Department of Medicine, University of Washington, Seattle, WA.
HIV/STD Program, Public Health-Seattle and King County, Seattle, WA.
J Acquir Immune Defic Syndr. 2019 Apr 15;80(5):533-541. doi: 10.1097/QAI.0000000000001952.
Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk of HIV. We evaluated the integration of pre-exposure prophylaxis (PrEP) referrals into STD partner services (PS) for MSM.
King County, Washington.
Disease Intervention Specialists (DIS) in King County attempt to provide PS to all MSM with early syphilis and, as resources allow, MSM with gonorrhea or chlamydia. Our health department defines MSM with any of the following as at high HIV risk: early syphilis, rectal gonorrhea, methamphetamine/poppers use, sex work, or an HIV-unsuppressed partner. DIS offer high-risk MSM referral to our STD Clinic for PrEP and other MSM referral to community providers. In 2017, we interviewed a random sample of MSM offered referrals in 2016 to assess PrEP initiation after PS.
From August 2014 to August 2017, 7546 cases of bacterial STDs were reported among HIV-negative MSM. DIS provided PS to 3739 MSM, of whom 2055 (55%) were at high risk. DIS assessed PrEP use in 1840 (90%) of these men, 895 (49%) of whom reported already using PrEP. DIS offered referrals to 693 (73%) of 945 MSM not on PrEP; 372 (54%) accepted. Among 132 interviewed for the random sample, men who accepted referrals at initial interview were more likely to report using PrEP at follow-up (32/68 = 47%) than those who did not (12/64 = 19%) (P = 0.0006). An estimated 10.4% of all interviewed MSM initiated PrEP following PS-based referral.
Integrating PrEP referrals into STD PS is an effective population-based strategy to link MSM at high HIV risk to PrEP.
患有细菌性性传播疾病（STD）的男男性行为者（MSM）感染 HIV 的风险较高。我们评估了将暴露前预防（PrEP）转介纳入男男性行为者 STD 伙伴服务（PS）的情况。
华盛顿州金县。
金县的疾病干预专家（DIS）试图为所有患有早期梅毒的 MSM 以及在资源允许的情况下，为患有淋病或衣原体感染的 MSM 提供 PS。我们的卫生部门将以下任何一种情况的 MSM 定义为 HIV 高风险：早期梅毒、直肠淋病、使用冰毒/摇头丸、性工作者或 HIV 未受抑制的伴侣。DIS 为高危 MSM 提供转介到我们的 STD 诊所进行 PrEP 治疗，以及为其他 MSM 提供社区提供者的转介。2017 年，我们对 2016 年接受转介的 MSM 进行了随机抽样采访，以评估 PS 后 PrEP 的启动情况。
从 2014 年 8 月到 2017 年 8 月，报告了 7546 例 HIV 阴性 MSM 的细菌性 STD 病例。DIS 为 3739 名 MSM 提供了 PS，其中 2055 名（55%）处于高危状态。DIS 在这些男性中评估了 PrEP 的使用情况，其中 1840 名（90%）报告已经使用 PrEP。DIS 为 693 名（73%）未服用 PrEP 的 MSM 提供了转介；其中 372 名（54%）接受了转介。在随机抽样采访的 132 名男性中，在初次采访时接受转介的男性更有可能在随访时报告使用 PrEP（32/68=47%），而未接受转介的男性则为 12/64=19%（P=0.0006）。根据估计，在接受 PS 为基础的转介的所有接受采访的 MSM 中，有 10.4%的人开始使用 PrEP。
将 PrEP 转介纳入 STD PS 是一种有效的基于人群的策略，可以将 HIV 风险较高的 MSM 与 PrEP 联系起来。
