Institute for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba.
National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada.
AIDS. 2023 May 1;37(6):987-992. doi: 10.1097/QAD.0000000000003484. Epub 2023 Jan 19.
To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya.
Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14-24 years in Mombasa, Kenya.
Dried blood spot specimens were collected from study participants ( n = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool ( https://hiv.biozentrum.unibas.ch/ETI/ ), and data on self-reported events were obtained from the survey.
The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7-88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker.
Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course.
推断肯尼亚蒙巴萨自我认同为女性性工作者（FSW）的青春期女孩和年轻妇女（AGYW）的性生命历程中自我报告事件与艾滋病毒获得时间的关系。
在 Transitions 研究中，对肯尼亚蒙巴萨年龄在 14-24 岁的 AGYW 进行了横断面生物行为调查，对感染艾滋病毒的 AGYW 进行了下一代病毒测序。
从研究参与者（共 37 名，均为 FSW）中采集了干血斑标本。使用内部下一代测序测定法对 HIV pol 基因的一部分进行了测序，用于 HIV 耐药性突变基因分型。使用 HIV EVO 基于网络的工具（ https://hiv.biozentrum.unibas.ch/ETI/ ）推断估计的感染时间（ETI），并从调查中获得自我报告事件的数据。
FSW 的中位 ETI 为 3.4 年（四分位间距= 1.7-6.3），在正式性工作前 1.5 年中位 ETI。我们估计，74.1%（95%置信区间= 53.7-88.9%）自我认同为 FSW 且携带艾滋病毒的参与者可能在自我认同为性工作者之前获得了艾滋病毒。
研究结果表明，从事性工作的 AGYW 中普遍存在的艾滋病毒感染很大一部分源自正式性工作之前的感染。针对性工作者量身定制的当前艾滋病毒预防方案可能会错过艾滋病毒预防的关键机会，因为这些方案旨在在正式性工作后针对女性，这表明需要针对高风险 AGYW 制定更早的专门方案，以在其性生命历程中进行干预。
