BACKGROUND South Africa is at the epicentre of the HIV pandemic, with the world's highest number of new infections and the largest treatment programme. Using metrics proposed by the Joint United Nations Programme on AIDS (UNAIDS), we evaluate progress toward epidemic control and highlight areas for intervention in a hyperendemic South African setting. METHODS The Africa Health Research Institute (AHRI) maintains a comprehensive population-based surveillance system in the Hlabisa sub-district of KwaZulu-Natal. Between 2005 and 2017, we tested 39 735 participants (aged 15-49 years) for HIV and followed 22 758 HIV-negative and 13 460 HIV-positive participants to identify new infections and all-cause AIDS-related deaths, respectively. Using these data, we estimated the percentage reduction in incidence, the absolute incidence rate, the incidence-mortality ratio and the incidence-prevalence ratio over place and time. RESULTS We observed a 62% reduction in the number of new infections among men between 2012 and 2017 and a 34% reduction among women between 2014 and 2017. Among men, the incidence-mortality ratio peaked at 4.1 in 2013 and declined to 3.1 in 2017, and among women it fell from a high of 6.4 in 2014 to 4.3 in 2017. Between 2012 and 2017, the female-incidence/male-prevalence ratio declined from 0.24 to 0.13 and the male-incidence/female-prevalence ratio from 0.05 to 0.02. CONCLUSIONS Using data from a population-based cohort study, we report impressive progress toward HIV epidemic control in a severely affected South African setting. However, overall progress is off track for 2020 targets set by the UNAIDS. Spatial estimates of the metrics, which demonstrate remarkable heterogeneity over place and time, indicate areas that could benefit from additional or optimized HIV prevention services.

中文翻译：

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南非夸祖鲁-纳塔尔省农村地区的艾滋病毒流行状况：疾病指标的新应用，用于评估轨迹并突出干预领域。


背景南非是艾滋病毒大流行的中心，拥有世界上新感染人数最多的国家和最大的治疗方案。我们利用联合国艾滋病联合规划署 (UNAIDS) 提出的指标，评估流行病控制进展，并重点关注南非高流行地区的干预领域。方法 非洲健康研究所 (AHRI) 在夸祖鲁-纳塔尔省赫拉比萨分区维持着一个以人群为基础的综合监测系统。 2005 年至 2017 年间，我们对 39 735 名参与者（年龄 15-49 岁）进行了 HIV 检测，并跟踪了 22 758 名 HIV 阴性参与者和 13 460 名 HIV 阳性参与者，以分别确定新感染和与艾滋病相关的全因死亡。利用这些数据，我们估计了随时间和地点的发病率下降百分比、绝对发病率、发病率-死亡率比和发病率-患病率。结果 我们观察到，2012 年至 2017 年间，男性新感染人数减少了 62%，2014 年至 2017 年间，女性新感染人数减少了 34%。在男性中，发病率与死亡率之比于 2013 年达到峰值 4.1，并于 2017 年下降至 3.1。女性发病率从 2014 年的 6.4 下降到 2017 年的 4.3。2012 年至 2017 年间，女性发病率/男性患病率之比从 0.24 下降至 0.13，男性发病率/女性患病率之比从 0.05 下降至0.02。结论 使用基于人群的队列研究数据，我们报告了在受严重影响的南非地区艾滋病毒流行控制方面取得的令人瞩目的进展。然而，总体进展偏离了联合国艾滋病规划署设定的 2020 年目标。 这些指标的空间估计显示出不同地点和时间的显着异质性，表明可以从额外或优化的艾滋病毒预防服务中受益的领域。