Background

A target to eliminate HIV transmission in England by 2030 was set in early 2019. This study aimed to estimate trends from 2013 to 2019 in HIV prevalence, particularly the number of people living with undiagnosed HIV, by exposure group, ethnicity, gender, age group, and region. These estimates are essential to monitor progress towards elimination.

Methods

A Bayesian synthesis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England was used to estimate trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV. All estimates were stratified by exposure group, ethnicity, gender, age group (15–34, 35–44, 45–59, or 60–74 years), region (London, or outside of London) and year (2013–19).

Findings

The total number of people living with HIV aged 15–74 years in England increased from 83 500 (95% credible interval 80 200–89 600) in 2013 to 92 800 (91 000–95 600) in 2019. The proportion diagnosed steadily increased from 86% (80–90%) to 94% (91–95%) during the same time period, corresponding to a halving in the number of undiagnosed infections from 11 600 (8300–17 700) to 5900 (4400–8700) and in undiagnosed prevalence from 0·29 (0·21–0·44) to 0·14 (0·11–0·21) per 1000 population. Similar steep declines were estimated in all subgroups of gay, bisexual, and other men who have sex with men and in most subgroups of Black African heterosexuals. The pace of reduction was less pronounced for heterosexuals in other ethnic groups and people who inject drugs, particularly outside London; however, undiagnosed prevalence in these groups has remained very low.

Interpretation

The UNAIDS target of diagnosing 90% of people living with HIV by 2020 was reached by 2016 in England, with the country on track to achieve the new target of 95% diagnosed by 2025. Reductions in transmission and undiagnosed prevalence have corresponded to large scale-up of testing in key populations and early diagnosis and treatment. Additional and intensified prevention measures are required to eliminate transmission of HIV among the communities that have experienced slower declines than other subgroups, despite having very low prevalences of HIV.

Funding

UK Medical Research Council and Public Health England.

中文翻译：

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英格兰未确诊艾滋病毒流行趋势以及到 2030 年消除艾滋病毒传播的影响：证据综合模型

背景

2019 年初设定了到 2030 年在英格兰消除 HIV 传播的目标。这项研究旨在估计 2013 年至 2019 年 HIV 流行趋势，特别是未确诊 HIV 感染者的数量，按暴露组、种族、性别、年龄组划分, 和地区。这些估计数对于监测消除进展情况至关重要。

方法

来自与英格兰 HIV 相关的多个监测、人口统计和调查数据集的证据的贝叶斯综合被用于估计 HIV 感染者人数的趋势、不知道自己感染 HIV 的人口比例以及未确诊 HIV 的相应流行率. 所有估计均按暴露组、种族、性别、年龄组（15-34、35-44、45-59 或 60-74 岁）、地区（伦敦或伦敦以外）和年份（2013-19）分层.

发现

英国 15-74 岁的艾滋病毒感染者总数从 2013 年的 83500 人（95% 可信区间 80200-89600）增加到 2019 年的 92800 人（91000-95600）。确诊的比例稳步上升在同一时期从 86% (80–90%) 降至 94% (91–95%)，相当于未确诊感染人数减半，从 11 600 (8300–17 700) 减半至 5900 (4400–8700)未确诊患病率从每 1000 人 0·29 (0·21–0·44) 到 0·14 (0·11–0·21)。在男同性恋、双性恋和其他男男性行为者的所有亚群以及非洲黑人异性恋者的大多数亚群中，估计都出现了类似的急剧下降。其他族群的异性恋者和注射吸毒者的减少速度不太明显，尤其是在伦敦以外地区；然而，

解释

联合国艾滋病规划署的目标是到 2020 年诊断出 90% 的艾滋病毒感染者，到 2016 年在英国实现，该国有望实现到 2025 年诊断出 95% 的新目标。传播和未确诊流行率的减少与大规模-加强重点人群检测和早诊早治。需要采取额外和强化的预防措施，以消除艾滋病毒在社区中的传播，尽管艾滋病毒的流行率非常低，但下降速度比其他亚群慢。

资金

英国医学研究委员会和英国公共卫生。