Tweya Hannock, Chimpandule Tiwonge, Wu William, Goeke Leah, Zheng Zhouyun, Mbiriyawanda Stone, Masina Tobias, Ozitiosauka Washington, Muyaso Martha, Drabko Anna, Bilicki Dominik, Chen Jiehua, Nyirenda Rose, Jahn Andreas
International Training and Education Center for Health (I-TECH), Lilongwe, Malawi.
Department of Global Health, University of Washington, Seattle, Washington, USA.
J Int AIDS Soc. 2025 Jun;28 Suppl 1(Suppl 1):e26473. doi: 10.1002/jia2.26473.
In Malawi, where HIV prevalence remains high at 6.7%, post-exposure prophylaxis (PEP) has been implemented as one of the HIV prevention strategies. However, there is limited data on the characteristics of PEP users and HIV seroconversion. Using national routine HIV testing services (HTS) programme data, we described the demographic characteristics and risk of exposure to HIV for HTS clients reporting PEP use and determined HIV seroconversion rates among those with baseline HIV-negative results.
We conducted a descriptive cross-sectional study of individuals aged 2 years and older accessing HTS who reported PEP use. A subset was included in a retrospective cohort to determine HIV seroconversion rates. The risk of exposure to HIV was classified as high, ongoing, low and not assessed. HTS encounters data were extracted from a national HTS data repository. Some HTS clients had multiple HTS encounters. Descriptive statistics were reported for the study populations and Poisson regression model with an offset was used to estimate HIV seroconversion rates.
Between November 2022 and July 2023, there were 21,298 HTS encounters where PEP use was reported any time prior. Of the 21,298 encounters, 1847 (8.7%) HTS clients with a baseline HIV-negative status were included in the cohort study component. The median follow-up time was 30 days (interquartile range 30-61). Of the 1847 HTS clients, 1055 (57.1%) were males and 928 (50.2%) were aged 20 and 29 years. A total of 329 (17.8%) HTS clients reported a high-risk HIV exposure event in the past 3 months, 581 (31.5%) had an ongoing risk of exposure to HIV, 892 (48.3%) had low risk of exposure to HIV and 45 (2.4%) assessment was not done. Overall, five individuals seroconverted, yielding a seroconversion rate of 2.08 (0.87-4.99) per 100 person-years.
The majority of PEP users were young adults and males. A sizeable proportion had an ongoing risk of exposure to HIV. The HIV seroconversion rate was high. Targeted efforts should focus on promoting condom use, encouraging partner testing and expanding access to PEP for those with ongoing HIV exposure.
在马拉维，艾滋病毒流行率仍高达6.7%，暴露后预防（PEP）已作为艾滋病毒预防策略之一实施。然而，关于PEP使用者特征和艾滋病毒血清转化的数据有限。利用国家常规艾滋病毒检测服务（HTS）项目数据，我们描述了报告使用PEP的HTS客户的人口统计学特征和艾滋病毒暴露风险，并确定了基线艾滋病毒检测结果为阴性者的艾滋病毒血清转化率。
我们对2岁及以上报告使用PEP的HTS使用者进行了描述性横断面研究。一个子集被纳入回顾性队列以确定艾滋病毒血清转化率。艾滋病毒暴露风险分为高、持续、低和未评估。HTS接触数据从国家HTS数据存储库中提取。一些HTS客户有多次HTS接触。报告了描述性统计数据，并使用带有偏移量的泊松回归模型来估计艾滋病毒血清转化率。
在2022年11月至2023年7月期间，有21298次HTS接触报告曾在任何时间使用过PEP。在这21298次接触中，1847名（8.7%）基线艾滋病毒检测结果为阴性的HTS客户被纳入队列研究部分。中位随访时间为30天（四分位间距30 - 61天）。在1847名HTS客户中，1055名（57.1%）为男性，928名（50.2%）年龄在20至29岁之间。共有329名（17.8%）HTS客户报告在过去3个月中有高危艾滋病毒暴露事件，581名（31.5%）有持续的艾滋病毒暴露风险，892名（48.3%）有低艾滋病毒暴露风险，45名（2.4%）未进行评估。总体而言，有5人发生血清转化，血清转化率为每100人年2.08（0.87 - 4.99）。
大多数PEP使用者为年轻成年人且为男性。相当一部分人有持续的艾滋病毒暴露风险。艾滋病毒血清转化率较高。有针对性的努力应集中在促进避孕套使用、鼓励性伴侣检测以及为有持续艾滋病毒暴露风险的人扩大PEP的可及性。
