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塞拉利昂艾滋病毒感染者中梅毒感染的血清流行率:一项全国性横断面医院为基础的研究。

Sero-prevalence of syphilis infection among people living with HIV in Sierra Leone: a cross-sectional nationwide hospital-based study.

机构信息

Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.

College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

出版信息

BMC Infect Dis. 2023 Nov 6;23(1):762. doi: 10.1186/s12879-023-08740-9.

Abstract

BACKGROUND

Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV).

METHODS

A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson's χ test, Fisher's exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05.

RESULTS

Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis.

CONCLUSIONS

We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.

摘要

背景

全球 2020 年估计有 710 万例新梅毒感染,其中 30%以上的新感染发生在塞拉利昂等非洲国家。尽管如此,塞拉利昂并没有针对艾滋病毒的特异性梅毒筛查计划。因此,需要数据来为公共卫生实践提供信息。在这项研究中,我们旨在确定梅毒血清阳性率以及与艾滋病毒感染者(PLHIV)梅毒血清阳性相关的因素。

方法

2022 年 9 月至 2023 年 1 月,在塞拉利昂 10 个卫生机构对年龄在 18 岁或以上的成年 HIV 患者进行了一项横断面研究。收集了包括年龄、性别、婚姻、抗逆转录病毒治疗(ART)方案、HIV 病毒载量、ART 治疗持续时间和医院护理水平在内的参数。梅毒抗体通过基于免疫层析的快速检测法检测。使用 R 软件版本 4.2.3(R 核心团队,奥地利维也纳)进行数据分析。适当应用 Pearson's χ 检验、Fisher's 确切检验和 Kruskal-Wallis H 检验评估组间梅毒血清阳性率的差异。应用单变量逻辑回归和多变量逻辑回归分析评估与梅毒血清阳性相关的因素。统计学显著性水平设定为 P<0.05。

结果

在我们的研究中,3082 名 PLHIV 中有 2294 名(74.4%)为女性,2867 名(93.0%)正在接受 ART。中位年龄为 36 岁,211 名(6.8%,95%CI 6.0-7.7)梅毒血清阳性。60 岁及以上人群梅毒血清阳性率最高(21.1%,95%CI 14.7-29.2),其次是 50-60 岁人群(15.5%,95%CI 11.9-19.9)和丧偶人群(11.9%,95%CI 8.9-15.8)。性别、ART 状况、ART 方案、ART 持续时间、HIV 病毒载量和医院护理水平之间梅毒血清阳性率无差异。年龄较大(50-60 岁:调整后的 OR 3.49,95%CI 2.09-5.85 P<0.001;60-100 岁:调整后的 OR 4.28,95%CI 2.21-8.17,P<0.001)是梅毒血清阳性的独立预测因素。

结论

我们观察到 PLHIV 中梅毒的高患病率。老年人和丧偶人群梅毒血清阳性率较高。年龄较大是梅毒阳性的独立预测因素。因此,我们呼吁将梅毒筛查、治疗和预防纳入艾滋病毒服务中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2532/10626761/a60aa93d589d/12879_2023_8740_Fig1_HTML.jpg

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