Background

Community randomised trials have had mixed success in implementing combination prevention strategies that diagnose 90% of people living with HIV, initiate and retain on antiretroviral therapy (ART) 90% of those diagnosed, and achieve viral load suppression in 90% of those on ART (90-90-90). The Bukoba Combination Prevention Evaluation (BCPE) aimed to achieve 90-90-90 in Bukoba Municipal Council, Tanzania, by scaling up new HIV testing, linkage, and retention interventions.

Method

We did population-based, cross-sectional surveys before and after our community-wide intervention in Bukoba—a mixed urban and rural council of approximately 150 000 residents located on the western shore of Lake Victoria in Tanzania. BCPE interventions were implemented in 11 government-supported health-care facilities throughout Bukoba from Oct 1, 2014, to March 31, 2017, when national ART-eligibility guidelines expanded from CD4 counts of less than 350 cells per μL (Oct 1, 2014–Dec 31, 2015) and 500 or less cells per μL (Jan 1, 2016–Sept 30, 2016) to any CD4 cell count (test and treat, Oct 1, 2016–March 31, 2017). We used pre-intervention (Nov 4, 2013–Jan 25, 2014) and post-intervention (June 21, 2017–Sept 20, 2017) population-based household surveys to assess population prevalence of undiagnosed HIV infection and ART coverage, and progress towards 90-90-90, among residents aged 18–49 years.

Findings

During the 2·5-year intervention, BCPE did 133 695 HIV tests, diagnosed and linked 3918 people living with HIV to HIV care at 11 Bukoba facilities, and returned to HIV care 604 patients who had stopped care. 4795 and 5067 residents aged 18–49 years participated in pre-intervention and post-intervention surveys. HIV prevalence before and after the intervention was similar: pre-intervention 8·9% (95% CI 7·5–10·4); post-intervention 8·4% (6·9–9·9). Prevalence of undiagnosed HIV infection decreased from 4·7% to 2·0% (prevalence ratio 0·42, 95% CI 0·31–0·57), and current ART use among all people living with HIV increased from 32·2% to 70·9% (2·20, 1·82–2·66) overall, 23·0% to 62·1% among men (2·70, 1·84–3·96), and 16·7% to 64·4% among people aged 18–29 years (3·87, 2·54–5·89). Of 436 and 435 people living with HIV aged 18–49 years who participated in pre-intervention and post-intervention surveys, previous HIV diagnosis increased from 47·4% (41·3–53·4) to 76·2% (71·8–80·6), ART use among diagnosed people living with HIV increased from 68·0% (60·9–75·2) to 93·1% (90·2–96·0), and viral load suppression of those on ART increased from 88·7% (83·6–93·8) to 91·3% (88·6–94·1).

Interpretation

BCPE findings suggest scaling up recommended HIV testing, linkage, and retention interventions can help reduce prevalence of undiagnosed HIV infection, increase ART use among all people living with HIV, and make substantial progress towards achieving 90-90-90 in a relatively short period. BCPE facility-based testing and linkage interventions are undergoing national scale up to help achieve 90-90-90 in Tanzania.

Funding

US Presidents' Emergency Plan for AIDS Relief.

中文翻译：

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坦桑尼亚布科巴的社区范围内的 HIV 检测、关联案例管理和违约者追踪：干预前和干预后、基于人群的调查评估。

背景

社区随机试验在实施联合预防策略方面取得了不同的成功，这些策略可诊断 90% 的 HIV 感染者，启动并保留 90% 的被诊断者的抗逆转录病毒治疗 (ART)，并在 90% 的 ART 患者中实现病毒载量抑制。 90-90-90）。布科巴联合预防评估 (BCPE) 旨在通过扩大新的 HIV 检测、关联和保留干预措施，在坦桑尼亚布科巴市议会实现 90-90-90。

方法

我们在布科巴（位于坦桑尼亚维多利亚湖西岸的大约 150 000 名居民的混合城乡委员会）进行社区范围干预之前和之后进行了基于人口的横断面调查。从 2014 年 10 月 1 日到 2017 年 3 月 31 日，BCPE 干预措施在布科巴全境的 11 个政府支持的医疗机构中实施，当时国家 ART 资格指南从每微升的 CD4 计数低于 350 个细胞（2014 年 10 月 1 日– 2015 年 12 月 31 日）和每微升 500 个或更少细胞（2016 年 1 月 1 日至 2016 年 9 月 30 日）对任何 CD4 细胞计数（测试和治疗，2016 年 10 月 1 日至 2017 年 3 月 31 日）。我们使用干预前（2013 年 11 月 4 日至 2014 年 1 月 25 日）和干预后（2017 年 6 月 21 日至 2017 年 9 月 20 日）基于人群的家庭调查来评估未确诊 HIV 感染的人群患病率和 ART 覆盖率，

发现

在 2·5 年的干预中，BCPE 进行了 133695 次 HIV 检测，诊断出 3918 名 HIV 感染者并将其与 11 个布科巴机构的 HIV 护理联系起来，并使 604 名停止护理的患者返回 HIV 护理。4795 和 5067 名 18-49 岁的居民参加了干预前和干预后调查。干预前后的 HIV 流行率相似：干预前 8·9% (95% CI 7·5–10·4)；干预后 8·4% (6·9–9·9)。未确诊的 HIV 感染率从 4·7% 下降到 2·0%（流行率 0·42，95% CI 0·31–0·57），所有 HIV 感染者当前的 ART 使用率从 32·2 增加% 到 70·9% (2·20, 1·82–2·66), 男性 23·0% 到 62·1% (2·70, 1·84-3·96), 16·7在 18-29 岁（3·87、2·54-5·89）的人群中，这一比例为 % 至 64·4%。

解释

BCPE 的研究结果表明，扩大推荐的 HIV 检测、联系和保留干预措施有助于降低未确诊 HIV 感染的流行率，增加所有 HIV 感染者的 ART 使用，并在相对较短的时间内实现 90-90-90 的实质性进展。BCPE 基于设施的测试和联系干预正在全国范围内进行，以帮助坦桑尼亚实现 90-90-90。

资金

美国总统的艾滋病救济紧急计划。