Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Emory University, Atlanta, GA, USA.
J Int AIDS Soc. 2020 Oct;23 Suppl 6(Suppl 6):e25604. doi: 10.1002/jia2.25604.
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.
MSM and TGW ≥ 18 years were recruited using respondent-driven sampling (RDS) from March-August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.
A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS-adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV-positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut-off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.
These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV-related outcomes for MSM in Rwanda.
鉴于存在交叉的生物学、网络和结构性风险，男男性行为者（MSM）和跨性别女性（TGW）的 HIV 负担一直很高。尽管 MSM 是卢旺达的一个重点人群，但缺乏指导规划的流行病学数据。本研究旨在描述基加利 MSM 和 TGW 中的 HIV 流行率和护理级联。
2018 年 3 月至 8 月，我们使用回应驱动抽样（RDS）从基加利招募了年龄在 18 岁及以上的 MSM 和 TGW。参与者接受了一项包括个人、网络和结构决定因素的结构化访谈。我们对参与者进行了 HIV 和性传播感染（STI）的检测，包括梅毒、淋病奈瑟菌（NG）和沙眼衣原体（CT）。对携带 HIV 的 MSM 进行了病毒载量检测。使用稳健泊松回归来描述 HIV 感染和参与 HIV 治疗级联的决定因素。
共纳入了 736 名参与者。平均年龄为 27 岁（范围：18 至 68 岁），14%（106 人）为 TGW。HIV 流行率为 10%（RDS 调整后：9.2%（95%CI：6.4 至 12.1））。未调整的任何 STI 患病率为 20%（147 人）；梅毒：5.7%（42 人）；CT：9.1%（67 人）和 NG：8.8%（65 人）。预期（41%）、感知（36%）和实施（45%）的污名很常见，且在 TGW 中更高（p<0.001）。在多变量 RDS 调整分析中，年龄较大（aPR：1.08（95%CI：1.05 至 1.12））和曾与女性发生过性行为（aPR：3.39（95%CI：1.31 至 8.72））与 HIV 流行呈正相关。接受过割礼（aPR：0.52（95%CI：0.28 至 0.9））与 HIV 感染呈负相关。总体而言，61%（45/74）的受访者报告了他们的 HIV 阳性状况。在这些人中，98%（44/45）报告了抗逆转录病毒治疗（ART）的使用；44 人中的 75%（33/44）的病毒载量使用<200 拷贝/mL 的截止值得到抑制。在 29 名未报告任何 HIV 诊断或 ART 使用的参与者中，38%（11/29）的病毒载量得到抑制。累积来看，74 名 HIV 感染者中有 59%（44/74）的人病毒载量得到抑制。
这些数据表明卢旺达基加利的 MSM/TGW 中 HIV 负担很重。双性恋同时发生很常见，且与 HIV 感染流行相关，这表明在卢旺达提供全面的 HIV 预防服务时，需要对所有的性行为和偏好进行全面的筛查。病毒抑制率低于联合国艾滋病规划署的目标，表明依从性差，可能存在抗逆转录病毒治疗耐药性。需要采取依从性支持、原发性和继发性抗逆转录病毒治疗耐药性筛查以及污名减轻干预措施，以优化卢旺达 MSM 的 HIV 相关结局。
Zotero 插件