Addressing gender inequities could be key to the elimination of vertical transmission of HIV. Women experiencing intimate partner violence (IPV) might be at an increased risk of vertical transmission due to their vulnerability to HIV acquisition and barriers to access to and retention in care. Sub-Saharan Africa, where IPV burden is among the highest globally, accounts for most new paediatric HIV infections. We aimed to examine the proportion of excess vertical transmission attributable to IPV in this region. In this modelling analysis, we created a probability tree model of vertical HIV transmission among women aged 15–49 years in 46 African countries. We estimated the proportion of vertical transmission attributable to past-year physical or sexual IPV, or both, as an age-standardised population attributable fraction (PAF) and as excess vertical transmission risk per 1000 births among women experiencing IPV. We incorporated perinatal and postnatal vertical transmission among women who acquired HIV before pregnancy, during pregnancy, and during breastfeeding. Fertility, HIV prevalence, HIV incidence, antiretroviral therapy (ART) uptake, and ART retention varied in the model by women's IPV experience. The model was parameterised using UNAIDS' 2023 Spectrum model data, WHO's Global Database on Violence Against Women, and the peer-reviewed literature. Uncertainty intervals (95% UI) were calculated through 1000 Monte Carlo simulations. Across 46 countries 13% (95% UI 6–21) of paediatric HIV infections in 2022 were attributed to IPV, corresponding to over 22 000 paediatric infections. The PAF ranged from 4% (2–7) in Niger to 28% (13–43) in Uganda. The PAF was highest among girls aged 15–19 years (20%, 8–33) and lowest among women aged 45–49 years (6%, 3–9). In southern Africa, where women's HIV prevalence is highest (23%), IPV led to 11 (5–20) additional infections per 1000 births among women affected by IPV. IPV might be responsible for one in eight paediatric HIV infections in sub-Saharan Africa. Ending IPV could accelerate vertical transmission elimination, especially among young women who bear the highest burden of violence. Canadian Institutes of Health Research, Canada Research Chair, and Fonds de recherche du Québec-Santé. For the French, Georgian and Spanish translations of the abstract see Supplementary Materials section.

中文翻译：

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亲密伴侣暴力对艾滋病毒垂直传播的影响：对 46 个非洲国家的建模分析


解决性别不平等问题可能是消除艾滋病毒垂直传播的关键。遭受亲密伴侣暴力 (IPV) 的妇女由于容易感染艾滋病毒以及获得和保留护理方面的障碍，垂直传播的风险可能会增加。撒哈拉以南非洲地区是全球 IPV 负担最高的地区之一，也是新发儿科艾滋病毒感染病例最多的地区。我们的目的是研究该地区由 IPV 引起的过度垂直传播的比例。在本模型分析中，我们创建了 46 个非洲国家 15-49 岁女性艾滋病毒垂直传播的概率树模型。我们估计了过去一年身体或性 IPV 或两者兼而有之的垂直传播比例，作为年龄标准化人口归因分数 (PAF) 和经历 IPV 的妇女中每 1000 名新生儿的过度垂直传播风险。我们纳入了怀孕前、怀孕期间和母乳喂养期间感染艾滋病毒的妇女的围产期和产后垂直传播情况。模型中的生育力、HIV 感染率、HIV 发病率、抗逆转录病毒治疗 (ART) 接受率和 ART 保留率因女性的 IPV 经历而异。该模型使用联合国艾滋病规划署的 2023 Spectrum 模型数据、世界卫生组织的暴力侵害妇女行为全球数据库以及同行评审的文献进行参数化。不确定性区间 (95% UI) 通过 1000 次蒙特卡洛模拟计算得出。 2022 年，46 个国家的儿童 HIV 感染中有 13%（95% UI 6-21）归因于 IPV，相当于超过 22,000 例儿童感染。 PAF 范围从尼日尔的 4% (2-7) 到乌干达的 28% (13-43)。 PAF 在 15-19 岁女孩中最高（20%，8-33），在 45-49 岁女性中最低（6%，3-9）。 在南部非洲，妇女艾滋病毒感染率最高（23%），在受 IPV 影响的妇女中，每 1000 名新生儿中 IPV 导致 11 例（5-20​​ 例）额外感染。在撒哈拉以南非洲地区，IPV 可能导致八分之一的儿童艾滋病毒感染。终止 IPV 可以加速消除垂直传播，特别是在承受暴力负担最重的年轻女性中。加拿大健康研究所、加拿大研究主席和魁北克健康基金会。有关摘要的法语、格鲁吉亚语和西班牙语翻译，请参阅补充材料部分。