Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD.
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.
J Acquir Immune Defic Syndr. 2019 Apr 1;80(4):444-453. doi: 10.1097/QAI.0000000000001934.
To date, HIV incidence studies among men who have sex with men (MSM) across sub-Saharan Africa have focused on studying sexual risk practices with less focus on sexual networks.
TRUST/RV368 conducted in Abuja and Lagos, Nigeria, recruited MSM using respondent-driven sampling and followed HIV-negative men for incident infection over 4 years.
Four-hundred forty-one HIV-uninfected MSM underwent a parallel rapid HIV testing algorithm every 3 months for up to 18 months. HIV incidence per 100 person-years (PY) and 95% confidence intervals (CIs) were estimated using Poisson regression. Individual and network characteristics were examined using multivariable Cox-proportional hazards regression adjusted and unadjusted for respondent-driven sampling weights.
Among cohort members with a median age of 23 years [interquartile range (IQR): 20-27], 81 HIV infections occurred over 527 PY (incidence 15.4/100 PY; 95% CI: 12.3 to 19.0). The incidence rate was highest among 16-19 year olds as compared to those 25 years or older (30.9/100 PY; 95% CI: 22.1 to 45.3 vs. 6.9/100 PY; 95% CI: 4.2 to 10.9, respectively). Individual determinants included receptive partnerships, condomless sex, no history of testing for HIV, and rectal gonorrhea. Sexual networks were larger and consisted of an older sexual partner, although there was no clustering by recruitment networks.
These HIV incidence data reinforce the unmet HIV prevention needs among young MSM in Nigeria. Even in the context of emerging HIV diagnostic and prevention strategies, structural challenges including stigma and criminalization of same-sex practices highlight the need for novel implementation approaches in the context of MSM-friendly services.
迄今为止，撒哈拉以南非洲地区针对男男性行为者（MSM）的艾滋病毒感染率研究主要集中在研究性行为风险行为，而对性网络的关注较少。
TRUST/RV368 在尼日利亚阿布贾和拉各斯进行，使用回应者驱动抽样招募 MSM，并在 4 年内对 HIV 阴性男性进行了 4 年的感染率研究。
441 名未感染 HIV 的 MSM 每 3 个月接受一次平行的快速 HIV 检测算法，最长可达 18 个月。使用泊松回归估计每 100 人年（PY）和 95%置信区间（CI）的 HIV 感染率。使用多变量 Cox 比例风险回归，调整和未调整回应者驱动抽样权重，检查个体和网络特征。
在队列成员的中位年龄为 23 岁[四分位间距（IQR）：20-27]中，527 PY 中有 81 例 HIV 感染（发病率为 15.4/100 PY；95%CI：12.3 至 19.0）。与 25 岁或以上的人相比，16-19 岁的发病率最高（30.9/100 PY；95%CI：22.1 至 45.3 与 6.9/100 PY；95%CI：4.2 至 10.9）。个体决定因素包括接受性伙伴关系、无保护的性行为、无 HIV 检测史和直肠淋病。性网络更大，包括年龄较大的性伴侣，但招募网络没有聚类。
这些艾滋病毒感染率数据强化了尼日利亚年轻 MSM 中未满足的艾滋病毒预防需求。即使在新兴的艾滋病毒诊断和预防策略的背景下，包括对同性性行为的污名化和刑事化等结构性挑战也突出表明，需要在 MSM 友好服务的背景下采取新的实施方法。
