005,39(4):446-453.
[28]Joint United Nations Programme on HIV/AIDS(UNAIDS).Ending AIDS Progress towards the 90-90-90targets[Z].Geneva,2017.
[29]Gisslén M,Svedhem V,Lindborg L,et al.Sweden,the first country to achieve the Joint United Nations Programme on HIV/AIDS(UNAIDS)/World Health Organization(WHO)90-90-90continuum of HIV care targets[J].HIV medicine,2017,18(4):305-307.
[30]Gangakhedkar RR.Ending AIDS:The 90-90-90strategy[J].medical journal armed forces india,2017,73(1):3-4.
[31]Amukele TK,Sokoll LJ,Pepper D,et al.Can unmanned aerial systems(drones)be used for the routine transport of chemistry,hematology,and coagulation laboratory specimens[J].PLoS One,2015,10(7):e0134020.
[32]WHO/UNITAID,Landscape for HIV rapid diagnostic tests for HIV selftesting[Z].Geneva:UNITAID and World Health Organization,2015.
[33]Hill A,Pozniak A.HIV treatment cascades:how can all countries reach the UNAIDS 90-90-90target[J].AIDS,2015,29(18):2523-2525.
[34]Larru B,Eby J,Lowenthal ED.Antiretroviral treatment in HIV-1infected pediatric patients:focus on efavirenz[J].Pediatric Health Med Ther,2014,5:29-42.
[35]Spreen WR,Margolis DA,Jr JCP.Long-acting injectable antiretrovirals for HIV treatment and prevention[J].Current Opinion in HIV&AIDS,2013,8(6):565-571.
[36]Mao L,Adam PC,Kippax S,et al.Evolving views and practices of antiretroviral treatment prescribers in Australia[J].Med J Aust,2015,202(5):258-261.
[37]Medland NA,Mao L,Crooks L,et al.Obstacles to prescribers′initiation early antiretroviral therapy:a barrier to achieving 90-90-90goals[J].The Lancet HIV,2016,3(12):e559-e560.
[38]Wringe A,Renju J,Seeley J,et al.Bottlenecks to HIV care and treatment in sub-Saharan Africa:a multi-country qualitative study[J].Sex Transm Infect,2017,93(Suppl 3):1-3.
[39]Poppe LK,Chunda-Liyoka C,Kwon EH,et al.HIV drug resistance in infants increases with changing prevention of motherto-child transmission regimens[J].AIDS,2017,31(13):1885-1889.
[40]Moreno M,Caballero E,Mateus RM,et al.HIV drug resistance in Africa:an emerging problem that deserves urgent attention[J].AIDS,2017,31(11):1637-1639.
[41]Anderson DA,Crowe SM,Garcia M.Point-of-care testing[J].Curr HIV/AIDS Rep,2011,8(1):31-37.
[42]Kop MLVD,Thabane L,Awiti PO,et al.Advanced HIV disease at presentation to care in Nairobi,Kenya:late diagnosis or delayed linkage to care—a cross-sectional study[J].Bmc Infectious Diseases,2016,16(1):169.
[43]Nyika H,Mugurungi O,Shambira G,et al.Factors associated with late presentation for HIV/AIDS care in Harare City,Zimbabwe,2015[J].Bmc Public Health,2016,16(1):1-7.
[2]洪坤学,邹森,邵一鸣.艾滋病生物医学预防策略现状及挑战[J].中国热带医学,2016,16(11):1049-1051.
[3]Remis RS,Alary M,Liu J,et al.HIV transmission among men who have sex with men due to condom failure[J].PLoS One,2014,9(9):e107540.
[4]Karim SSA,Karim QA.Antiretroviral prophylaxis:a defining moment for HIV prevention[J].Lancet,2011,378(9809):e23.
[5]Havlir DV,Kendall MA,Ive P,et al.Timing of Antiretroviral Therapy for HIV-1Infection and Tuberculosis[J].N Engl J Med,2011,365(16):1482-1491.
[6]Cohen MS,Chen YQ,McCauley M,et al.Prevention of HIV-1infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[7]Oldenburg CE,Brnighausen T,Tanser F,et al.Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hyperendemic community in rural South Africa[J].Clin Infect Dis,2016,63(4):548-554.
[8]UNAIDS.90-90-90.an ambitious treatment target to help end the AIDS epidemic[Z].Geneva Switzerland Unaids Joint United Nations Programme on Hiv/aids Oct,2014.
[9]Granich RM,Gilks CF,Dye C,et al.Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission:a mathematical model[J].Lancet,2009,373(9657):48-57.
[10]Levi J,Raymond A,Pozniak A,et al.Can the UNAIDS 90-90-90target be achieved?A systematic analysis of national HIV treatment cascades[J].Bmj Global Health,2016,1(2):e000010.
[11]Chkhartishvili N,Chokoshvili O,Dvali N,et al.Significant Improvements Are Needed in HIV Care Continuum to Meet 90-90-90Targets in Georgia[J].J Int Assoc Provid AIDS Care,2016,15(6):451-454.
[12]Nsanzimana S,Kanters S,Remera E,et al.HIV care continuum in Rwanda:a cross-sectional analysis of the national programme[J].The lancet HIV,2015,2(5):e208-e215.
[13]刘黎,彭志行,王璐,等.中美艾滋病疫情信息和估计方法的比较[J].现代预防医学,2010,37(20):3808-3811.
[14]朱博文,倪蕴嘉,庄勋.AIDS疫情估计方法研究进展[J].中国公共卫生,2017,33(6):1028-1032.
[15]UNAIDS.90-90-90.On the right track towards the global target[Z].Geneva Switzerland Unaids,2016.
[16]沈蕊,邢文革.HIV实验室检测策略[J].中国艾滋病性病,2015,21(9):833-834.
[17]Beyrer C,Baral SD,van Griensven F,et al.Global epidemiology of HIV infection in men who have sex with men[J].The Lancet,2012,380(9839):367-377.
[18]张娜,蒋岩.HIV新发感染检测方法研究进展[J].国际病毒学杂志,2013,20(2):76-80.
[19]Granich R,Williams B,Montaner J,et al.90-90-90and ending AIDS:necessary and feasible[J].The Lancet,2017,390(10092):341-343.
[20]Gaolathe T,Wirth KE,Holme MP,et al.Botswana's progress toward achieving the 2020UNAIDS 90-90-90antiretroviral therapy and virological suppression goals:apopulation-based survey[J].The lancet HIV,2016,3(5):e221-e230.
[21]Insight Start Study Group.Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection[J].N Engl J Med,2015,373(9):795-807.
[22]Strategies for Management of Antiretroviral Therapy(SMART)Study Group.CD4+count-guided interruption of antiretroviral treatment[J].N Engl J Med,2006,355(22):2283-2296.
[23]Horton R.Offline:Ending the AIDS epidemic[J].The Lancet,2014,384(9941):388.
[24]World Health Organization.Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV,web supplement:annex 2:evidence to decision-making tables and supporting evidence[R].World Health Organization,2015.
[25]吴尊友.我国实现艾滋病防治策略三个90%的进展与挑战[J].中华疾病控制杂志,2016,20(12):1187-1189.
[26]Saksena NK,Rodes B,Wang B,et al.Elite HIV controllers:myth or reality[J].AIDS Rev,2007,9(4):195-207.
[27]Marks G,Crepaz N,Senterfitt J W,et al.Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States:implications for HIV prevention programs[J].JAIDS Journal of Acquired Immune Deficiency Syndromes,2005,39(4):446-453.
[28]Joint United Nations Programme on HIV/AIDS(UNAIDS).Ending AIDS Progress towards the 90-90-90targets[Z].Geneva,2017.
[29]Gisslén M,Svedhem V,Lindborg L,et al.Sweden,the first country to achieve the Joint United Nations Programme on HIV/AIDS(UNAIDS)/World Health Organization(WHO)90-90-90continuum of HIV care targets[J].HIV medicine,2017,18(4):305-307.
[30]Gangakhedkar RR.Ending AIDS:The 90-90-90strategy[J].medical journal armed forces india,2017,73(1):3-4.
[31]Amukele TK,Sokoll LJ,Pepper D,et al.Can unmanned aerial systems(drones)be used for the routine transport of chemistry,hematology,and coagulation laboratory specimens[J].PLoS One,2015,10(7):e0134020.
[32]WHO/UNITAID,Landscape for HIV rapid diagnostic tests for HIV selftesting[Z].Geneva:UNITAID and World Health Organization,2015.
[33]Hill A,Pozniak A.HIV treatment cascades:how can all countries reach the UNAIDS 90-90-90target[J].AIDS,2015,29(18):2523-2525.
[34]Larru B,Eby J,Lowenthal ED.Antiretroviral treatment in HIV-1infected pediatric patients:focus on efavirenz[J].Pediatric Health Med Ther,2014,5:29-42.
[35]Spreen WR,Margolis DA,Jr JCP.Long-acting injectable antiretrovirals for HIV treatment and prevention[J].Current Opinion in HIV&AIDS,2013,8(6):565-571.
[36]Mao L,Adam PC,Kippax S,et al.Evolving views and practices of antiretroviral treatment prescribers in Australia[J].Med J Aust,2015,202(5):258-261.
[37]Medland NA,Mao L,Crooks L,et al.Obstacles to prescribers′initiation early antiretroviral therapy:a barrier to achieving 90-90-90goals[J].The Lancet HIV,2016,3(12):e559-e560.
[38]Wringe A,Renju J,Seeley J,et al.Bottlenecks to HIV care and treatment in sub-Saharan Africa:a multi-country qualitative study[J].Sex Transm Infect,2017,93(Suppl 3):1-3.
[39]Poppe LK,Chunda-Liyoka C,Kwon EH,et al.HIV drug resistance in infants increases with changing prevention of motherto-child transmission regimens[J].AIDS,2017,31(13):1885-1889.
[40]Moreno M,Caballero E,Mateus RM,et al.HIV drug resistance in Africa:an emerging problem that deserves urgent attention[J].AIDS,2017,31(11):1637-1639.
[41]Anderson DA,Crowe SM,Garcia M.Point-of-care testing[J].Curr HIV/AIDS Rep,2011,8(1):31-37.
[42]Kop MLVD,Thabane L,Awiti PO,et al.Advanced HIV disease at presentation to care in Nairobi,Kenya:late diagnosis or delayed linkage to care—a cross-sectional study[J].Bmc Infectious Diseases,2016,16(1):169.
[43]Nyika H,Mugurungi O,Shambira G,et al.Factors associated with late presentation for HIV/AIDS care in Harare City,Zimbabwe,2015[J].Bmc Public Health,2016,16(1):1-7.