Keshinro Babajide, Crowell Trevor A, Nowak Rebecca G, Adebajo Sylvia, Peel Sheila, Gaydos Charlotte A, Rodriguez-Hart Cristina, Baral Stefan D, Walsh Melissa J, Njoku Ogbonnaya S, Odeyemi Sunday, Ngo-Ndomb Teclaire, Blattner William A, Robb Merlin L, Charurat Manhattan E, Ake Julie
Department of Defense Walter Reed Program-Nigeria, Abuja, Nigeria;
Walter Reed Army Institute of Research, U.S. Military HIV Research Program, Silver Spring, MD, USA.
J Int AIDS Soc. 2016 Dec 7;19(1):21270. doi: 10.7448/IAS.19.1.21270. eCollection 2016.
Sexually transmitted infection (STI) and HIV prevalence have been reported to be higher amongst men who have sex with men (MSM) in Nigeria than in the general population. The objective of this study was to characterize the prevalence of HIV, chlamydia and gonorrhoea in this population using laboratory-based universal testing.
TRUST/RV368 represents a cohort of MSM and transgender women (TGW) recruited at trusted community centres in Abuja and Lagos, Nigeria, using respondent-driven sampling (RDS). Participants undergo a structured comprehensive assessment of HIV-related risks and screening for anorectal and urogenital and , and HIV. Crude and RDS-weighted prevalence estimates with 95% confidence intervals (CIs) were calculated. Log-binomial regression was used to explore factors associated with prevalent HIV infection and STIs.
From March 2013 to January 2016, 862 MSM and TGW (316 in Lagos and 546 in Abuja) underwent screening for HIV, chlamydia and gonorrhoea at study enrolment. Participants' median age was 24 years [interquartile range (IQR) 21-27]. One-third (34.2%) were identified as gay/homosexual and 65.2% as bisexual. The overall prevalence of HIV was 54.9%. After adjusting for the RDS recruitment method, HIV prevalence in Abuja was 43.5% (95% CI 37.3-49.6%) and in Lagos was 65.6% (95% CI 54.7-76.5%). The RDS-weighted prevalence of chlamydia was 17.0% (95% CI 11.8-22.3%) in Abuja and 18.3% (95% CI 11.1-25.4%) in Lagos. Chlamydia infection was detected only at the anorectal site in 70.2% of cases. The RDS-weighted prevalence of gonorrhoea was 19.1% (95% CI 14.6-23.5%) in Abuja and 25.8% (95% CI 17.1-34.6%) in Lagos. Overall, 84.2% of gonorrhoea cases presented with anorectal infection only. Over 95% of STI cases were asymptomatic. In a multivariable model, increased risk for chlamydia/gonorrhoea was associated with younger age, gay/homosexual sexual orientation and higher number of partners for receptive anal sex. HIV infection was associated with older age, female gender identity and number of partners for receptive anal sex.
There is a high burden of infection with HIV and asymptomatic chlamydia and gonorrhoea among MSM and TGW in Nigeria. Most cases would have been missed without anorectal screening. Interventions are needed to target this population for appropriate STI screening and management beginning at a young age.
据报道，尼日利亚男男性行为者（MSM）中的性传播感染（STI）和艾滋病毒流行率高于普通人群。本研究的目的是通过基于实验室的普遍检测来描述该人群中艾滋病毒、衣原体和淋病的流行情况。
TRUST/RV368代表了一组通过应答驱动抽样（RDS）在尼日利亚阿布贾和拉各斯的可信社区中心招募的男男性行为者和变性女性（TGW）。参与者接受了与艾滋病毒相关风险的结构化综合评估以及肛门直肠和泌尿生殖系统的筛查以及艾滋病毒检测。计算了粗患病率和RDS加权患病率估计值以及95%置信区间（CI）。采用对数二项回归来探讨与艾滋病毒感染流行和性传播感染相关的因素。
2013年3月至2016年1月，862名男男性行为者和变性女性（拉各斯316名，阿布贾546名）在研究入组时接受了艾滋病毒、衣原体和淋病筛查。参与者的中位年龄为24岁[四分位间距（IQR）21 - 27]。三分之一（34.2%）被认定为同性恋，65.2%为双性恋。艾滋病毒的总体流行率为54.9%。在调整了RDS招募方法后，阿布贾的艾滋病毒流行率为43.5%（95%CI 37.3 - 49.6%），拉各斯为65.6%（95%CI 54.7 - 76.5%）。衣原体的RDS加权流行率在阿布贾为17.0%（95%CI 错译：11.8 - 22.3%），在拉各斯为18.3%（95%CI 11.1 - 25.4%）。70.2%的衣原体感染病例仅在肛门直肠部位被检测到。淋病的RDS加权流行率在阿布贾为19.1%（95%CI 14.6 - 23.5%），在拉各斯为25.8%（95%CI 17.1 - 34.6%）。总体而言，84.2%的淋病病例仅表现为肛门直肠感染。超过95%的性传播感染病例无症状。在多变量模型中，衣原体/淋病风险增加与年龄较小、同性恋性取向以及接受肛交的性伴侣数量较多有关。艾滋病毒感染与年龄较大、女性性别认同以及接受肛交的性伴侣数量有关。
尼日利亚的男男性行为者和变性女性中艾滋病毒、无症状衣原体和淋病的感染负担很高。如果不进行肛门直肠筛查，大多数病例将会被漏诊。需要采取干预措施，针对这一人群在年轻时进行适当的性传播感染筛查和管理。
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