PDF(Pubmed)
Abstract：
BACKGROUND: UNAIDS 90-90-90 goals for HIV have been surpassed in the UK, with focus now moving to ending transmission by 2030. The concept of zero transmission is complex and many factors can influence transmission. We aimed to investigate how the target of zero transmission might be reached in the UK.
METHODS: We developed a de novo Markov state transition open cohort model of HIV with a 50-year time horizon, which models six key screening, treatment and prevention parameters, including treatment-as-prevention (TasP) and pre-exposure prophylaxis (PrEP). We studied the anticipated HIV epidemic trajectory over time in men who have sex with men (MSM), with and without changing the six key parameters, defining zero transmission as a 60% reduction in incidence compared with 2010 incidence.
RESULTS: Zero transmission in the MSM population was not achieved within the model\'s time horizon in our base case scenario, when the six key parameters were set to their 2019 values. Several future scenarios were explored, including a combination approach to preventing HIV transmission through increasing five key parameter values and considering three different TasP values; zero transmission was achieved by 2030 in the scenario where TasP was increased from its current level of 97-99%, avoiding 48,969 new HIV cases over the time horizon and reducing the lifetime risk of acquiring HIV for HIV-negative MSM not using PrEP from 13.65 to 7.53%.
CONCLUSIONS: Zero transmission in the UK MSM population can be reached by the target year of 2030 with bold changes to HIV policy. A combination approach such as the UK Government\'s \'Towards Zero\' Action plan, impacting multiple policies and including an increase in TasP, has the potential to achieve meaningful reductions in HIV transmission and meet this ambitious goal.
METHODS: We developed a de novo Markov state transition open cohort model of HIV with a 50-year time horizon, which models six key screening, treatment and prevention parameters, including treatment-as-prevention (TasP) and pre-exposure prophylaxis (PrEP). We studied the anticipated HIV epidemic trajectory over time in men who have sex with men (MSM), with and without changing the six key parameters, defining zero transmission as a 60% reduction in incidence compared with 2010 incidence.
RESULTS: Zero transmission in the MSM population was not achieved within the model\'s time horizon in our base case scenario, when the six key parameters were set to their 2019 values. Several future scenarios were explored, including a combination approach to preventing HIV transmission through increasing five key parameter values and considering three different TasP values; zero transmission was achieved by 2030 in the scenario where TasP was increased from its current level of 97-99%, avoiding 48,969 new HIV cases over the time horizon and reducing the lifetime risk of acquiring HIV for HIV-negative MSM not using PrEP from 13.65 to 7.53%.
CONCLUSIONS: Zero transmission in the UK MSM population can be reached by the target year of 2030 with bold changes to HIV policy. A combination approach such as the UK Government\'s \'Towards Zero\' Action plan, impacting multiple policies and including an increase in TasP, has the potential to achieve meaningful reductions in HIV transmission and meet this ambitious goal.
摘要：
背景：联合国艾滋病规划署针对艾滋病毒的90-90-90目标在英国已经被超越，现在的重点是到2030年结束传输。零传输的概念很复杂，许多因素都会影响传输。我们的目的是调查如何在英国实现零传输的目标。
方法：我们开发了一个HIV的从头马尔可夫状态转移开放队列模型，时间为50年，它模拟了六个关键的筛选，治疗和预防参数，包括预防治疗（TasP）和暴露前预防（PrEP）。我们研究了与男性发生性关系（MSM）的男性中预期的HIV流行轨迹，有和没有改变六个关键参数，将零传播定义为与2010年发病率相比发病率降低60%。
结果：在我们的基本情况下，在模型的时间范围内没有实现MSM人群中的零传输，当六个关键参数设置为2019年值时。探索了几种未来的情景，包括通过增加五个关键参数值和考虑三个不同的TasP值来预防艾滋病毒传播的组合方法；在TasP从目前的97-99%增加到2030年的情况下，零传播实现了，在时间范围内避免了48,969例新的HIV病例，并将不使用PrEP的HIV阴性MSM的终生感染HIV的风险从13.65降低到7.53％。
结论：到2030年的目标年，通过对HIV政策进行大胆更改，可以实现英国MSM人群的零传播。诸如英国政府的“迈向零”行动计划之类的组合方法，影响多项政策，包括TasP的增加，有可能实现有意义的减少艾滋病毒传播并实现这一雄心勃勃的目标。
方法：我们开发了一个HIV的从头马尔可夫状态转移开放队列模型，时间为50年，它模拟了六个关键的筛选，治疗和预防参数，包括预防治疗（TasP）和暴露前预防（PrEP）。我们研究了与男性发生性关系（MSM）的男性中预期的HIV流行轨迹，有和没有改变六个关键参数，将零传播定义为与2010年发病率相比发病率降低60%。
结果：在我们的基本情况下，在模型的时间范围内没有实现MSM人群中的零传输，当六个关键参数设置为2019年值时。探索了几种未来的情景，包括通过增加五个关键参数值和考虑三个不同的TasP值来预防艾滋病毒传播的组合方法；在TasP从目前的97-99%增加到2030年的情况下，零传播实现了，在时间范围内避免了48,969例新的HIV病例，并将不使用PrEP的HIV阴性MSM的终生感染HIV的风险从13.65降低到7.53％。
结论：到2030年的目标年，通过对HIV政策进行大胆更改，可以实现英国MSM人群的零传播。诸如英国政府的“迈向零”行动计划之类的组合方法，影响多项政策，包括TasP的增加，有可能实现有意义的减少艾滋病毒传播并实现这一雄心勃勃的目标。
