Lancet Global Health最新文献

Improving Ebola virus disease outbreak control through targeted post-exposure prophylaxis. 通过有针对性的接触后预防措施改进埃博拉病毒疾病的爆发控制。

IF 34.3 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-10 DOI: 10.1016/s2214-109x(24)00255-9

Elin Hoffmann Dahl,Placide Mbala,Sylvain Juchet,Abdoulaye Touré,Alice Montoyo,Beatrice Serra,Richard Kojan,Eric D'Ortenzio,Bjorn Blomberg,Marie Jaspard

Ebola virus disease kills more than half of people infected. Since the disease is transmitted via close human contact, identifying individuals at the highest risk of developing the disease is possible on the basis of the type of contact (correlated with viral exposure). Different candidates for post-exposure prophylaxis (PEP; ie, vaccines, antivirals, and monoclonal antibodies) each have their specific benefits and limitations, which we discuss in this Viewpoint. Approved monoclonal antibodies have been found to reduce mortality in people with Ebola virus disease. As monoclonal antibodies act swiftly by directly targeting the virus, they are promising candidates for targeted PEP in contacts at high risk of developing disease. This intervention could save lives, halt viral transmission, and, ultimately, help curtail outbreak propagation. We explore how a strategic integration of monoclonal antibodies and vaccines as PEP could provide both immediate and long-term protection against Ebola virus disease, highlighting ongoing clinical research that aims to refine this approach, and discuss the transformative potential of a successful PEP strategy to help control viral haemorrhagic fever outbreaks.

埃博拉病毒感染者中有一半以上会死亡。由于该疾病是通过人类密切接触传播的，因此可以根据接触类型（与病毒暴露相关）来确定罹患该疾病风险最高的个人。暴露后预防（PEP，即疫苗、抗病毒药物和单克隆抗体）的不同候选药物各有其特定的优点和局限性，我们将在本视点中对此进行讨论。经证实，获批的单克隆抗体可降低埃博拉病毒感染者的死亡率。由于单克隆抗体直接针对病毒迅速起效，因此很有希望用于对高危接触者进行有针对性的预防性治疗。这种干预措施可以挽救生命，阻止病毒传播，最终帮助遏制疫情蔓延。我们探讨了将单克隆抗体和疫苗战略性地整合在一起作为预防性治疗如何能够提供针对埃博拉病毒疾病的直接和长期保护，重点介绍了旨在完善这种方法的正在进行的临床研究，并讨论了成功的预防性治疗策略在帮助控制病毒性出血热疫情方面的变革潜力。

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引用次数: 0

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries. 手术部位感染的微生物检测能力和抗菌药物耐药性：在七个低收入和中等收入国家进行的 FALCON 随机试验的事后、前瞻性二次分析。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-05 DOI: 10.1016/S2214-109X(24)00330-9

Background: Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs).

Methods: This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs.

Findings: Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR.

Interpretation: Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR.

Funding: National Institute for Health and Care Research.

Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.

背景：手术部位感染（SSI）是最常见的医疗相关感染之一，大大增加了抗生素的使用量。有针对性地使用抗生素预防 SSI 并进行有效治疗对控制抗菌药耐药性（AMR）至关重要。本研究旨在描述中低收入国家（LMICs）SSI 微生物的检测能力和多重耐药性（MDR）：这项分析包括在七个中低收入国家（贝宁、加纳、印度、墨西哥、尼日利亚、卢旺达和南非）接受腹部手术的患者，是 FALCON 随机对照试验的一部分。根据美国疾病控制和预防中心（CDC）的定义，从确诊为 SSI 的患者身上采集了伤口拭子。根据 CDC 和欧洲疾病预防与控制中心的定义，对微生物种类和 MDR 数据进行了分析，同时还分析了当地微生物学实践的医院级数据。还进行了调整分析，以确定与 MDR 相关的围手术期因素。检测能力根据阳性诊断 SSI 的拭子检测完成情况进行评估：2018年12月10日至2020年9月7日期间，FALCON试验共招募了5788名患者。1163名患者被确诊为SSI，其中905人（77%-8%）在手术前接受了预防性抗生素治疗。在 SSI 患者中，1163 人中有 935 人（80-4%）没有进行伤口拭子检查；195 人来自没有进行拭子检查的医院（15 家医院），740 人来自有能力但没有进行拭子检查的医院（35 家医院）。在 228 名接受拭抹的患者中，有 200 人（88-5%）检测到微生物。大肠埃希菌（200 例中有 89 例，占 37-9%）是最常见的微生物，200 例中有 116 例（占 58-0%）患者未使用围手术期预防性抗生素。在有数据可确定 MDR 状态的 147 例患者中，102 例（69-4%）发现了 MDR。调整后的分析发现，适当的预防性抗生素覆盖率（调整后的几率比0-43，95% CI 0-19-0-96）和感染控制小组的定期到位率（0-32，0-11-0-93）与MDR的显著减少有关：在低收入国家，腹部污染手术围术期针对性抗生素预防措施不足，只有极少数 SSI 微生物经过正式诊断。扩大检测能力、制定地方指南、成立感染控制小组，可以通过有针对性的抗生素预防措施预防SSI，从而减轻MDR的负担：国家健康与护理研究所：摘要的法文和西班牙文译文见 "补充材料 "部分。

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引用次数: 0

Strengthening surgical systems in LMICs: data-driven approaches. 加强低收入和中等收入国家的外科系统：数据驱动方法。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-05 DOI: 10.1016/S2214-109X(24)00375-9

Hyla-Louise Kluyts

引用次数: 0

Mechanisms and causes of death after abdominal surgery in low-income and middle-income countries: a secondary analysis of the FALCON trial. 低收入和中等收入国家腹部手术后死亡的机制和原因：FALCON 试验的二次分析。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-05 DOI: 10.1016/S2214-109X(24)00318-8

Background: Death after surgery is devasting for patients, families, and communities, but remains common in low-income and middle-income countries (LMICs). We aimed to use high-quality data from an existing global randomised trial to describe the causes and mechanisms of postoperative mortality in LMICs. To do so, we developed a novel framework, learning from both existing classification systems and emerging insights during data analysis.Methods: This study was a preplanned secondary analysis of the FALCON trial in 54 hospitals across seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). FALCON was a pragmatic, 2 × 2 factorial, randomised controlled trial that compared the effectiveness of two types of interventions for skin preparation (10% aqueous povidone-iodine vs 2% alcoholic chlorhexidine) and sutures (triclosan-coated vs uncoated). Patients who did not have surgery or were lost to follow-up were excluded (n=231). The primary outcomes of the present analysis were the mechanism and cause of death within 30-days of surgery, determined using a modified verbal autopsy strategy from serious adverse event reports. Factors associated with mortality were explored in a mixed-effects Cox proportional hazards model. The FALCON trial is registered with ClinicalTrials.gov, NCT03700749.Findings: This preplanned secondary analysis of the FALCON trial included 5558 patients who underwent abdominal surgery, of whom 4248 (76·4%) patients underwent surgery in tertiary, referral centres and 1310 (23·6%) underwent surgery in primary referral (ie, district or rural) hospitals. 3704 (66·7%) of 5558 surgeries were emergent. 306 (5·5%) of 5558 patients died within 30 days of surgery. 226 (74%) of 306 deaths were due to circulatory system failure, which included 173 (57%) deaths from sepsis and 29 (9%) deaths from hypovolaemic shock including bleeding. 47 (15%) deaths were due to respiratory failure. 60 (20%) of 306 patients died without a clear cause of death: 45 (15%) patients died with sepsis of unknown origin and 15 (5%) patients died of an unknown cause. 46 (15%) of 306 patients died within 24 h, 111 (36%) between 24 h and 72 h, 57 (19%) between >72 h and 168 h, and 92 (30%) more than 1 week after surgery. 248 (81%) of 306 patients died in hospital and 58 (19%) patients died out of hospital. The adjusted Cox regression model identified age (hazard ratio 1·01, 95% CI 1·01-1·02; p<0·0001), ASA grade III-V (4·93, 3·45-7·03; p<0·0001), presence of diabetes (1·47, 1·04-2·41; p=0·033), being an ex-smoker (1·59, 1·10-2·30; p=0·013), emergency surgery (2·08, 1·45-2·98; p<0·0001), cancer (1·98, 1·42-2·76; p<0·0001), and major surgery (3·94, 2·30-6·75; p<0·0001) as risk factors for postoperative mortality INTERPRETATION: Circulatory failure leads to most deaths after abdominal surgery, with sepsis accounting for almost two-thirds. Variability in timing of death highlights opportun

背景：手术后死亡对患者、家庭和社区都是巨大的打击，但在低收入和中等收入国家（LMICs）仍很常见。我们的目标是利用现有全球随机试验的高质量数据来描述低收入和中等收入国家术后死亡的原因和机制。为此，我们开发了一个新颖的框架，既借鉴了现有的分类系统，又在数据分析过程中获得了新的见解：本研究是对 FALCON 试验的一项预先计划的二次分析，该试验在 7 个低收入、中等收入国家/地区（贝宁、加纳、印度、墨西哥、尼日利亚、卢旺达和南非）的 54 家医院进行。FALCON 是一项务实的 2 × 2 因式随机对照试验，比较了两种备皮（10% 聚维酮碘水溶液与 2% 洗必泰酒精）和缝合（三氯生涂层与无涂层）干预措施的效果。未进行手术或失去随访的患者被排除在外（231 人）。本次分析的主要结果是手术后 30 天内的死亡机制和原因，根据严重不良事件报告采用改良的口头尸检策略确定。通过混合效应 Cox 比例危险模型探讨了与死亡率相关的因素。FALCON试验已在ClinicalTrials.gov上注册，编号为NCT03700749.研究结果：FALCON试验的这项预先计划的二次分析纳入了5558名接受腹部手术的患者，其中4248名（76-4%）患者在三级转诊中心接受了手术，1310名（23-6%）患者在一级转诊医院（即地区或农村医院）接受了手术。5558 例手术中有 3704 例（66-7%）为急诊手术。5558名患者中有306名（5-5%）在术后30天内死亡。306 例死亡病例中有 226 例（74%）死于循环系统衰竭，其中 173 例（57%）死于败血症，29 例（9%）死于低血容量休克，包括出血。47人（15%）死于呼吸衰竭。306 名患者中有 60 人（20%）死于无明确死因：45（15%）名患者死于原因不明的败血症，15（5%）名患者死因不明。306例患者中有46例（15%）在术后24小时内死亡，111例（36%）在术后24小时至72小时内死亡，57例（19%）在术后72小时以上至168小时内死亡，92例（30%）在术后1周以上死亡。306名患者中有248人（81%）死于住院，58人（19%）死于院外。调整后的 Cox 回归模型确定了年龄（危险比 1-01，95% CI 1-01-1-02；pFunding：国家健康与护理研究所全球健康研究组。

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引用次数: 0

Correction to Lancet Glob Health 2024; 12: e1278-87. Lancet Glob Health 2024; 12: e1278-87 更正。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-02 DOI: 10.1016/S2214-109X(24)00377-2

引用次数: 0

Final clauses to ensure better compliance with the Pandemic Agreement. 确保更好地遵守《大流行病协定》的最后条款。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-01 Epub Date: 2024-07-19 DOI: 10.1016/S2214-109X(24)00293-6

Tae Jung Park

引用次数: 0

A risk-differentiated, community-led intervention to strengthen uptake and engagement with HIV prevention and care cascades among female sex workers in Zimbabwe (AMETHIST): a cluster randomised trial. 以社区为主导的风险区分干预措施，旨在加强津巴布韦女性性工作者对艾滋病预防和护理级联的吸收和参与（AMETHIST）：分组随机试验。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-01 DOI: 10.1016/S2214-109X(24)00235-3

Frances M Cowan, Fortunate Machingura, M Sanni Ali, Sungai T Chabata, Albert Takaruza, Jeffrey Dirawo, Memory Makamba, Tsitsi Hove, Loveleen Bansi-Matharu, Primrose Matambanadzo, Maryam Shahmanesh, Joanna Busza, Richard Steen, Raymond Yekeye, Amon Mpofu, Owen Mugurungi, Andrew N Phillips, James R Hargreaves

Background: Female sex workers remain disproportionately affected by HIV. The aim of this study was to determine the effect of risk-differentiated, peer-led support for female sex workers in Zimbabwe on the risk of HIV acquisition and HIV transmission from sex among female sex workers.Methods: In this cluster randomised, open-label, controlled study, 22 clinics dedicated to female sex workers co-located in government health facilities throughout Zimbabwe were allocated (1:1, through restricted randomisation) to usual care or AMETHIST intervention. Usual care comprised HIV testing, pre-exposure prophylaxis (PrEP), referral to government antiretroviral therapy (ART) services, contraception, condoms, syndromic management of sexually transmitted infections, health education, legal advice, and peer support. AMETHIST added peer-led microplanning tailored to individuals' risk and participatory self-help groups. All cisgender women (aged >18 years) who had sold sex within the past 30 days and lived or worked within trial cluster areas were eligible. Intervention status was not masked to programme implementers but was masked to survey teams and laboratory staff. After 28 months, a respondent-driven sampling (RDS) survey was done in the female sex worker population around each clinic, which measured the primary outcome, the combined proportion of female sex workers in the surveyed population at risk of transmitting HIV (ie, were HIV positive, not virally suppressed, and not consistently using condoms) or at risk of acquiring HIV (ie, were HIV negative and not consistently using condoms or PrEP). We report prespecified analyses of the disaggregated proportions of female sex workers in the surveyed population at risk of either transmission or acquisition of HIV. Analyses were prespecified, RDS-weighted, and age-adjusted. This trial is registered with the Pan African Clinical Trials Registry, PACTR202007818077777.Findings: The AMETHIST intervention was started on May 15, 2019, and data were collected from June 1, 2019, until Dec 13, 2021. The RDS survey was done from Oct 18 to Dec 13, 2021, with 2137 women included in the usual care group (11 clusters) and 2131 in the AMETHIST intervention group (11 clusters) after excluding survey seeds (n=132) and women with missing key data (n=44). 1973 (46·2%) of the 4268 female sex workers surveyed were living with HIV; of these, 863 (93·5%; RDS-adjusted) of 931 women in the intervention group and 927 (88·8%) of 1042 in the usual care group were virologically suppressed. 287 (22·4%) of 1200 HIV-negative women in the intervention group and 194 (15·7%) of 1096 in the usual care group reported currently taking PrEP, of whom only two (0·4%) of 569 had protective tenofovir diphosphate concentrations in dried blood spots (>700 fmol/dried blood punch). There was no effect of the intervention on the primary endpoint of risk of both HIV transmission and acquisiti

背景：女性性工作者受 HIV 感染的比例仍然过高。本研究旨在确定在津巴布韦为女性性工作者提供有风险区分的同伴支持对女性性工作者感染 HIV 和通过性行为传播 HIV 风险的影响：在这项分组随机、开放标签、对照研究中，津巴布韦各地政府医疗机构中的 22 家女性性工作者专用诊所被分配（1:1，通过限制性随机分配）接受常规护理或 AMETHIST 干预。常规护理包括 HIV 检测、暴露前预防 (PrEP)、政府抗逆转录病毒疗法 (ART) 服务转介、避孕、安全套、性传播感染综合症管理、健康教育、法律咨询和同伴支持。AMETHIST 增加了针对个人风险的同伴引导式微型规划和参与式自助小组。所有在过去 30 天内卖过性，并在试验群组地区内居住或工作的顺性别女性（年龄大于 18 岁）都符合条件。计划实施者不会被告知干预情况，但调查小组和实验室工作人员会被告知干预情况。28 个月后，我们对每个诊所周围的女性性工作者人群进行了受访者驱动的抽样调查（RDS），该调查测量了主要结果，即调查人群中存在传播 HIV 风险（即 HIV 阳性、病毒未被抑制且未坚持使用安全套）或存在感染 HIV 风险（即 HIV 阴性且未坚持使用安全套或 PrEP）的女性性工作者的综合比例。我们报告了对调查人群中存在传播或感染 HIV 风险的女性性工作者比例进行的预设分析。分析经过预设、RDS 加权和年龄调整。该试验已在泛非临床试验注册中心（PACTR202007818077777）注册：AMETHIST干预于2019年5月15日开始，数据收集时间为2019年6月1日至2021年12月13日。RDS调查于2021年10月18日至12月13日进行，在排除调查种子选手（n=132）和关键数据缺失的妇女（n=44）后，2137名妇女被纳入常规护理组（11个群组），2131名妇女被纳入AMETHIST干预组（11个群组）。在接受调查的 4268 名女性性工作者中，1973 人（46-2%）感染了艾滋病毒；其中，干预组 931 名女性中的 863 人（93-5%；RDS 调整后）和常规护理组 1042 名女性中的 927 人（88-8%）病毒得到抑制。在干预组的 1200 名 HIV 阴性女性中，有 287 人（22-4%）、在常规护理组的 1096 人中，有 194 人（15-7%）表示目前正在服用 PrEP，其中 569 人中只有 2 人（0-4%）的干血斑中存在保护性的二磷酸替诺福韦浓度（>700 fmol/干血冲）。干预措施对艾滋病毒传播和感染风险的主要终点没有影响（干预组 n=1156/2131，RDS 调整后比例为 55-3%；常规护理组 n=1104/2137，RDS 调整后比例为 52-7%；年龄调整后风险差异为 -0-9%，95% CI -5-7%至 3-9%，p=0-70）。在次要结果方面，与常规护理组（103/1041，10-4%）相比，干预组（n=63/931，RDS 调整后比例为 5-8%）中有传播风险的女性 HIV 感染者比例较低且显著减少，年龄调整后的风险差异为 -5-5%（95% CI -8-2% 至 -2-9%，p=0-0003）。干预组（n=1093/1200，RDS调整后比例为92-1%）和常规护理组（1001/1096，92-2%）中HIV阴性女性的感染风险相似，年龄调整后的风险差异为-0-6%（95% CI -4-6至3-4，p=0-74）：解释：干预措施对传播或感染的综合风险没有总体益处。感染艾滋病病毒的妇女的病毒载量抑制率很高，AMETHIST似乎进一步改善了这一情况，这表明在易感人群和流动人群中，抗逆转录病毒疗法的接受率和坚持率有可能大幅提高。持续治疗和重振预防仍然至关重要：资金来源：惠康信托基金会和比尔及梅琳达-盖茨基金会：摘要的绍纳语和恩代贝勒语译文见补充材料部分。

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引用次数: 0

Leveraging universal health coverage to leave no one behind in tackling AMR. 利用全民医保，在应对 AMR 的过程中不让任何人掉队。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-01 Epub Date: 2024-07-10 DOI: 10.1016/S2214-109X(24)00309-7

Pamela Cipriano, James Chau, Mariam Jashi, Ilona Kickbusch, Justin Koonin, Tlaleng Mofokeng, Joy Phumaphi, Magda Robalo, Akihisa Shiozaki

引用次数: 0

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23. 撒哈拉以南非洲主要人群的人口规模、艾滋病毒感染率和抗逆转录病毒疗法覆盖率：2010-23 年调查数据的整理与综合。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-01 DOI: 10.1016/S2214-109X(24)00236-5

Oliver Stevens, Keith Sabin, Rebecca L Anderson, Sonia Arias Garcia, Kalai Willis, Amrita Rao, Anne F McIntyre, Elizabeth Fearon, Emilie Grard, Alice Stuart-Brown, Frances Cowan, Louisa Degenhardt, James Stannah, Jinkou Zhao, Avi J Hakim, Katherine Rucinski, Isabel Sathane, Makini Boothe, Lydia Atuhaire, Peter S Nyasulu, Mathieu Maheu-Giroux, Lucy Platt, Brian Rice, Wolfgang Hladik, Stefan Baral, Mary Mahy, Jeffrey W Imai-Eaton

Background: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa.

Methods: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors.

Findings: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV.

Interpretation: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.

Funding: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.

背景：撒哈拉以南非洲地区的重点人群艾滋病防治计划需要流行病学信息，以确保公平、普遍地获得有效服务。我们旨在整合并统一女性性工作者、男男性行为者、注射毒品者和变性人的调查数据，以估算撒哈拉以南非洲大陆国家的关键人群规模、HIV 感染率和抗逆转录病毒疗法（ART）覆盖率：我们从现有数据库中整理了 2010 年至 2023 年撒哈拉以南非洲 39 个国家的主要人口规模估计值、HIV 感染率和抗逆转录病毒疗法覆盖率数据，并根据原始文件进行了核实。我们使用贝叶斯混合效应空间回归法，将城市关键人口规模估计值模拟为 15-49 岁性别匹配、年份匹配和地区匹配人口的比例。我们以年龄匹配、性别匹配、年份匹配和省份匹配的总人口估计数作为预测因子，对国家以下重点人群的艾滋病毒感染率和抗逆转录病毒疗法覆盖率进行了建模：我们提取了 2065 个重点人群规模数据点、1183 个艾滋病流行率数据点和 259 个抗逆转录病毒疗法覆盖率数据点。在全国城市人口中，中位数为 1-65%（IQR 1-35-1-91）的顺性别成年女性是女性性工作者，0-89%（0-77-0-95）是男男性行为者，0-32%（0-31-0-34）是注射毒品的男性，0-10%（0-06-0-12）是变性女性。重点人群中的艾滋病毒感染率平均是相匹配的总人口感染率的四到六倍，抗逆转录病毒疗法的覆盖率与总人口抗逆转录病毒疗法的覆盖率相关，但低于总人口抗逆转录病毒疗法的覆盖率，而且不同研究中抗逆转录病毒疗法的相对覆盖率存在很大差异。在整个撒哈拉以南非洲地区，关键人群估计占 15-49 岁总人口的 1-2%（95% 可信区间为 0-9-1-6），但占艾滋病毒感染者的 6-1%（4-5-8-2）：在撒哈拉以南非洲地区，重点人群的艾滋病毒感染率较高，抗逆转录病毒疗法的覆盖率较低，这说明需要提供重点预防和治疗服务。2024 年，有限的数据可用性和异质性限制了对计划制定和趋势监测的精确估计。加强关键人群调查和国家艾滋病毒战略信息系统内的常规数据将有助于做出更精确的估计：联合国艾滋病规划署、比尔及梅林达-盖茨基金会和美国国立卫生研究院。

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引用次数: 0

Correction to Lancet Glob Health 2024; 12: e1089-90. Lancet Glob Health 2024; 12: e1089-90 更正。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-09-01 Epub Date: 2024-06-21 DOI: 10.1016/S2214-109X(24)00273-0

引用次数: 0