Division of sexually transmitted diseases (STD) Prevention, National Center for Human Immunodeficiency Virus (HIV), Hepatitis, STD, and tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
STD/HIV Program, Louisiana Department of Health, New Orleans.
Clin Infect Dis. 2020 Mar 3;70(6):1115-1120. doi: 10.1093/cid/ciz303.
Human immunodeficiency virus (HIV) prevention interventions for prevention interventions for women include screening, partner notification, promoting condoms, and preexposure prophylaxis (PrEP). Women's risk of acquiring HIV can help guide recommendations.
We used data from Louisiana's sexually transmitted infection (STI) and HIV registries to study 13- to 59-year-old women following first diagnosis of syphilis, gonorrhea, or chlamydia during 2000-2015. We measured HIV rates reported subsequent to STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11 000 per year, and effectiveness estimated as 100%.
STIs were syphilis (6574), gonorrhea (64 995), or chlamydia (140 034). These 211 603 women had 1 865 488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5186 HIV diagnoses over 24 359 397 person-years. HIV rates diagnosis (per 100 000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7 371 111 000 and could have prevented 546 HIV diagnoses. Limiting PrEP to 1 year after syphilis or gonorrhea diagnosis would cost $963 847 334, but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis.
Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.
人类免疫缺陷病毒（HIV）预防干预措施包括对女性进行筛查、通知性伴侣、推广避孕套和暴露前预防（PrEP）。女性感染 HIV 的风险有助于指导建议。
我们使用路易斯安那州性传播感染（STI）和 HIV 登记处的数据，研究了 2000 年至 2015 年间首次诊断出梅毒、淋病或衣原体感染的 13 至 59 岁女性。我们测量了 STI 之后报告的 HIV 发病率（截至 2016 年）。通过从报告病例中减去 STI 女性和人口普查估计数，我们估计了没有 STI 的女性的发病率。PrEP 成本估计为每年 11000 美元，有效性估计为 100%。
STI 分别为梅毒（6574 例）、淋病（64995 例）或衣原体（140034 例）。这 211603 名女性有 1865488 人年的随访和 969 例 HIV 诊断。没有 STI 的女性在 24359397 人年中有 5186 例 HIV 诊断。与没有 STI 的女性相比，梅毒（177.3）、淋病（73.2）或衣原体（35.4）后 HIV 诊断率（每 10 万人年）更高。如果为所有诊断出梅毒或淋病的女性提供 PrEP，将花费 73711110 万美元，可以预防 546 例 HIV 诊断。将 PrEP 限制在梅毒或淋病诊断后 1 年内，将花费 963847334 美元，但只有 143 例 HIV 诊断是在梅毒或淋病诊断后 2 年内发生的。
女性感染 STI 后 HIV 诊断率较高，但不足以使 PrEP 具有成本效益。大多数诊断出 HIV 的女性以前没有报告过 STI。
