缅甸男男性行为者和跨性别女性中与 HIV 检测呈阳性相关的 HIV 发病率及相关因素：基于社区的 HIV 检测服务数据。
HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community-based HIV testing services.
机构信息
Disease Elimination Program, Burnet Institute, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
出版信息
J Int AIDS Soc. 2020 Feb;23(2):e25454. doi: 10.1002/jia2.25454.
INTRODUCTION
In Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale-up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar.
METHODS
An electronic data management system was implemented in two community-based, MSM and TW -tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression.
RESULTS
2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving ≥2 tests (incidence = 10.1 per 100 person-years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non-openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history.
CONCLUSIONS
High HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW.
简介
在缅甸，男男性行为者（MSM）和跨性别女性（TW）受到艾滋病毒的不成比例的影响，尽管国家艾滋病毒规划有所扩大。然而，有限的艾滋病毒监测能力阻碍了对疫情趋势和规划影响的监测。本研究旨在估计 MSM 和 TW 客户在缅甸接受艾滋病毒检测诊所的艾滋病毒流行率和发病率，并探讨相关的性风险行为。
方法
2016 年 8 月，在缅甸的两个基于社区的、专门针对 MSM 和 TW 的艾滋病毒检测诊所实施了电子数据管理系统。独特的客户标识符使能够对服务参与、测试频率和结果进行前瞻性监测。我们在 15 个月的时间内估计了客户在基线测试访问中的艾滋病毒发病率和艾滋病毒诊断率。使用多变量逻辑回归确定了艾滋病毒诊断的相关因素。
结果
共对 2794 名 MSM 和 TW 进行了艾滋病毒检测。在他们的基线测试中，38%的客户报告有过任何以前的检测，93%的客户报告在过去三个月中有过性行为，74%的客户报告与偶然的男性伴侣发生过性行为，28%的客户报告与偶然伴侣持续使用安全套。291 名客户在基线时首次检测出艾滋病毒阳性（10.4%；95%CI：9.3 至 11.6）。在接受≥2 次检测的 279 名患者中，检测到 12 例新发病例（发病率为 10.1 例/100 人年；95%CI：5.73 至 17.8）。基线时的艾滋病毒诊断与跨性别女性或非公开披露的男男性行为者、年龄 26 至 39 岁以及无检测史显著相关。
结论
高艾滋病毒发病率和新诊断与报告无检测史有关，这表明未确诊的艾滋病毒在缅甸推动了传播。重复检测并不常见。缅甸的艾滋病毒规划必须重点关注促进 MSM 和 TW 频繁进行艾滋病毒检测，同时充分覆盖教育和初级预防干预措施。
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