共查询到20条相似文献,搜索用时 15 毫秒
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Meghan C. DiCarlo Gina A. Dallabetta Chris Akolo Sergio BautistaArredondo H. Victor Digolo Virginia A. Fonner Grace Jill Kumwenda Patrick Mbulaje Peninah W. Mwangi Navindra E. Persuad Simon Sikwese Tisha A. Wheeler R. Cameron Wolf Hally R. Mahler 《Journal of the International AIDS Society》2022,25(7)
IntroductionGlobally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services.DiscussionThe Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID‐19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered “extras,” not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements.ConclusionsAs nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community‐based and community‐driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95‐95‐95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered. 相似文献
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Harriet S. Jones Bernadette Hensen Sithembile Musemburi Lilian Chinyanganya Albert Takaruza Sungai T. Chabata Primrose Matambanadzo Brian Rice Frances M. Cowan James R. Hargreaves 《Journal of the International AIDS Society》2022,25(7)
IntroductionEarly diagnosis of HIV is critical for epidemic control. To achieve this, successful testing programmes are essential and test positivity is often used as a marker of their performance. The aim of this study was to analyse trends and predictors of HIV test positivity over time and explore how an understanding of seroconversion rates could build on our interpretation of this indicator among female sex workers in Zimbabwe.MethodsWe analysed HIV test data from Zimbabwe''s nationally scaled sex work programme between 2009 and 2019. We defined test positivity as the proportion of all tests that were HIV positive and measured new diagnoses by estimating seroconversion rates among women with repeat tests, defined as an HIV‐positive test after at least one HIV‐negative test in the programme. We used logistic regression to analyse test positivity over three time‐periods: 2009–2013, 2014–2017 and 2018–2019, adjusting for potential confounding by demographic factors and the mediating effects of time since last HIV test. We calculated the seroconversion rates for the same time‐periods.ResultsDuring the 10‐year study period, 54,503 tests were recorded in 39,462 women. Between 2009 and 2013, 18% of tests were among women who reported testing in the previous 6 months. By 2018–2019, this had increased to 57%. Between 2018 and 2019, test positivity was 9.6%, compared to 47.9% for 2009–2013 (aOR 6.08 95% CI 5.52–6.70) and 18.8% for 2014–2017 (aOR 2.17 95% CI 2.06–2.28). Adjusting for time since last test reduced effect estimates for 2009–2013 (aOR 4.03 95% CI 3.64–4.45) and 2014–2017 (aOR 1.97 95% CI 1.86–2.09) compared to 2018–2019. Among 7573 women with an initial HIV‐negative test in the programme and at least one subsequent test, 464 tested HIV positive at a rate of 3.9 per 100 pyar (95% CI 3.5–4.2).ConclusionsTest positivity decreased among women testing through the programme over time, while seroconversion rates remained high. These declines were partly driven by changes in individual testing history, reflecting comprehensive coverage of testing services and greater knowledge of HIV status, but not necessarily declining rates of seroconversion. Understanding testing history and monitoring new HIV infections from repeat tests could strengthen the interpretation of test positivity and provide a better understanding of programme performance. 相似文献
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Sharon Esi Duoduwa Quaye Yuwei Cheng Rayner Kay Jin Tan Joel R. Koo Kiesha Prem Alvin Kuo Jing Teo Alex R. Cook 《Journal of the International AIDS Society》2023,26(3):e25973
Introduction
Singapore lacks robust data on the sizes of the key populations that are most at risk for HIV. Using the network scale-up method for hidden or hard-to-reach populations, we estimate the sizes of five key populations—male clients of female sex workers (MCFSW), men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID) and transgender people—and profile the ages and ethnicities of respondents with the high-risk contacts they report knowing.Methods
We conducted a cross-sectional online survey between March and May 2019 (n = 2802) using a network scale-up instrument previously developed for Singapore. Participants were recruited using an existing panel and online advertising, and the sample reweighted by age, sex, ethnicity and education attained to represent the general adult population. We built a Bayesian hierarchical model to estimate the sizes of the five key populations for HIV in Singapore.Results
After adjustment, the sizes of the at-risk populations are estimated to be: 76,800 (95% credible interval [CI]: 64,200–91,800) MCFSW; 139,000 (95% CI: 120,000–160,000) MSM; 8030 (95% CI: 3980–16,200) FSW; 3470 (95% CI: 1540–7830) PWID and 18,000 (95% CI: 14,000–23,200) transgender people. Generally, men reported knowing more people in all the high-risk groups; older people reported knowing more MCFSW, FSW and transgender people; and younger people reported knowing more MSM. There was a bimodal effect of age on those who reported knowing more PWIDs: people in their 20s and 60s reported more contacts.Conclusions
This study demonstrates that a size estimation study of hidden populations is quickly and efficiently scalable through using online surveys in a socially conservative society, like Singapore, where key populations are stigmatized or criminalized. The approach may be suitable in other countries where stigma is prevalent and where barriers to surveillance and data collection are numerous. 相似文献9.
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Introduction : Black men who have sex with men (MSM) continue to suffer a disproportionate burden of new HIV diagnoses and mortality. To better understand some of the reasons for these profound disparities, we examined whether the association between social trust and late HIV diagnosis and mortality differed by race/ethnicity, and investigated potential indirect effects of any observed differences. Methods : We performed generalized structural equation modelling to assess main and interaction associations between trust among one's neighbours in 2009 (i.e. social trust) and race/ethnicity (Black, White, and Hispanic) predicting late HIV diagnosis (a CD4 count ≤200 cell/µL within three months of a new HIV diagnosis) rates and all‐cause mortality rates of persons ever diagnosed late with HIV, across 47 American states for the years 2009–2013. We examined potential indirect effects of state‐level HIV testing between social trust and late HIV diagnosis. Social trust data were from the Gallup Healthways Survey, HIV data from the Centers for Disease Control and Prevention, and HIV testing from the Behavioral Risk Factor Surveillance System. Covariates included state‐level structural, healthcare, and socio‐demographic factors including income inequality, healthcare access, and population density. We stratified analysis by transmission group (male‐to‐male, heterosexual, and injection drug use (IDU)). Results : States with higher levels of social trust had lower late HIV diagnosis rates: Adjusted Rate Ratio [aRR] were consistent across risk groups (0.57; 95%CI 0.53–0.62, male‐to‐male), (aRR 0.58; 95%CI 0.54–0.62, heterosexual) and (aRR 0.64; 95%CI 0.60–0.69, IDU). Those associations differed by race/ethnicity (all p < 0.001). The associations were most protective for Blacks followed by Hispanics, and least protective for Whites. HIV testing mediated between 18 and 32% of the association between social trust and late HIV diagnosis across transmission group but for Blacks relative to Whites only. Social trust was associated with lower all‐cause mortality rates and that association varied by race/ethnicity within the male‐to‐male and IDU transmission groups only. Conclusions : Social trust may promote timely HIV testing, which can facilitate earlier HIV diagnosis, thus it can be a useful determinant to monitor the relationship with HIV care continuum outcomes especially for racial/ethnic minority groups disproportionately infected by HIV. 相似文献
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Shannon Williams Jenny Renju Ludovica Ghilardi Alison Wringe 《Journal of the International AIDS Society》2017,20(1)
Introduction : Observational studies have shown considerable attrition among adolescents living with HIV across the “cascade” of HIV care in sub‐Saharan Africa, leading to higher mortality rates compared to HIV‐infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub‐Saharan Africa. Methods : We systematically searched five databases for studies published between 2005 and 2016 that met pre‐defined inclusion criteria. We used a meta‐ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio‐ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. Results and discussion : We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third‐order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self‐efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent‐friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual‐level factors, including past illness experiences, identifying mechanisms to manage pill‐taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Conclusions : Adolescents' initial and ongoing use of HIV care was frequently undermined by individual‐level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual‐level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as “test and treat” policies are scaled up. 相似文献
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Introduction : The rapid and accurate diagnosis of HIV‐associated tuberculosis (TB), timely initiation of curative or preventative treatment and assurance of favourable treatment outcomes is a complex process. The current system of monitoring and reporting TB diagnosis and treatment does not include several key aspects of the care cascade, and may obscure systematic bottlenecks, inefficiencies or sources of sub‐optimal care. Methods : We critically reviewed the current World Health Organizations recommended system of monitoring and reporting, and identified the following key deficiencies that could limit the ability of healthcare workers to identify structural problems in the provision of TB/HIV care. Results : We identified the following key deficiencies in the current monitoring and evaluation system: (1) an emphasis on national‐level reporting and programmatic analysis results in a loss of granularity; (2) the absence of a general framework to anchor indicators in relation to one another as well as the overall goals for TB/HIV collaborative activities; (3) de‐linking of TB treatment indicators from those for screening and diagnosis; (4) few indicators are tied to suggested times for completion of an activity. We defined three distinct stages comprising the cascade of HIV‐associated TB diagnosis and treatment: (1) Screening & Diagnosis, (2) Treatment and (3) Preventive Therapy. We detailed major steps within each stage, described potential sources of variability, and proposed data elements, process indicators, main outcomes, and retention calculations for each stage. Conclusions : This proposed framework of monitoring is novel in its focus on a cohort experience through the entire scope of the care cascade from screening and TB diagnosis through curative or preventive treatment. This approach can be applied to all settings at clinic, district or national level, and used to identify crucial areas for improvement in order to maximize health outcomes for all those affected by the dual epidemics of TB and HIV. 相似文献
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Declining HIV incidence in sub‐Saharan Africa: a systematic review and meta‐analysis of empiric data
Keya Joshi Justin Lessler Oluwasolape Olawore Gideon Loevinsohn Sophrena Bushey Aaron A R Tobian M Kate Grabowski 《Journal of the International AIDS Society》2021,24(10)
IntroductionUNAIDS models suggest HIV incidence is declining in sub‐Saharan Africa. The objective of this study was to assess whether modelled trends are supported by empirical evidence.MethodsWe conducted a systematic review and meta‐analysis of adult HIV incidence data from sub‐Saharan Africa by searching Embase, Scopus, PubMed and OVID databases and technical reports published between 1 January 2010 and 23 July 2019. We included prospective and cross‐sectional studies that directly measured incidence from blood samples. Incidence data were abstracted according to population risk group, geographic location, sex, intervention arm and calendar period. Weighted regression models were used to assess incidence trends across general population studies by sex. We also identified studies reporting greater than or equal to three incidence measurements since 2010 and assessed trends within them.ResultsTotal 291 studies, including 22 sub‐Saharan African countries, met inclusion criteria. Most studies were conducted in South Africa (n = 102), Uganda (n = 46) and Kenya (n = 41); there were 26 countries with no published incidence data, most in western and central Africa. Data were most commonly derived from prospective observational studies (n = 163; 56%) and from geographically defined populations with limited demographic or risk‐based enrolment criteria other than age (i.e., general population studies; n = 151; 52%). Across general population studies, average annual incidence declines since 2010 were 0.12/100 person‐years (95% CI: 0.06–0.18; p = 0.001) among men and 0.10/100 person‐years (95% CI: −0.02–0.22; p = 0.093) among women in eastern Africa, and 0.25/100 person‐years (95% CI: 0.17–034; p < 0.0001) among men and 0.42/100 person‐years (95% CI: 0.23–0.62; p = 0.0002) among women in southern Africa. In nine of 10 studies with multiple measurements, incidence declined over time, including in two studies of key populations. Across all population risk groups, the highest HIV incidence estimates were observed among men who have sex with men, with rates ranging from 1.0 to 15.4/100 person‐years. Within general population studies, incidence was typically higher in women than men with a median female‐to‐male incidence rate ratio of 1.47 (IQR: 1.11 to 1.83) with evidence of a growing sex disparity over time.ConclusionsEmpirical incidence data show the rate of new HIV infections is declining in eastern and southern Africa. However, recent incidence data are non‐existent or very limited for many countries and key populations. 相似文献
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