Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2022 Feb 1;112(2):13502.
Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections.
To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa.
In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) ≤200 copies/mL were considered virally suppressed.
Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed.
In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission.
为了加速实现零新发 HIV 感染的目标，需要更好地整合 HIV 和性传播感染（STI）预防和治疗服务。
描述南非两家初级保健诊所就诊的有症状 STI 患者中 HIV 阳性率、抗逆转录病毒治疗（ART）使用情况、病毒抑制和 HIV 感染近期情况。
在一项横断面研究中，在知情同意后，招募出现符合 STI 综合征症状的男性和女性 STI 服务就诊者。采用访谈员管理的问卷进行调查，并采集适当的生殖器和血液标本，进行 STI 检测和 HIV 生物标志物测量，包括近期感染和抗逆转录病毒（ARV）药物水平。采用描述性统计方法描述入组的就诊者，并确定 HIV 阳性、近期感染、接受 ART 和病毒抑制的就诊者比例。检测到 ARV 的 HIV 阳性就诊者被认为正在接受 ART，而病毒载量（VL）≤200 拷贝/mL 的就诊者被认为病毒抑制。
在分析数据的 451 名有症状就诊者中，93 名（20.6%）HIV 阳性，其中 15/93（16.1%）为近期感染。近期感染与就诊时出现生殖器溃疡疾病独立相关，尤其是无明显 STI 病原体的溃疡。在 78 名（83.9%）长期感染的就诊者中，只有 30 名（38.5%）正在接受 ART，其中 23/30（76.7%）病毒抑制。
在一个有 HIV 传播风险的人群中，近期感染和未抑制的 VLs 负担很高。将暴露前预防、ART 启动和依从性支持纳入 STI 服务将是消除 HIV 传播的必要条件。
