南非男男性行为者和跨性别女性队列中的 HIV 流行率和发病率：Sibanye 预防包方案（MP3）项目。

HIV prevalence and incidence in a cohort of South African men and transgender women who have sex with men: the Sibanye Methods for Prevention Packages Programme (MP3) project.

机构信息

Rollins School of Public Health, Emory University, Atlanta, GA, USA.

DVC Research and Innovation Office, North West University, Potchefstroom, South Africa.

出版信息

J Int AIDS Soc. 2020 Oct;23 Suppl 6(Suppl 6):e25591. doi: 10.1002/jia2.25591.

DOI:10.1002/jia2.25591

PMID:33000918

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7527763/

Abstract

INTRODUCTION

Men who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre-exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa.

METHODS

From 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow-up visits (targeted for three, six and twelve months). All HIV-negative PrEP-eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV-negative participants with HIV tests at three, six and twelve months.

RESULTS

Among 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV-negative participants who were followed prospectively for 144.7 person-years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1).

CONCLUSIONS

HIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation-oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM.

摘要

简介

男男性行为者（MSM）和跨性别女性（TGW）感染艾滋病毒的风险增加，但非洲这些关键人群的艾滋病毒发病率数据有限。了解艾滋病毒的流行率和发病率为设计艾滋病毒预防策略提供了重要背景，包括暴露前预防（PrEP）方案。我们描述了南非开普敦和伊丽莎白港的一组 MSM 和 TGW 的艾滋病毒流行率、艾滋病毒感染意识、艾滋病毒发病率和相关因素。

方法

2015 年至 2016 年，在开普敦和伊丽莎白港招募 MSM 和 TGW 并进行了为期 12 个月的前瞻性随访，为他们提供了一整套艾滋病毒预防服务。在基线和随访访视时进行艾滋病毒检测（目标是三个月、六个月和十二个月）。所有 HIV 阴性的 PrEP 合格参与者在研究参与的前四个月内都被提供了 PrEP 登记。我们确定了基线时参与者的 HIV 流行率，并通过对最初 HIV 阴性的参与者在三个月、六个月和十二个月时进行重复 HIV 筛查来确定发病率。

结果

在 292 名入组的参与者中，HIV 流行率很高（43%；95%CI：38 至 49），HIV 感染状况意识较低（50%）。167 名 HIV 阴性的参与者前瞻性随访了 144.7 人年；记录了 9 例 HIV 感染。总的年发病率为 6.2%（CI：2.8 至 11.8），且不因城市而异。年龄较小（18 至 19 岁）的 MSM 和 TGW 的年 HIV 发病率明显较高（MSM：21.8%（CI：1.2 至 100）；TGW：31.0（CI：3.7，111.2））。约一半的参与者在研究期间开始使用 PrEP；82 名（49%）PrEP 使用者的 HIV 年发病率为 3.6%（CI：0.4，13.1），未开始 PrEP 的 HIV 年发病率为 7.8%（CI：3.1，16.1）。

结论

在接受综合预防干预措施和提供 PrEP 的情况下，MSM 和 TGW 中的 HIV 发病率很高。PrEP 的使用率很高；在开始使用 PrEP 的人群中观察到的 HIV 发病率约为未开始使用 PrEP 的人群的一半。未来面向实施的研究应重点关注那些风险最高的人，包括年轻的 MSM，决定开始和继续使用 PrEP。