艾滋病 z-bo 2020-09-19 330

　　Victorian Kenyan fishermen cast their nets on the beach on the shore of Lake Victoria to dry the fish caught in the sun. In a row of tents by the lake, medical staff are spreading another very different "net." This will help you find the best way to get rid of the AIDS virus (HIV). These tents are stable for tourists because fishermen, their families, farmers, students and others in the nearby community have heard that they can get vitamin A, condoms, and medicines for wormwood and malaria. Attract traffic. At the same time, medical staff should provide various screening tests, including HIV screening, agree to conduct tests while enjoying other medical services, and accept sexual infections as needed. Virus treatment.

　　Nyanza, Kenya, has the highest HIV infection rate in the country. This community is also part of groundbreaking research aimed at explaining difficult problems. Interventions to prevent HIV infection that work under experimental conditions, such as rapid HIV on-site testing and effective treatment, usually do not play an appropriate role in a true epidemic. An existing study called "Sustainable East Africa Regional Health Survey" (SEARCH) employs more than 335,000 employees in Kenya and Uganda and is at the forefront of thinking about the best way to deal with AIDS. .. In the past, there was a view that to curb the HIV/AIDS pandemic, substantial new biomedical interventions, such as treatment and vaccines, were needed. However, there is a growing consensus that if the right methods are used, the tools needed to eradicate HIV already exist.

　　ambitious goals

　　SEARCH is aligned with the ambitious global strategy to eliminate HIV. In 2014, the United Nations HIV/AIDS Joint Programme, headquartered in Geneva, Switzerland, proposed a "90-90-90" target. Diagnose 90% of HIV-infected people; 90% of them can receive antiretroviral transcribed viral therapy; because 90% of therapists suppress the virus, HIV is not detected in the body. The achievement of these goals by 2020 indicates that AIDS as a global threat will end in 2030, thereby limiting the number of new infections per year to 200,000.

　　But it's easier said than done. Mitchell Warren, the head of the HIV prevention organization AVAC, said: "This is a conservative statement that it is an ambitious goal." In some parts of the world, there are less than half of HIV. The infected person was tested for HIV. In most areas, less than 40% of HIV-infected people have received treatment. At the same time, the proportion of HIV-infected people whose viral infections have been suppressed is very low, only 30% in the United States. This year, about 15 million people worldwide receive antiretroviral therapy.

　　This problem is particularly serious in sub-Saharan Africa. There are 70% of new infections and HIV infections worldwide. Eight years ago, doctors from the aid organization Doctors Without Borders (MSF) said that as the number of people receiving antiretroviral treatment increased, people who visited the HIV clinic in Kayarisha, Cape Town, South Africa, were taking medication. I noticed that it is already available. It is getting harder and harder. To get this drug, they must go to the clinic for frequent check-ups and check virus levels and T-cell counts. Both are signs of progressive infection. However, each appointment requires waiting several hours to see the overwhelmed nurse. At the same time, due to lack of drugs, they often return empty-handed. One year after the patients started to be infected, about a quarter of the patients stopped AIDS treatment.

　　MSF decided to try another method. We meet in the clinic every two months and establish a club led by well-trained consultants. The club gathers in the free time of the clinic, and the counselor puts each patient's medicine in a pre-packaged bag to the venue, and presides over a group discussion on the importance of adherence to treatment. A nurse visits once a year to collect blood samples and measure virus levels and T cell counts.

　　These clubs are very successful. Compared with patients who continued to use the previous clinic system for treatment, the number of patients who discontinued the care was reduced by 57%. Today, such clubs are seen as a model for patients to continue to receive treatment and are organized in informal settings (such as private homes after get off work).

　　Integration of nursing and healthcare systems

　　SEARCH trial was established based on the concept that the care of HIV patients meets their needs. This will not only help patient care, but we will also investigate whether integrating HIV care with the entire medical system can prevent possible loopholes in the gradual care process. , You can consider the prevention and treatment of AIDS from a broader perspective.

　　The first step is diagnosis. In Kenya, only 40% of people living with HIV know they are carrying the virus. One of the problems is to avoid targeted HIV testing activities. The other is the people who are most vulnerable to infection, such as those who walk around looking for work, and those who are least likely to be exposed to testing activities. Therefore, SEARCH appreciates other ways to attract people. For example, by carrying out community health activities in Nyanza, people can get the medical services and HIV tests they need. Those who did not participate in the community project will contact them through door-to-door advertisements and receive an HIV test to enable them to participate in their residences. along with

　　The SEARCH trial will evaluate how people who test positive can start and continue treatment more quickly. Patients sometimes start taking rapid antiretroviral drugs on the same day of diagnosis. In this project, we have developed a classification system designed to quickly guide HIV patients who can comfortably enter and leave the clinic during physical examinations and reduce the number of visits. The project attempts to book reminders and establish a telephone hotline to help patients continue to participate in care. In addition, at the beginning of treatment, after 6 months and next year every year, measure the patient's virus level to see if the treatment is effective.

　　Researchers are still using practical science to understand why interventions such as rituals and preventive measures are not widely used. For example, a trial in the mid-2000s proved that male voluntary arbitration can reduce the risk of female partners transmitting HIV by 60%. In 2007, the World Health Organization (WHO) recommended the use of rituals to prevent AIDS. The Bill and Melinda Gates Foundation (Bill and Melinda Gates Foundation) and the United Nations AIDS Programme (UN) jointly determined that 80% of eligible African men should Take responsibility before 2016. Prevent 3.4 million new HIV infections. The President’s AIDS Emergency Assistance Program (PEPFAR) and other projects are funding this. Since 2007, 9 million ceremonies have been held.

　　However, even this large-scale event only achieved 28% of the target. One problem is that the ceremony is a surgical procedure, which is different from the knowledge and resources provided by existing AIDS programs. Establishing another ritual procedure will divert resources from existing resources, which have already been used up. Potential population epidemiologist Farley Craighorn (Farley Craighorn) said: "There are many logistics and operational issues that prevent the country from achieving its goals."

　　Practical scientific evidence

　　In a meta-analysis released in March of this year, Nicole Harborland, a social scientist with the New York Population Council, showed that girls have reduced the prevalence of pregnancy, HIV and sexually transmitted diseases. I studied a project aimed at helping. She said, for example, if these programs include gender or power-focused educational content, how girls should discuss condom use and how gender inequality affects their lives. By discussing how to do it, they found that they might reduce the risk of illness. Of the 10 projects that contain such content, 8 have played a role. In contrast, only two of the 12 projects that did not solve these problems worked.

　　In response to these achievements, PEPFAR released the DREAMS project in December 2014. Together with the Bill and Melinda Gates Foundation and the Nike Foundation, we will spend $210 million in two years to provide young girls with a series of preventive interventions, such as HIV testing, counseling and care for rape survivors . At the same time, funds will be provided for projects to improve the adaptation of girls and their families.

　　However, it has proved very difficult to directly contact some interventions to reduce the risk of girls transmitting HIV. From July 19 to 22, two studies will be conducted in Vancouver, Canada, specifically to test whether providing cash to children who meet specific learning goals can reduce the risk of HIV infection in South Africa. The research results will be reported at the International AIDS Association meeting. Audrey Pettyfor, an epidemiologist who led one of the trials, said such interventions are effective in very poor countries such as Malawi, but may not be applicable in other regions. In her experiment, when the girl went to school, she and her family received $24 in cash per month. But compared with the much poorer African countries, the expectations of South African youths are quite different. The desire for luxury goods is accompanied by severe poverty, unemployment and the spread of HIV. In Pettifor's experiment, the girls thought they needed all the items they needed, including designer jeans, Italian shoes and BlackBerry smartphones.

　　At the same time, practical science is relatively new in the field of HIV/AIDS, and it is not clear whether it will help researchers achieve all the goals of "90-90-90". Petifor said: "The reasons for planning or intervening to achieve these goals are still very complex."

　　Researchers hope that the field will mature and become more rigorous. For example, the SEARCH test assesses whether "simplifying" HIV care can bring health and economic benefits to the community, including increased fishing and agricultural income and increased child school enrollment.