撒哈拉以南非洲（AWI-Gen）老年人艾滋病流行率、发病率和社会人口危险因素：一项多中心纵向队列研究

IF 13.4 Q1 GERIATRICS & GERONTOLOGY

Lancet Healthy Longevity Pub Date : 2025-03-01 DOI:10.1016/j.lanhl.2025.100690

Luicer A Ingasia Olubayo PhD , Theophilous Mathema MSc , Chodziwadziwa Kabudula PhD , Prof Lisa K Micklesfield PhD , Shukri F Mohamed PhD , Isaac Kisiangani MSc , Cairo B Ntimane MSc , Solomon S Choma MSc , Prof Brian Houle PhD , Prof Scott Hazelhurst PhD , Prof Nigel Crowther PhD , Stephen Tollman PhD , Furahini D Tluway PhD , Prof Michele Ramsay PhD , Prof F Xavier Gómez-Olivé PhD , AWI-Gen and H3Africa Consortium

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引用次数: 0

摘要

撒哈拉以南非洲的老龄化人口包括越来越多的50岁及以上成年人感染艾滋病毒。尽管抗逆转录病毒疗法（ART）延长了预期寿命，但老年人中艾滋病毒发病率和治疗结果的数据仍然很少。为了为有针对性的公共卫生干预提供信息，我们旨在研究撒哈拉以南非洲老年人中艾滋病毒的流行率和发病率，以及与艾滋病毒感染和治疗结果相关的社会人口统计学决定因素。方法sawi - gen是一项多中心、纵向队列研究。我们评估了2013年8月5日至2016年8月19日（第一波）收集的40 - 60岁成年人随机社区样本的数据，以及2019年1月24日至2022年11月23日（第二波）收集的40岁及以上成年人的数据，这些样本来自内罗毕（肯尼亚）和索韦托、阿金科特和迪克盖尔·马马博罗·莫提巴（南非）。社会人口统计数据通过访谈者管理的问卷和结构化访谈收集。主要结局是第一波和第二波的HIV状态，分为HIV阳性或HIV阴性。我们评估了艾滋病毒的流行率和发病率、抗逆转录病毒治疗覆盖率和自我报告的艾滋病毒意识，并使用逻辑回归来检查与艾滋病毒感染和治疗结果相关的危险因素。在第一波招募和随访的7919名参与者中，6505名（82.1%）参与者年龄在40-60岁之间，其中5730名（88.1%）提供了与hiv相关的数据。女性3148人（54.9%），男性2582人（45.1%）。在第2波中，来自第1波的4520名参与者被随访，另外招募了579名参与者。5076名（99.5%）参与者年龄在40岁及以上，其中4931名（97.1%）提供了与hiv相关的数据。女性2767人（56.1%），男性2164人（43.9%）。总体而言，第1波5730名参与者中有1271人（22.2%）感染艾滋病毒，第2波4931名参与者中有1073人（21.8%）感染艾滋病毒，存在区域差异（χ2 p< 0.0001），女性的感染率高于男性（χ2 p< 0.0001）。第1波40 ~ 45岁人群患病率最高（1698例中有454例[26.7%]），第2波46 ~ 50岁人群患病率最高（994例中有297例[29.9%]），年龄越大患病率越低（χ2 p< 0.0001）。HIV总发病率为0.35 / 100人-年（95% CI 0.26 - 0.48）， 51-55岁参与者血清转化风险降低(发病率比[IRR] 0.42 [95% CI 0.17 - 0.93]；P = 0.039)， 56 ~ 60岁(0.19 [0.05 ~ 0.52]；p = 0·0033)。与接受过正规教育的参与者相比，未接受过正规教育的参与者的发病率高出近4倍（IRR为0.96 [95% CI为0.50 - 1 - 85]比0.26[0.16 - 0.44]）。居住在农村地区的妇女和男子的艾滋病毒感染预测概率始终高于城市地区的妇女和男子。自我报告的hiv阳性状态的准确性从第1波的55.5% （95% CI 51·1 - 59·8）提高到第2波的76.7%（73.1 - 80·0）。ART覆盖率在第1波（277名报告HIV检测结果阳性的参与者中有250名[90.3%]）和第2波（429名参与者中有404名[94.2%]）之间也有所增加。研究结果强调了年龄、教育程度、性别和地点在形成艾滋病毒风险方面的复杂相互作用。尽管抗逆转录病毒治疗的覆盖率有所提高，但老年人在预防艾滋病毒方面面临相当大的障碍，包括教育差距和性别不平等，特别是在农村地区。针对老年人群的量身定制的干预措施对于解决这些差距至关重要，因为感染艾滋病毒的风险尽管普遍低于年轻人群，但仍然值得注意。资助国家人类基因组研究所、美国国立卫生研究院国家环境健康科学研究所和南非科学与创新部。

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The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study

Background

Sub-Saharan Africa’s ageing population includes a rising number of adults aged 50 years and older living with HIV. Although antiretroviral therapy (ART) has extended life expectancy, data on HIV incidence and treatment outcomes among older adults remain scarce. To inform targeted public health interventions, we aimed to examine the prevalence and incidence of HIV, as well as sociodemographic determinants associated with HIV acquisition and treatment outcomes, among older adults in sub-Saharan Africa.

Methods

AWI-Gen is a multicentre, longitudinal cohort study. We assessed data from random community-based samples of adults aged 40–60 years collected between Aug 5, 2013, and Aug 19, 2016 (wave 1) and of adults aged 40 years and older collected between Jan 24, 2019, and Nov 23, 2022 (wave 2) from Nairobi (Kenya) and from Soweto, Agincourt, and Dikgale Mamabolo Mothiba (South Africa). Sociodemographic data were collected through interviewer-administered questionnaires and structured interviews. The primary outcome was HIV status at both wave 1 and wave 2, classified as either HIV-positive or HIV-negative. We evaluated the prevalence and incidence of HIV, ART coverage, and self-reported HIV awareness and used logistic regression to examine risk factors associated with HIV acquisition and treatment outcomes.

Findings

Among 7919 participants in wave 1 who were recruited and followed up, 6505 (82·1%) participants were aged 40–60 years, of whom 5730 (88·1%) contributed HIV-related data. 3148 (54·9%) participants were women and 2582 (45·1%) were men. In wave 2, 4520 participants from wave 1 were followed up with an additional 579 participants recruited. 5076 (99·5%) participants were aged 40 years and older, of whom 4931 (97·1%) contributed HIV-related data. 2767 (56·1%) participants were women and 2164 (43·9%) were men. Overall, 1271 (22·2%) of 5730 participants in wave 1 and 1073 (21·8%) of 4931 participants in wave 2 were living with HIV, with regional variability (χ² p<0·0001) and higher prevalence in women than in men (χ² p<0·0001). Prevalence was highest among individuals aged 40–45 years (454 [26·7%] of 1698 participants) in wave 1 and those aged 46–50 years (297 [29·9%] of 994 participants) in wave 2, decreasing significantly in older age groups (χ² p<0·0001). Overall HIV incidence was 0·35 per 100 person-years (95% CI 0·26–0·48), with a reduced risk of seroconversion in participants aged 51–55 years (incidence rate ratio [IRR] 0·42 [95% CI 0·17–0·93]; p=0·039) and 56–60 years (0·19 [0·05–0·52]; p=0·0033). Compared with participants with formal education, incidence among those with no formal education was nearly four times higher (IRR 0·96 [95% CI 0·50–1·85] vs 0·26 [0·16–0·44]). Women and men residing in rural areas showed consistently higher predicted probabilities of HIV status than their counterparts in urban settings. The accuracy of self-reported HIV-positive status improved from 55·5% (95% CI 51·1–59·8) in wave 1 to 76·7% (73·1–80·0) in wave 2. ART coverage also increased between wave 1 (250 [90·3%] of 277 participants who reported a positive HIV test result) and wave 2 (404 [94·2%] of 429 participants).

Interpretation

The findings emphasise the complex interplay of age, education, gender, and location in shaping HIV risk. Although ART coverage has improved, older adults face considerable barriers to HIV prevention, including educational disparities and gender inequities, particularly in rural settings. Tailored interventions targeting older populations are essential to address these gaps because the risk of HIV acquisition, albeit generally lower than in younger populations, remains noteworthy.

Funding

National Human Genome Research Institute, the National Institute of Environmental Health Sciences of the US National Institutes of Health, and the Department of Science and Innovation, South Africa.

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来源期刊

Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-

CiteScore

16.30

自引率

2.30%

发文量

192

审稿时长

12 weeks

期刊介绍： The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.