From the Department of Epidemiology, Rollins School of Public Health, Emory University.
National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Sex Transm Dis. 2022 Oct 1;49(10):669-676. doi: 10.1097/OLQ.0000000000001685. Epub 2022 Jul 29.
Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM.
Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence.
Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection.
Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
之前的模型已经估计了淋病奈瑟菌和沙眼衣原体（NG/CT）在男男性行为者（MSM）中对 HIV 发病率的总人群归因分数，但这并不能代表实际的干预效果。我们估计了对 MSM 中 NG/CT 进行筛查对 HIV 下游发病率的潜在影响。
我们使用网络模型估计了不同优先人群中不同性传播感染筛查覆盖率水平对 MSM 中 HIV 发病率的影响：所有有性行为的 MSM，无论 HIV 血清状态如何；过去 6 个月有多个近期性伴侣的 MSM，无论血清状态如何；没有 HIV 的 MSM；和 HIV 阳性的 MSM。在假设所有筛查都包括尿道检测的情况下，我们还检查了增加包括直肠筛查 NG/CT 的筛查事件比例对 HIV 发病率的影响。
在 10 年内，每年对有性行为的 MSM 进行 60%的 NG/CT 筛查，可预防 4.9%的 HIV 感染（四分位距，2.8%-6.8%）。当筛查集中在有多个近期性伴侣的 MSM 时，可预防更多的 HIV 感染：对有多个近期性伴侣的 MSM 进行 60%的筛查覆盖率，可预防 9.8%的 HIV 感染（四分位距，8.1%-11.6%）。与因筛查 HIV 阳性 MSM 而预防的 HIV 传播相比，对没有 HIV 的 MSM 进行性传播感染筛查可预防更多新的 HIV 感染，但需要对 HIV 阳性 MSM 进行较少的 NG/CT 检测，才能预防单个新的 HIV 感染。
对 MSM 进行 NG/CT 筛查预计将导致 MSM 中 HIV 发病率适度但具有临床意义的降低。
