Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Int AIDS Soc. 2023 Sep;26(9):e26135. doi: 10.1002/jia2.26135.
INTRODUCTION: Antiretroviral treatment (ART) sharing has been reported among fishermen and sex workers in Uganda and South Africa. However, no population-based studies have documented ART diversion prevalence (including sharing [giving/receiving], buying and selling) or its relationship with viremia among men and women living with HIV in Africa. METHODS: In 2018-2020, we surveyed people living with HIV aged 15-49 years in 41 communities in the Rakai Community Cohort Study, a population-based cohort in south-central Uganda. We assessed the prevalence and correlates of self-reported lifetime and past-year ART diversion, stratifying by age and gender and documenting sources of diverted drugs. We used log-binomial regression to quantify the relationship between diversion patterns and viremia (viral load >40 copies/ml), reported as unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). RESULTS: Of 2852 people living with HIV and self-reporting current ART use, 266 (9.3%) reported lifetime ART diversion. Giving/receiving drugs were most common; few participants reported buying, and none reported selling. Men (12.9%) were more likely to report lifetime diversion than women (7.4%), with men aged 25-34 reporting high levels of sharing (18.9%). Friends were the most common sources of shared drugs, followed by spouses/sexual partners. Patterns of lifetime and past-year diversion were similar. Among participants with viral load results, 8.6% were viraemic. In adjusted analyses, people who reported only giving ART were nearly twice as likely to be viraemic than those who reported no diversion (aPR: 1.94, 95% CI: 1.10-3.44), and those reporting only receiving ART were less likely to exhibit viremia (aPR: 0.46, 95% CI: 0.12-1.79), although the latter was not statistically significant. Reporting both giving and receiving ART was not associated with viremia (aPR: 0.79, 95% CI: 0.43-1.46). Reporting buying ART, though rare, was also correlated with higher rates of viremia, but this relationship was not statistically significant (aPR: 1.98, 95% CI: 0.72-5.45). CONCLUSIONS: ART sharing is common among persons reporting ART use in rural Uganda, particularly among men. Sharing ART was associated with viremia, and receiving ART may facilitate viral suppression. HIV programmes may benefit from considering ART sharing in counselling messages.
简介：在乌干达和南非，已有研究报告表明渔民和性工作者之间存在抗逆转录病毒治疗（ART）共享的情况。然而，在非洲，还没有基于人群的研究记录过艾滋病毒感染者中 ART 转用的流行率（包括共享[给予/接受]、购买和销售）或其与病毒载量之间的关系。
方法：在 2018-2020 年期间，我们对乌干达中南部的 Rakai 社区队列研究中的 41 个社区中年龄在 15-49 岁的艾滋病毒感染者进行了调查。我们评估了自我报告的终生和过去一年 ART 转用的流行率和相关因素，按年龄和性别分层，并记录了转用药物的来源。我们使用对数二项式回归来量化转用模式与病毒载量（病毒载量>40 拷贝/ml）之间的关系，报告为未经调整和调整后的患病率比（aPR）及其 95%置信区间（CI）。
结果：在 2852 名自我报告正在使用 ART 的艾滋病毒感染者中，有 266 名（9.3%）报告了终生的 ART 转用。给予/接受药物是最常见的转用方式；很少有参与者报告购买，没有人报告销售。男性（12.9%）比女性（7.4%）更有可能报告终生转用，年龄在 25-34 岁的男性报告了较高的共享水平（18.9%）。朋友是共享药物的最常见来源，其次是配偶/性伴侣。终生和过去一年的转用模式相似。在有病毒载量结果的参与者中，8.6%的人病毒载量升高。在调整后的分析中，仅报告给予 ART 的人比未报告转用的人发生病毒血症的可能性几乎高出两倍（aPR：1.94，95%CI：1.10-3.44），而仅报告接受 ART 的人发生病毒血症的可能性较低（aPR：0.46，95%CI：0.12-1.79），尽管后者在统计学上并不显著。同时报告给予和接受 ART 与病毒血症无关（aPR：0.79，95%CI：0.43-1.46）。尽管报告购买 ART 的情况很少见，但也与更高的病毒载量有关，但这种关系在统计学上并不显著（aPR：1.98，95%CI：0.72-5.45）。
结论：在乌干达农村地区，报告使用 ART 的人群中，ART 共享很常见，尤其是男性。共享 ART 与病毒血症有关，而接受 ART 可能有助于病毒抑制。艾滋病毒规划可能受益于在咨询信息中考虑 ART 共享的问题。
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