Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Social and Scientific Systems, Inc., a DLH Holdings company, Atlanta, Georgia, USA.
Clin Infect Dis. 2023 Jan 13;76(2):307-314. doi: 10.1093/cid/ciac774.
Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV). In the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project, 7 community collaboratives were developed to provide comprehensive HIV prevention services for these populations.
We analyzed National HIV Surveillance System data to determine the number of HIV diagnoses for each year from 2014 to 2019 among Black, Hispanic/Latino, and White MSM in 7 THRIVE-eligible Metropolitan Statistical Areas (MSAs) that were awarded funding and 12 THRIVE-eligible MSAs that were not awarded funding. We used generalized linear Poisson regression models to estimate adjusted estimated annual percentage changes (EAPCs) with 95% confidence intervals for HIV diagnosis rates controlling for HIV prevalence, viral suppression, HIV testing rates, preexposure prophylaxis (PrEP) prescription rates, poverty, education, and insurance status.
We found larger estimated decreases in HIV diagnosis rates in THRIVE jurisdictions compared with non-THRIVE jurisdictions. The adjusted EAPC among Black MSM was -8.2 (-11.7 to -4.6) in THRIVE MSAs compared with -4.2 (-7.8 to -0.4) in non-THRIVE MSAs. The adjusted EAPC among Hispanic/Latino MSM was -8.6 (-12.2 to -4.8) in THRIVE MSAs compared with -2.6 (-5.1 to -0.1)in non-THRIVE MSAs. The adjusted EAPC among White MSM was -7.6 (-12.0 to -3.1) in THRIVE MSAs compared with 5.9 (1.8-10.1) in non-THRIVE MSAs.
The THRIVE community collaborative model was associated with a decrease in HIV diagnoses among Black and Hispanic/Latino MSM. To achieve the goals of the US Ending the HIV Epidemic initiative, effective interventions aimed to increase PrEP use need to be focused on Black and Hispanic/Latino MSM.
与男性发生性行为的黑人和西班牙裔/拉丁裔男性(MSM)受到人类免疫缺陷病毒(HIV)的影响不成比例。在靶向高效干预以扭转 HIV 流行(THRIVE)示范项目中,成立了 7 个社区合作组织,为这些人群提供全面的 HIV 预防服务。
我们分析了国家 HIV 监测系统数据,以确定从 2014 年到 2019 年,在获得资金的 7 个 THRIVE 合格大都市统计区(MSA)和 12 个未获得资金的 THRIVE 合格 MSA 中,黑人和西班牙裔/拉丁裔以及白人 MSM 中每年 HIV 诊断的数量。我们使用广义线性泊松回归模型来估计 HIV 诊断率的调整后的估计年百分比变化(EAPC),控制 HIV 流行率、病毒抑制率、HIV 检测率、暴露前预防(PrEP)处方率、贫困、教育和保险状况。
我们发现,与非 THRIVE 司法管辖区相比,THRIVE 司法管辖区的 HIV 诊断率下降幅度更大。与非 THRIVE MSA 相比,THRIVE MSA 中黑人 MSM 的调整后 EAPC 为-8.2(-11.7 至-4.6)。THRIVE MSA 中西班牙裔/拉丁裔 MSM 的调整后 EAPC 为-8.6(-12.2 至-4.8),而非 THRIVE MSA 为-2.6(-5.1 至-0.1)。THRIVE MSA 中白人 MSM 的调整后 EAPC 为-7.6(-12.0 至-3.1),而非 THRIVE MSA 为 5.9(1.8-10.1)。
THRIVE 社区合作模式与黑人和西班牙裔/拉丁裔 MSM 的 HIV 诊断减少有关。为了实现美国终结 HIV 流行倡议的目标,需要将重点放在黑人和西班牙裔/拉丁裔 MSM 上,以增加 PrEP 的使用。