美国终结艾滋疫情优先县 2005-2019 年性传播感染发病率研究

Examination of Incidence of Sexually Transmitted Infections in the Ending the HIV Epidemic Priority Counties of the United States, 2005-2019.

机构信息

From the Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL.

Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL.

出版信息

Sex Transm Dis. 2024 Mar 1;51(3):139-145. doi: 10.1097/OLQ.0000000000001910. Epub 2023 Dec 13.

DOI:10.1097/OLQ.0000000000001910

PMID:38100791

Abstract

BACKGROUND

The incidence of sexually transmitted infections (STIs) has been increasing in the United States, and this trend has continued alongside expanding/changing human immunodeficiency virus (HIV) prevention strategies, moving from reliance solely on behavioral interventions like condoms to biomedical methods like oral and injectable antiretroviral preexposure prophylaxis (PrEP). In 2019, the Ending the HIV Epidemic (EHE) initiative was released to prioritize resource allocation to the 50 jurisdictions in the United States with the highest HIV incidence, providing an opportunity to monitor STI incidence in a national group of discrete, geographic units and identify trends and differences across jurisdictions.

OBJECTIVES AND DESIGN

Using existing data from the US CDC and Census Bureau, a retrospective analysis was conducted to examine the incidence of STIs in 49 of the 50 EHE priority counties between 2005 and 2019. This timeframe was divided into 2 periods representing a before and after entry into the biomedical era of HIV prevention: P1 (2005-2011) and P2 (2012-2019).

KEY RESULTS

A total of 49 EHE counties were included in this analysis, representing 27.4% of the total US population. Entry into the biomedical HIV prevention era was associated with an increase in STI incidence in 28 EHE counties and a decrease in 14 EHE counties. The greatest percent increase in total STI incidence was in the District of Columbia (+12.1%; incidence rate ratio = 1.121 [1.115, 1.127]; P < 0.001) and the greatest percent decrease was identified in Orleans Parish, LA (-8.7%; incidence rate ratio = 0.913 [0.908, 0.919]; P < 0.001).

CONCLUSIONS

Rising STI rates in the biomedical era of HIV prevention represent missed opportunities for comprehensive sexual and preventive healthcare. County-level data provide actionable insight for reducing STI incidence. The EHE counties that have experienced decreases in STI incidence while being in the biomedical era may provide models of best practice, which may be scaled in other jurisdictions.

摘要

背景

在美国，性传播感染（STIs）的发病率一直在上升，并且这种趋势一直伴随着扩大/改变人类免疫缺陷病毒（HIV）预防策略而持续，从仅依赖避孕套等行为干预措施转变为口腔和注射型抗逆转录病毒暴露前预防（PrEP）等生物医学方法。2019 年，发布了终结艾滋病流行（EHE）倡议，以优先分配资源给美国 50 个 HIV 发病率最高的司法管辖区，这为监测全国范围内离散地理单位的 STI 发病率提供了机会，并确定了各司法管辖区的趋势和差异。

目的和设计

使用美国疾病控制与预防中心（CDC）和人口普查局现有的数据，进行了回顾性分析，以检查 2005 年至 2019 年间 50 个 EHE 优先县中的 49 个县的 STI 发病率。这个时间框架分为代表 HIV 预防生物医学时代之前和之后的两个时期：P1（2005-2011 年）和 P2（2012-2019 年）。

主要结果

本分析共纳入 49 个 EHE 县，占美国总人口的 27.4%。进入生物医学 HIV 预防时代与 28 个 EHE 县的 STI 发病率上升和 14 个 EHE 县的 STI 发病率下降相关。总 STI 发病率的最大百分比增加发生在哥伦比亚特区（+12.1%；发病率比=1.121[1.115，1.127]；P<0.001），最大百分比下降发生在路易斯安那州奥尔良教区（-8.7%；发病率比=0.913[0.908，0.919]；P<0.001）。