世衛組織的創新性愛滋病毒檢測之建議旨在擴大治療的覆蓋面
世界衛生組織 / 2019年11月27日新聞稿 / 瑞士日內瓦 /財團法人台灣紅絲帶基金會編譯
世界衛生組織（世衛組織）發布了新建議，幫助各國去觸及810萬尚未被診斷出來的愛滋病毒感染者，他們因尚未被診斷而無法獲得拯救生命的治療。
Tedros Adhanom Ghebreyesus博士說：「過去十年，愛滋病毒流行的面貌發生了巨大變化。目前接受治療的人數比以往任何時候都多，但是仍有太多人得不到所需的幫助，因為他們還沒有獲得診斷。世衛組織新的愛滋病毒檢測指南旨在顯著地改變這一狀況。」
愛滋病毒檢測是確保人們及早診斷和開始治療的關鍵。良好的檢測服務還可以確保愛滋病毒檢測結果為陰性的人獲得適當且有效的預防服務。這將有助於減少每年新增的170萬例愛滋病毒感染。
世衛組織的指南是在世愛滋病日（12月1日）和非洲愛滋病與性傳播感染問題國際大會（ICASA2019，12月2日至7日，於盧安達之基加利召開）之前發布的。今天，全世界有三分之二的愛滋病毒感染者生活在非洲區域。
世衛組織新的《愛滋病毒檢測服務綜合指南》建議採取一系列創新方法去回應當代的需求。
l 鑑於愛滋病毒流行形勢已因接受檢測和治療的人口比例很高而改變，世衛組織正在鼓勵所有國家採用標準的愛滋病毒檢測策略，即進行三個連續性反應檢測來確認愛滋病毒陽性診斷。此前，大多數高負擔國家採用兩次連續檢測。這種新方法可以幫助各國在最大程度上提高愛滋病毒檢測的準確性。
l 基於新證據顯示，愛滋病毒風險較高卻不在臨床環境中進行檢測的人，如果能夠取得愛滋病毒自我檢測，就更有可能接受檢測。因此世衛組織建議各國利用愛滋病毒自我檢測作為一種診斷途徑，
l 世衛組織還建議開展以社交網絡為基礎的愛滋病毒檢測，以覆蓋高風險但獲得服務機會較少的重點人群，其中包括男男間性行為者、靜脈注射藥癮者、性工作者、跨性別人群和監所在押人員。這些「重點人群」及其伴侶佔愛滋病毒新感人數的50%以上。例如，在針對剛果民主共和國143個愛滋病毒陽性者其社交網絡中的99個人進行檢測時，有48%的人被檢測出愛滋病毒陽性。
l 使用同儕引領及創新的數位通信手段（如簡訊和視頻）可以增加對愛滋病毒檢測的需求並實際增加檢測的發生。越南的證據表明，線上外聯的工作人員為人數約6,500來自高危關鍵族群的人們提供了諮詢，建議其中80%的人去進行愛滋病毒檢測，有95%的人實際接受了檢測。大多數（75%）接受諮詢的人在此之前從未接觸過有關愛滋病毒防治的同儕服務或外聯服務。
l 世衛組織建議長期以來仍在使用以實驗室為基礎的西方墨點法（western blotting）的歐洲、東南亞、西太平洋和東地中海地區等之相關國家，聚焦在社區上努力主要透過非專業人員去提供快速之檢測。來自吉爾吉斯斯坦的證據顯示，採用西方墨點法診斷愛滋病毒需要4-6週，而現在只需要1-2週，而且由於政策上的改變，在費用上也更加負擔得起。
l 產檢首次做愛滋病毒檢測時即進行愛滋病毒/梅毒雙重快速檢測，可幫助各國消除這兩種透過母嬰傳播的感染症。此舉有助於縮小檢測和治療方面的缺口，並對抗全球第二大死產原因。也還鼓勵採用更多整合的方法以進行愛滋病毒、梅毒和B肝病毒檢測。
世衛組織愛滋病毒檢測、預防和人口小組的負責人Rachel Baggaley博士說：「從愛滋病毒前拯救生命要從檢測開始。這些新建議可以幫助各國加快進展，更有效地應對愛滋病毒流行特徵上的變化。」
截至2018年底，全球共有3,790萬愛滋病毒感染者。其中，79%已經確診，62%正在接受治療，53%透過持續的治療已經將愛滋病毒水平大幅降低，也大幅地減少愛滋病毒傳播的風險。
Innovative WHO HIV testing recommendations aim to expand treatment coverage
27 November 2019 |News release |Geneva, Switzerland
The World Health Organization (WHO) has issued new recommendations to help countries reach the 8.1 million people living with HIV who are yet to be diagnosed, and who are therefore unable to obtain lifesaving treatment.
“The face of the HIV epidemic has changed dramatically over the past decade,” said Dr Tedros Adhanom Ghebreyesus. “More people are receiving treatment than ever before, but too many are still not getting the help they need because they have not been diagnosed. WHO’s new HIV testing guidelines aim to dramatically change this.”
HIV testing is key to ensuring people are diagnosed early and start treatment. Good testing services also ensure that people who test HIV negative are linked to appropriate, effective prevention services. This will help reduce the 1.7 million new HIV infections occurring every year.
The WHO guidelines are released ahead of World AIDS Day (1 December), and the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA2019) which takes place in Kigali, Rwanda on 2-7 December. Today, three in 4 of all people with HIV live in the African Region.
The new “WHO consolidated guidelines on HIV testing services”recommend a range of innovative approaches to respond to contemporary needs.
l Responding to changing HIV epidemics with high proportions of people already tested and treated, WHO is encouraging all countries to adopt a standard HIV testing strategy which uses three consecutive reactive tests to provide an HIV positive diagnosis. Previously, most high burden countries were using two consecutive tests. The new approach can help countries achieve maximum accuracy in HIV testing.
l WHO recommends countries use HIV self-testing as a gateway to diagnosis based on new evidence that people who are at higher HIV risk and not testing in clinical settings are more likely to be tested if they can access HIV self-tests.
l The Organization also recommends social network-based HIV testing to reach key populations, who are at high risk but have less access to services. These include men who have sex with men, people who inject drugs, sex workers, transgender population and people in prisons. These “key populations” and their partners account for over 50% of new HIV infections. For example, when testing 99 contacts from social networks of 143 HIV-positive people in the Democratic Republic of Congo, 48% tested positive for HIV.
l The use of peer-led, innovative digital communications such as short messages and videos can build demand- and increase uptake of HIV testing. Evidence from Viet Nam shows that online outreach workers counselled around 6,500 people from at risk key population groups, of which 80% were referred to HIV testing and 95% took the tests. The majority (75%) of people who received counselling had never been in contact before with peer or outreach services for HIV.
l WHO recommends focused community efforts to deliver rapid testing through lay providers for relevant countries in the European, South-East Asian, Western Pacific and Eastern Mediterranean regions where longstanding laboratory-based method called “western blotting” is still in use. Evidence from Kyrgyzstan shows that HIV diagnosis which took 4-6 weeks with the “western blotting” method now takes only 1-2 weeks and is much more affordable resulting from policy change.
l Using HIV/syphilis dual rapid tests in antenatal care as the first HIV test can help countries eliminate mother-to-child transmission of both infections. The move can help close the testing and treatment gap and combat the second leading cause of stillbirths globally. More integrated approaches for HIV, syphilis and hepatitis B testing is also encouraged.
“Saving lives from HIV starts with testing,” says Dr Rachel Baggaley, WHO’s Team lead for HIV Testing, Prevention and Populations. “These new recommendations can help countries to accelerate their progress and respond more effectively to the changing nature of their HIV epidemics.”
At the end of 2018, there were 36.7 million people with HIV worldwide. Of these, 79% had been diagnosed, 62% were on treatment, and 53% had reduced their HIV levels through sustained treatment, to the point at which they have substantially reduced risk of transmitting HIV.