The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal.

IF 3.4 2区医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-10-01 Epub Date: 2024-07-01 DOI:10.1097/QAD.0000000000003974

Romain Silhol, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, Anthony Vautier, Clémence Doumenc-Aïdara, Olivier Geoffroy, Kouassi Noël N'Guessan, Younoussa Sidibé, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Christinah Mukandavire, Peter Vickerman, Abdelaye Keita, Cheikh Tidiane Ndour, Eboi Ehui, Joseph Larmarange, Marie-Claude Boily

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Abstract

Objectives: To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.

Design: HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].

Methods: Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012-2021 averted by condom use and antiretroviral therapy (ART) uptake among key populations and non-key populations, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012-2021 due to prevention gaps, and the distribution of undiagnosed people with HIV (PWH) by risk group in January 2022 and their tPAF over 2022-2031.

Results: Condom use and ART may have averted 81-88% of new HIV infections over 2012-2021 across countries, mostly due to condom use by key population. The tPAF of all key populations combined over 2012-2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key populations (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key populations = 15%), 46% in Mali (male key populations = 23%), and 69% in Senegal (male key populations = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key populations living with HIV in Côte d'Ivoire over 2022-2031, 53% in Mali, and 65% in Senegal.

Conclusion: Substantial HIV diagnosis gaps remain in Western Africa, especially among male key populations. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

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在科特迪瓦、马里和塞内加尔，过去的艾滋病毒干预措施和诊断差距对新感染艾滋病毒、艾滋病毒传播和艾滋病毒相关死亡的影响。

目标：在科特迪瓦、马里和塞内加尔，估计过去的 HIV 干预措施对流行病学的影响，以及不同风险群体中未诊断出的 HIV 对新感染 HIV 的影响程度和贡献：设计：在总体人群和关键人群[女性性工作者 (FSW)、其客户和男男性行为者]中建立 HIV 传播动态模型：方法：针对每个国家特定的人口、行为和流行病学数据集，对模型进行独立参数化和校准。我们估算了重点人群和非重点人群使用安全套和接受抗逆转录病毒疗法（ART）所避免的 2012-2021 年艾滋病毒新感染病例的比例、特定人群因预防差距而对 2012-2021 年新感染病例的直接和间接贡献[传播人口可归因比例（tPAF）]，以及 2022 年 1 月按风险人群分列的未确诊感染者分布情况及其 2022-2031 年的传播人口可归因比例：结果：使用安全套和抗逆转录病毒疗法可能避免了各国 2012-2021 年间 81-88% 的艾滋病毒新感染病例，这主要是因为关键人群使用了安全套。在 2012-2021 年期间，所有关键人群的总 tPAF 在 27%（科特迪瓦）和 79%（塞内加尔）之间。男性关键人群（性工作者和男男性行为者的客户）对新感染的贡献最大（在马里和塞内加尔>60%），因为他们的艾滋病毒感染率更高，预防差距更大。2022 年，在科特迪瓦（男性关键人群 = 15%）、马里（男性关键人群 = 23%）和塞内加尔（男性关键人群 = 55%），男性占所有未确诊感染的艾滋病毒感染者的 56%。如果艾滋病毒检测和抗逆转录病毒疗法的启动率保持在目前的水平，那么在 2022-2031 年期间，科特迪瓦 20% 的艾滋病毒新感染病例可能来自未确诊的重点人群艾滋病毒感染者，马里为 53%，塞内加尔为 65%：结论：在西非，艾滋病毒诊断仍存在巨大差距，尤其是在男性重点人群中。解决这些差距是影响该地区艾滋病疫情和实现到 2030 年根除艾滋病目标的关键。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.