*Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD; †Institute of Human Virology-Nigeria, Abuja, Nigeria; ‡US Military HIV Research Program, Silver Spring, MD; §International Centre for Advocacy on Rights to Health, Abuja, Nigeria; and ‖Johns Hopkins University, Center for Human Rights, Baltimore, MD.
J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2(Suppl 2):S114-23. doi: 10.1097/QAI.0000000000000439.
Experimental evidence has shown that treatment of HIV infection with antiretroviral therapy (ART) prevents heterosexual transmission of HIV to an uninfected partner. However, the "real-world" application of this strategy to key populations such as men who have sex with men (MSM) has been limited. We report findings on acceptability of a treatment as prevention (TasP) strategy among HIV-infected MSM at a Trusted Community Center providing comprehensive HIV prevention and treatment services to MSM in Abuja, Nigeria.
Using respondent-driven sampling (RDS), MSM who were 16 years and older and have engaged in either receptive or insertive anal intercourse within the previous 12 months were recruited into a prospective combination HIV prevention and treatment study (TRUST). Two weeks after enrollment, HIV testing and counseling was conducted. At each 3-month follow-up visits, HIV-infected individuals underwent clinical and laboratory evaluation, including CD4 count, plasma HIV viral load, immediate 3 weekly sessions of ART preparation, and then ART initiation per TasP strategy irrespective of CD4 count. Reasons for not engaging in pre-TasP preparation and TasP were documented. Characteristics associated with TasP engagement and loss to follow-up (LTFU) were determined using logistic and Cox regression, respectively.
Of 186 HIV-positive MSM enrolled, 58 (31.2%) were on ART at the time of recruitment, whereas 128 (68.8%) were ART-naive and provided opportunity for engaging TasP. Of these, 70 (54.7%) engaged in TasP. Compared with MSM who did not engage in TasP, those who engaged had significantly lower mean CD4 count (P = 0.001), were more likely to be Christian (P = 0.01), and had disclosed being MSM to family (P = 0.02) or health care providers (P = 0.02). In multivariate models, disclosure of being MSM to health care providers remained significantly associated with uptake of TasP. Among individuals engaged in TasP, 10% were LTFU in care at 18 months since enrollment. Being engaged in TasP (relative hazards = 0.08, P < 0.001) and on ART (relative hazards = 0.17, P < 0.001) were associated with decreased risk of LTFU.
Although there was high acceptance of HIV testing and low LTFU among individuals who were already on ART or engaged in TasP, a higher than expected proportion did not engage in TasP, suggesting the need for customized treatment preparation and an increase in enabling environments to support HIV treatment access with this key population.
实验证据表明，采用抗逆转录病毒疗法（ART）治疗艾滋病可防止艾滋病毒感染者将病毒传染给未受感染的伴侣。然而，在像男男性行为者（MSM）这样的关键人群中，将这一策略应用于“现实世界”的情况却受到了限制。我们报告了在尼日利亚阿布贾的一个信托社区中心为 MSM 提供全面艾滋病毒预防和治疗服务的情况下，艾滋病毒感染的 MSM 对治疗即预防（TasP）策略的接受程度。
使用响应驱动抽样（RDS），招募年龄在 16 岁及以上且在过去 12 个月内有过接受或插入性肛交的 MSM 参加一项针对 MSM 的前瞻性组合艾滋病毒预防和治疗研究（TRUST）。入组后两周进行艾滋病毒检测和咨询。在每 3 个月的随访中，对 HIV 感染者进行临床和实验室评估，包括 CD4 计数、血浆 HIV 病毒载量、立即进行 3 周的 ART 准备，然后根据 TasP 策略，无论 CD4 计数如何，均开始接受 ART。记录未进行 TasP 准备和 TasP 的原因。使用逻辑回归和 Cox 回归分别确定与 TasP 参与和失访（LTFU）相关的特征。
在 186 名 HIV 阳性的 MSM 中，58 名（31.2%）在招募时正在接受 ART，而 128 名（68.8%）为未接受过 ART 的患者，有机会接受 TasP。其中 70 名（54.7%）参与了 TasP。与未参与 TasP 的 MSM 相比，参与 TasP 的 MSM 的平均 CD4 计数明显较低（P=0.001），更有可能是基督教徒（P=0.01），并向家人（P=0.02）或医疗保健提供者（P=0.02）透露自己是 MSM。在多变量模型中，向医疗保健提供者透露自己是 MSM 与 TasP 的使用率显著相关。在参与 TasP 的人群中，18 个月后有 10%的人在护理中失访。参与 TasP（相对危险比=0.08，P<0.001）和接受 ART（相对危险比=0.17，P<0.001）均与降低 LTFU 的风险相关。
尽管已经接受 ART 治疗或参与 TasP 的个体对艾滋病毒检测的接受程度很高，且失访率很低，但仍有高于预期的比例的个体未参与 TasP，这表明需要为这一关键人群制定个性化的治疗准备方案，并增加有利环境以支持他们获得艾滋病毒治疗。
