番茄社区

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AMSTERDAM -- African communities that embraced a "test-and-treat" strategy for multiple diseases achieved greater reductions in HIV incidence when compared with other communities that treated patients on the basis of national guidelines, researchers said here.

After 3 years in which multiple testing was performed in events such as community health fairs in rural Uganda and Kenya, mortality decreased by 21%. In addition, tuberculosis cases decreased by 59% compared with standard-of-care communities, hypertension on a population level was reduced 26%, and suppression of HIV rose from 32% of the communities to 80%, reported Diane Havlir, MD, of the University of California San Francisco.

At a press briefing here at the , she said that one of the keys to success of the 350,000-person study was the decision to rapidly treat patients when health problems were detected through various screenings.

"I think our results mean that a multi-disease approach to HIV testing is a successful model that people can use. This works and can accelerate reduction in mortality and reduce tuberculosis, and is associated with a reduction in HIV incidence. But it didn't eliminate all HIV infections, so we still need programs along this multi-disease, multi-financed approach."

"We asked if this approach could reduce HIV incidence and improve overall community health," Havlir continued. "The vehicle for conducting the intervention was health fairs, where we offered testing for HIV, diabetes, hypertension, malaria testing, and other health services, which were well designed and very well received by the community."

She said that after 1 year of the intervention, the team rapidly ramped up HIV services and achieved "90-90-90" -- i.e., the goal of the United Nations Programme on HIV/AIDS to identify 90% of individuals with HIV-infection, get 90% of those patients into treatment, and get 90% of the treated patients to achieve undetectable viral loads.

"We were able to do this very, very quickly, and by the end of the 3 years our overall viral load suppression -- including people who migrated in -- was 79% and 10% higher for those people we started with," Havlir said. "We also showed that over the course of the study in the communities where the intervention took place, annual incidence of HIV decreased by 30%."

Incidence decreased similarly in both arms of the study due to general outreach and changes in national protocol over the 3-year period, she said.

Linda-Gail Bekker, PhD, president of the International AIDS Society, commented: "This is really important data from the world-renowned SEARCH study. We really need to congratulate countries and researchers in Africa, who have performed some really impressive studies and have presented some important data here."

The success of the test-and-treat approach was not isolated to Kenya and Uganda villages. In a countrywide program conducted in eSwatini – the small kingdom formerly known as Swaziland -- there were similar results, said Velepi Okello, MD, deputy director of clinical services for the Ministry of Health eSwatini, also speaking at the press conference.

The nation undertook a universal test-and-treat program, she said, essentially offering the services to everyone in that land-locked country located along the border of South Africa and Mozambique, and headed by the lone absolute monarch in Africa, King Mswati III, who rules over 1.34 million people.

Persons found to have HIV infection were immediately started on antiretroviral therapy, said Okello. The small nation had an HIV incidence rate of 31% among adults ages 18-49 in 2011, requiring government action, and since then HIV incidence rates have fallen by 44%.

The internationally funded MaxART Project was initiated in 2011, and patients were enrolled in a randomized step-wedge design. In the standard-of-care protocol, the program enrolled 2,034 patients and 1,371 patients were given early antiretroviral therapy. After 1 year, 86% of patients in the intervention arm were still retained in care, compared with 80% of those in standard-of-care treatment (P<0.005), which was the primary interim endpoint of the study.

"The MaxART study shows that early antiretroviral therapy is acceptable, feasible, and affordable and improves the health and well-being of people living with HIV," Okello said. "This study proves that treatment as prevention works not just in a research setting but also on a large scale in real life."

She emphasized that the improved retention came without an increase in healthcare costs.