Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD, USA.
J Int AIDS Soc. 2020 Oct;23 Suppl 6(Suppl 6):e25599. doi: 10.1002/jia2.25599.
INTRODUCTION: Young men who have sex with men (MSM) and transgender women (TGW) face stigmas that hinder access to healthcare. The aim of the study was to understand age-related determinants of healthcare needs and engagement among MSM and TGW. METHODS: The TRUST/RV368 cohort provides integrated prevention and treatment services for HIV and other sexually transmitted infections (STIs) tailored to the needs of sexual and gender minorities. MSM and TGW aged ≥16 years in Abuja and ≥18 years Lagos, Nigeria, completed standardized behavioural questionnaires and were tested for HIV, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) every three months for up to 18 months. Logistic regression was used to estimate adjusted odds ratios (aORs) for associations of age and other factors with outcomes of interest upon enrolment, including HIV care continuum steps - HIV testing, ART initiation and viral suppression <1000 copies/mL. Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) for associations with incident infections. RESULTS: Between March 2013 and February 2019, 2123 participants were enrolled with median age 23 (interquartile range 21 to 27) years. Of 1745 tested, 865 (49.6%) were living with HIV. HIV incidence was 11.6/100 person-years [PY], including 23.1/100PY (95% CI 15.5 to 33.1) among participants aged 16 to 19 years and 23.8/100 PY (95% CI 13.6 to 39.1) among TGW. Compared to participants aged ≥25 years, those aged 16 to 19 years had decreased odds of prior HIV testing (aOR 0.40 [95% CI 0.11 to 0.92]), disclosing same-sex sexual practices to healthcare workers (aOR 0.53 [95% CI 0.36 to 0.77]) and receiving HIV prevention information (aOR 0.60 [95% CI 0.41 to 0.87]). They had increased odds of avoiding healthcare (aOR 1.94 [95% CI 1.3 to 2.83]) and engaging in transactional sex (aOR 2.76 [95% CI 1.92 to 3.71]). Age 16 to 19 years was independently associated with increased incidence of HIV (aHR 4.09 [95% CI 2.33 to 7.49]), NG (aHR 3.91 [95% CI 1.90 to 8.11]) and CT (aHR 2.74 [95% CI 1.48 to 5.81]). CONCLUSIONS: Young MSM and TGW demonstrated decreased healthcare engagement and higher incidence of HIV and other STIs as compared to older participants in this Nigerian cohort. Interventions to address unique obstacles to healthcare engagement by adolescents and young adults are needed to curb the spread of HIV and other STIs among MSM and TGW in Nigeria.
简介：男男性行为者（MSM）和跨性别女性（TGW）面临阻碍他们获得医疗保健的污名化问题。本研究的目的是了解与年龄相关的 MSM 和 TGW 的医疗保健需求和参与的决定因素。
方法：TRUST/RV368 队列为 HIV 和其他性传播感染（STI）提供了综合预防和治疗服务，以满足性少数群体的需求。尼日利亚阿布贾和拉各斯≥16 岁和≥18 岁的 MSM 和 TGW 完成了标准化的行为问卷，并每三个月接受一次 HIV、淋病奈瑟菌（NG）和沙眼衣原体（CT）检测，最长可达 18 个月。使用逻辑回归估计年龄和其他因素与登记时感兴趣的结果之间的调整后优势比（aOR），包括 HIV 护理连续体步骤 - HIV 检测、开始 ART 和病毒载量<1000 拷贝/mL。使用 Cox 比例风险模型计算与感染事件相关的调整后风险比（aHR）。
结果：2013 年 3 月至 2019 年 2 月期间，共招募了 2123 名参与者，中位年龄为 23 岁（四分位间距 21 至 27 岁）。在 1745 名接受检测的人中，865 名（49.6%）患有 HIV。HIV 发病率为 11.6/100 人年[PY]，包括 16 至 19 岁参与者的 23.1/100PY（95%CI 15.5 至 33.1）和 TGW 的 23.8/100PY（95%CI 13.6 至 39.1）。与≥25 岁的参与者相比，16 至 19 岁的参与者之前进行 HIV 检测的可能性较低（aOR 0.40 [95%CI 0.11 至 0.92]），向医疗保健工作者披露同性性行为的可能性较低（aOR 0.53 [95%CI 0.36 至 0.77]），接受 HIV 预防信息的可能性较低（aOR 0.60 [95%CI 0.41 至 0.87]）。他们更有可能避免医疗保健（aOR 1.94 [95%CI 1.3 至 2.83]）和从事交易性性行为（aOR 2.76 [95%CI 1.92 至 3.71]）。16 至 19 岁与 HIV（aHR 4.09 [95%CI 2.33 至 7.49]）、NG（aHR 3.91 [95%CI 1.90 至 8.11]）和 CT（aHR 2.74 [95%CI 1.48 至 5.81]）的发病率增加独立相关。
结论：与该尼日利亚队列中的年长参与者相比，年轻的 MSM 和 TGW 在医疗保健参与方面表现出较低的参与度，HIV 和其他性传播感染的发病率较高。需要采取干预措施，解决青少年和年轻人获得医疗保健方面的独特障碍，以遏制尼日利亚 MSM 和 TGW 中 HIV 和其他性传播感染的传播。
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