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
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引用次数: 0

摘要

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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Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23.

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.

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来源期刊
Lancet Global Health
Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
44.10
自引率
1.20%
发文量
763
审稿时长
10 weeks
期刊介绍: The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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