解决伴侣暴力问题，终结婴儿艾滋病毒感染

Addressing partner violence to end infant HIV infection

——原载《柳叶刀 – 艾滋病毒》2024年第11卷第8期——

<The Lancet - HIV>, Volume 11, Issue 8, 2024

【提要】高效抗逆转录病毒疗法 (ART) 的成功促成了2011年全球消除婴儿HIV新感染的目标。到2016年，多个国家实现了这一目标，2021年，博茨瓦纳成为第一个实现这一目标的高负担国家。这些进步在一定程度上得益于B+方案战略，该战略要求立即让所有孕妇开始接受ART治疗，无论她们的健康状况如何。尽管通过B+方案在怀孕期间提供ART治疗是一项令人印象深刻的公共卫生进步，但围产期治疗的覆盖率和垂直传播率已趋于稳定。

卫生系统是确保尽早和持续获得围产期治疗的核心要素之一。研究发现，八分之一的儿科感染与母亲遭受伴侣暴力有关。据估计，2022年有22,000例儿科感染可归因于伴侣暴力，人口归因比例从尼日尔的4%到乌干达的28%不等。在南部和东部非洲等地区，归因于伴侣暴力的新增婴儿HIV感染比例上升至垂直感染的五分之一。这些估计数是由高HIV发病率和高ART吸收率推动的。换句话说，由于卫生系统能够有效地向HIV感染者提供药物，因此确实发生的新增婴儿感染更有可能是由于伴侣暴力等临床外原因造成的。重要的是，本文还为减轻暴力对垂直传播的显著影响奠定了基础。

[Summary] The success of highly active antiretroviral therapy (ART) led to the establishment of the 2011 global goal to eliminate new infant HIV infections. By 2016, multiple countries achieved this goal, and, in 2021, Botswana was the first high-burden country to do so. These gains were driven, in part, by the Option B+ strategy to immediately initiate all pregnant women on ART, regardless of their health status. Although ART provision around the time of pregnancy through Option B+ has been an impressive public health advance, coverage of perinatal treatment and rates of vertical transmission have plateaued.

Health systems are one core element of ensuring early and consistent access to perinatal treatment. The study found that one in eight paediatric infections are attributable to maternal IPV exposure. An estimated 22 000 paediatric infections could be attributed to IPV in 2022, with the population attributable fraction ranging from 4% in Niger to 28% in Uganda. In settings such as southern and eastern Africa, the proportion of new infant HIV infections attributed to IPV rises to one-fifth of vertical infections. These estimates are driven by high HIV incidence and high ART uptake. In other words, as the health system is effective in delivering medication to patients living with HIV, new infant infections that do occur are disproportionately more likely to be due to extra-clinical causes, such as IPV. Importantly, this paper also creates a foundation for mitigating the pronounced effect of violence on vertical transmission.

论文原文：AM Hatcher, L Kimbo (2024). Addressing partner violence to end infant HIV infection. The Lancet - HIV, Volume 11, Issue 8, Pages 500-501, August 2024.

https://doi.org/10.1016/S2352-3018(24)00180-2

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