背景:在2019-21期间,AutoTestVIH,自由调查Statut(ATLAS)计划向关键人群分发了大约3.8万套艾滋病毒自检包,包括女性性工作者,和男人发生性关系的男人,和他们的伙伴,在科特迪瓦,马里,塞内加尔。我们旨在评估ATLAS计划和国家扩大艾滋病毒自检分布对艾滋病毒诊断的影响,艾滋病毒治疗覆盖率,艾滋病毒发病率,与艾滋病毒相关的死亡率。
方法:我们调整了科特迪瓦艾滋病毒传播的确定性隔室模型,参数化并适合特定国家的人口统计,行为,艾滋病毒流行病学,科特迪瓦的干预数据,马里,和塞内加尔分别在1980-2020年。我们模拟了新的HIV感染的动态,艾滋病毒诊断,以及在有和没有艾滋病毒自检的情况下与艾滋病毒相关的死亡在关键人群中分布。模型分别参数化,并适合特定国家的流行病学和干预结果(按性别分层,风险,年龄组,和艾滋病毒状况,如果可用)在贝叶斯框架内随着时间的推移。我们估计了2021年底仅ATLAS方案和2028年底和2038年底HIV自检规模扩大方案对HIV确诊人数绝对增加的影响。我们估计了仅ATLAS方案的2019-21和2019-28期间以及2019-28和2019-38期间艾滋病毒自我检测放大方案的额外艾滋病毒诊断和抗逆转录病毒治疗开始的累积数量以及新的艾滋病毒感染和艾滋病毒相关死亡的比例和绝对数量。
结果:我们的模型估计,在科特迪瓦,ATLAS可能导致700(90%不确定区间[UI]500-900)额外的艾滋病毒诊断,500(300-900)在马里,在2019-21年期间,塞内加尔的300个(50-700个),到2021年底,整体增长了0.4个百分点(90%UI0·3-0·5)。在2019-28年期间,ATLAS估计在这三个国家避免了1900(90%UI1300-2700)新的HIV感染和600(400-800)与HIV相关的死亡。其中38·6%(90%UI31·8-48·3)的新感染和70·1%(60·4-77·3)的HIV相关死亡将在关键人群中。在此期间,ATLAS将避免三个国家中所有艾滋病毒相关死亡的1·5%(0·8-3·1)。扩大艾滋病毒自我检测将避免塞内加尔2019-28年期间所有新的艾滋病毒感染的16·2%(90%UI10·0-23·1),马里5·3%(3·0-8·9),科特迪瓦为1·6%(1·0-2·4)。据估计,到2028年底,在科特迪瓦,重点人群中艾滋病毒自我检测的扩大将使艾滋病毒的诊断率提高到1·3个百分点(90%UI0·8-1·9),塞内加尔10·6个百分点(5·3-16·8),马里的3·6个百分点(2·0-6·4)。
结论:扩大西非关键人群的艾滋病毒自检分布可以缩小获得艾滋病毒检测的差距,并减少关键人群及其伴侣的感染和死亡。
背景:Unitaid,Solthis,英国医学研究理事会全球传染病分析中心,欧盟欧洲与发展中国家临床试验伙伴关系计划,和威康信托基金会.
BACKGROUND: During 2019-21, the AutoTest VIH, Libre d\'accéder à la connaissance de son Statut (ATLAS) programme distributed around 380 000 HIV self-testing kits to key populations, including female sex workers, men who have sex with men, and their partners, in Côte d\'Ivoire, Mali, and Senegal. We aimed to estimate the effects of the ATLAS programme and national scale-up of HIV self-test distribution on HIV diagnosis, HIV treatment coverage, HIV incidence, and HIV-related mortality.
METHODS: We adapted a deterministic compartmental model of HIV transmission in Côte d\'Ivoire, parameterised and fitted to country-specific demographic, behavioural, HIV epidemiological, and intervention data in Côte d\'Ivoire, Mali, and Senegal separately during 1980-2020. We simulated dynamics of new HIV infections, HIV diagnoses, and HIV-related deaths within scenarios with and without HIV self-test distribution among key populations. Models were separately parameterised and fitted to country-specific sets of epidemiological and intervention outcomes (stratified by sex, risk, age group, and HIV status, if available) over time within a Bayesian framework. We estimated the effects on the absolute increase in the proportion of people with HIV diagnosed at the end of 2021 for the ATLAS-only scenario and at the end of 2028 and 2038 for the HIV self-testing scale-up scenario. We estimated cumulative numbers of additional HIV diagnoses and initiations of antiretroviral therapy and the proportion and absolute numbers of new HIV infections and HIV-related deaths averted during 2019-21 and 2019-28 for the ATLAS-only scenario and during 2019-28 and 2019-38 for the HIV self-testing scale-up scenario.
RESULTS: Our model estimated that ATLAS could have led to 700 (90% uncertainty interval [UI] 500-900) additional HIV diagnoses in Côte d\'Ivoire, 500 (300-900) in Mali, and 300 (50-700) in Senegal during 2019-21, a 0·4 percentage point (90% UI 0·3-0·5) increase overall by the end of 2021. During 2019-28, ATLAS was estimated to avert 1900 (90% UI 1300-2700) new HIV infections and 600 (400-800) HIV-related deaths across the three countries, of which 38·6% (90% UI 31·8-48·3) of new infections and 70·1% (60·4-77·3) of HIV-related deaths would be among key populations. ATLAS would avert 1·5% (0·8-3·1) of all HIV-related deaths across the three countries during this period. Scaling up HIV self-testing would avert 16·2% (90% UI 10·0-23·1) of all new HIV infections during 2019-28 in Senegal, 5·3% (3·0-8·9) in Mali, and 1·6% (1·0-2·4) in Côte d\'Ivoire. HIV self-testing scale-up among key populations was estimated to increase HIV diagnosis by the end of 2028 to 1·3 percentage points (90% UI 0·8-1·9) in Côte d\'Ivoire, 10·6 percentage points (5·3-16·8) in Senegal, and 3·6 percentage points (2·0-6·4) in Mali.
CONCLUSIONS: Scaling up HIV self-test distribution among key populations in western Africa could attenuate disparities in access to HIV testing and reduce infections and deaths among key populations and their partners.
BACKGROUND: Unitaid, Solthis, the UK Medical Research Council Centre for Global Infectious Disease Analysis, the EU European & Developing Countries Clinical Trials Partnership programme, and the Wellcome Trust.
UNASSIGNED: For the French translation of the abstract see Supplementary Materials section.