Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS One. 2018 Nov 12;13(11):e0207363. doi: 10.1371/journal.pone.0207363. eCollection 2018.
Despite the high HIV prevalence among men who have sex with men (MSM) and transgender women (TGW), there are limited data on progress on their respective HIV antiretroviral treatment (ART) cascades to identify progress and gaps in meeting UNAIDS 90-90-90 targets. We conducted a respondent-driven sampling survey of MSM and TGW in Bamako, Mali from October 2014 to February 2015. We describe the HIV treatment cascade for MSM and TGW, identify correlates of being unaware of HIV-infected status and having unsuppressed viral load levels, and estimate proportion of recent infections. We enrolled 387 MSM and 165 TGW. HIV prevalence was 13.7%. Of those living with HIV, 10.4% were aware of their serostatus, 61.2% of them self-reported being on treatment, and of them, 100% were virally suppressed. In multivariate analysis, factors associated with being unaware of HIV infection included not using free condoms in the last six months (aOR: 5.7, 95% CI: 1.1-29.5) and not having comprehensive knowledge of HIV (aOR: 6.5, 95% CI: 1.4-29.9). Having unsuppressed viral load was associated with identifying as a transgender woman (aOR: 4.8, 95% CI: 1.1-20.7) and not having comprehensive knowledge of HIV (aOR: 6.5, 95% CI: 1.0-40.9). Of the 79 HIV-positive participants, 5.1% had recent infections. While the proportion aware of their HIV status was low despite adjusting for viral load biomarkers, all MSM and TGW on treatment were virally suppressed. Improved testing strategies are urgently needed to achieve the first 90 of the HIV cascade among MSM and TGW in Bamako.
尽管男男性行为者（MSM）和跨性别女性（TGW）中的艾滋病毒感染率很高，但关于他们各自的艾滋病毒抗逆转录病毒治疗（ART）级联的进展数据有限，无法确定在实现艾滋病规划署 90-90-90 目标方面的进展和差距。我们于 2014 年 10 月至 2015 年 2 月在马里巴马科对 MSM 和 TGW 进行了一项基于应答者的抽样调查。我们描述了 MSM 和 TGW 的 HIV 治疗级联，确定了对 HIV 感染状况不知情和病毒载量未得到抑制的因素，并估计了最近感染的比例。我们共招募了 387 名 MSM 和 165 名 TGW。艾滋病毒感染率为 13.7%。在感染艾滋病毒的人群中，10.4%的人知晓自己的血清状况，其中 61.2%的人自述正在接受治疗，他们的病毒载量全部得到抑制。在多变量分析中，与对 HIV 感染不知情相关的因素包括过去六个月内未使用免费避孕套（调整后的比值比 [aOR]：5.7，95%置信区间 [CI]：1.1-29.5）和对 HIV 缺乏全面了解（aOR：6.5，95% CI：1.4-29.9）。病毒载量未得到抑制与被认定为跨性别女性（aOR：4.8，95% CI：1.1-20.7）和对 HIV 缺乏全面了解（aOR：6.5，95% CI：1.0-40.9）相关。在 79 名 HIV 阳性参与者中，5.1%有近期感染。尽管调整了病毒载量生物标志物，但所有接受治疗的 MSM 和 TGW 的病毒载量均得到抑制，尽管对 HIV 状况的知晓率较低。急需改进检测策略，以实现巴马科 MSM 和 TGW 的 HIV 级联的前 90 个目标。
