我们可以减少 PrEP 使用者的性传播感染筛查频率吗？评估 AMPrEP 研究中每半年一次的性传播感染筛查对诊断时间和传播风险的影响。

Can we screen less frequently for STI among PrEP users? Assessing the effect of biannual STI screening on timing of diagnosis and transmission risk in the AMPrEP Study.

机构信息

Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands

Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

出版信息

Sex Transm Infect. 2023 May;99(3):149-155. doi: 10.1136/sextrans-2022-055439. Epub 2022 May 18.

DOI:10.1136/sextrans-2022-055439

PMID:35584898

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10176338/

Abstract

BACKGROUND

In many countries, HIV pre-exposure prophylaxis (PrEP) users are screened quarterly for STIs. We assessed the consequences of less frequent STI testing. We also assessed determinants of asymptomatic STI and potential for onward transmission.

METHODS

Using data from the AMPrEP study, we assessed the proportion of syphilis, and genital, anal, and pharyngeal chlamydia and gonorrhoea diagnoses which would have been delayed with biannual versus quarterly screening. We assessed the potential for onward transmission by examining reported condomless anal sex (CAS) in periods after to-be-omitted visits when screening biannually. We assessed determinants of incident asymptomatic STIs using Poisson regression and calculated individual risk scores on the basis of the coefficients from this model.

RESULTS

We included 366 participants. Median follow-up was 47 months (IQR 43-50). 1,183STIs were diagnosed, of which 932(79%) asymptomatic. With biannual screening, 483 asymptomatic STIs (52%) diagnoses would have been delayed at 364 study visits. Of these visits, 129 (35%), 240 (66%) and 265 (73%) were followed by periods of CAS with steady, known casual or unknown casual partners, respectively. Older participants had a lower risk of asymptomatic STI (incidence rate ratio (IRR) 0.86/10-year increase, 95% CI 0.80 to 0.92), while CAS with known (IRR 1.36, 95% CI 1.10 to 1.68) and unknown (IRR 1.86, 95% CI 1.48 to 2.34) casual partners and chemsex (IRR 1.51, 95% CI 1.28 to 1.78) increased the risk. The individual risk scores had limited predictive value (sensitivity=0.70 (95% CI 0.66 to 0.74), specificity=0.50 (95% CI 0.48 to 0.51)).

CONCLUSION

Reducing the STI screening frequency to biannually among PrEP users will likely result in delayed diagnoses, potentially driving onward transmission. Although determinants for asymptomatic STIs were identified, predictive power was low.

摘要

背景

在许多国家，艾滋病毒暴露前预防（PrEP）使用者每季度接受性传播感染（STI）筛查。我们评估了较少频率的 STI 检测的后果。我们还评估了无症状 STI 的决定因素和潜在的传播。

方法

利用 AMPrEP 研究的数据，我们评估了梅毒、生殖器、肛门和咽淋病和衣原体的诊断比例，如果每半年而不是每季度进行筛查，这些诊断将被延迟。我们通过检查每半年筛查时漏检访问后报告的无保护肛交（CAS）来评估潜在的传播。我们使用泊松回归评估无症状 STI 的发生率，并根据该模型的系数计算个体风险评分。

结果

我们纳入了 366 名参与者。中位随访时间为 47 个月（IQR 43-50）。诊断出 1183 例 STI，其中 932 例（79%）为无症状。如果每半年进行一次筛查，在 364 次研究访问中，将有 483 例（52%）无症状 STI 诊断延迟。在这些访问中，分别有 129 次（35%）、240 次（66%）和 265 次（73%）随后与稳定、已知偶然或未知偶然伴侣进行了 CAS。年龄较大的参与者无症状 STI 的风险较低（发病率比（IRR）0.86/10 岁增加，95%CI 0.80 至 0.92），而与已知（IRR 1.36，95%CI 1.10 至 1.68）和未知（IRR 1.86，95%CI 1.48 至 2.34）偶然伴侣发生 CAS 和使用化学物质进行性行为（IRR 1.51，95%CI 1.28 至 1.78）会增加风险。个体风险评分的预测能力有限（敏感性=0.70（95%CI 0.66 至 0.74），特异性=0.50（95%CI 0.48 至 0.51））。