新诊断出 HIV 且使用 HIV-PrEP 的非西方出生男男性行为者在荷兰性传播感染门诊就诊：一项大型回顾性队列研究。
Newly diagnosed HIV and use of HIV-PrEP among non-western born MSM attending STI clinics in the Netherlands: a large retrospective cohort study.
机构信息
Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands.
Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
出版信息
Front Public Health. 2023 Jun 19;11:1196958. doi: 10.3389/fpubh.2023.1196958. eCollection 2023.
INTRODUCTION
The World Health Organization recommends HIV-PrEP for all people at risk for HIV infection, which includes men who have sex with men (MSM). Substantial part of new HIV diagnoses in the Netherlands are in non-western born MSM. This study evaluated new HIV diagnoses and reported PrEP use among non-western born MSM and compared it to western-born MSM. To inform public health efforts in the context of equitable PrEP access, we further assessed sociodemographic factors related to higher HIV risk and lower PrEP use among non-western born MSM.
METHODS
Surveillance data of consultations among MSM in all Dutch STI-clinics (2016-2021) were analyzed. STI-clinics provide PrEP via the national pilot-program since August 2019. In non-western born MSM (born in Eastern-Europe/Latin-America/Asia/Africa/Dutch-Antilles/Suriname), sociodemographic factors were evaluated for association with HIV (by multivariable generalized estimating equations) and reported PrEP use in the past 3 months (by multivariable logistic regression; restricted to an at-risk for HIV person-level data-subset from August 2019).
RESULTS
New HIV infections were diagnosed among 1.1% (493/44,394) of non-western born MSM-consultations (vs. 0.4% among western-born MSM, 742/210,450). Low education (aOR: 2.2, 95%CI: 1.7-2.7, vs. high education) and age under 25 years (aOR: 1.4, 95%CI: 1.1-1.8, vs. age above 35 years) were associated with new HIV diagnoses. PrEP use in the past 3 months was 40.7% in non-western born MSM (1,711/4,207; 34.9% among western-born MSM, 6,089/17,458). PrEP use was lower among non-western born MSM aged under 25 years (aOR: 0.3, 95%CI: 0.2-0.4), living in less urban areas (aOR: 0.7, 95%CI: 0.6-0.8), and having low education level (aOR: 0.6, 95%CI: 0.5-0.7).
CONCLUSION
Our study confirmed that non-western born MSM are an important key population in HIV prevention. Access to HIV prevention, including HIV-PrEP, should be further optimized to all non-western born MSM at risk for HIV, and specifically to those who are younger, live in less urban areas, and have a low education level.
简介
世界卫生组织建议所有有感染艾滋病毒风险的人使用 HIV-PrEP，包括男男性行为者（MSM）。荷兰新诊断的艾滋病病毒中有相当一部分是在非西方出生的 MSM 中发现的。本研究评估了非西方出生的 MSM 中的新 HIV 诊断，并报告了他们在过去 3 个月内使用 PrEP 的情况，并与西方出生的 MSM 进行了比较。为了在公平获得 PrEP 的背景下为公共卫生工作提供信息，我们进一步评估了与非西方出生的 MSM 中较高 HIV 风险和较低 PrEP 使用相关的社会人口因素。
方法
对所有荷兰性传播感染诊所（2016-2021 年）中 MSM 的咨询情况进行了监测数据分析。自 2019 年 8 月以来，性传播感染诊所通过国家试点计划提供 PrEP。在非西方出生的 MSM（出生于东欧/拉丁美洲/亚洲/非洲/荷属安的列斯群岛/苏里南）中，评估了社会人口因素与 HIV 的关联（多变量广义估计方程）和过去 3 个月内报告的 PrEP 使用情况（多变量逻辑回归；限于 2019 年 8 月高危人群水平的数据子集）。
结果
在非西方出生的 MSM 咨询（44394 人）中诊断出 1.1%（493 人）的新 HIV 感染（西方出生的 MSM 为 0.4%，即 210450 人中有 742 人）。低教育水平（OR：2.2，95%CI：1.7-2.7，与高教育水平相比）和年龄在 25 岁以下（OR：1.4，95%CI：1.1-1.8，与年龄在 35 岁以上相比）与新的 HIV 诊断相关。过去 3 个月内，非西方出生的 MSM 中有 40.7%（1711/4207 人）使用了 PrEP（西方出生的 MSM 为 34.9%，即 17458 人中有 6089 人）。年龄在 25 岁以下的非西方出生的 MSM 使用 PrEP 的比例较低（OR：0.3，95%CI：0.2-0.4），居住在城市地区较少的地区（OR：0.7，95%CI：0.6-0.8），且教育水平较低（OR：0.6，95%CI：0.5-0.7）。
结论
我们的研究证实，非西方出生的 MSM 是预防艾滋病病毒的一个重要重点人群。应进一步优化所有有感染艾滋病毒风险的非西方出生的 MSM 获得艾滋病毒预防措施的机会，包括 HIV-PrEP，并特别针对那些年龄较小、居住在城市地区较少地区、教育水平较低的人群。
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