Sanders Eduard J, Wahome Elizabeth, Otieno Fredrick, Kimani Joshua, Bentzer Alice, Okall Duncan, Nzioka Joseph, Gichuru Evans, van der Elst Elise M, Bailey Robert C, Mehta Supriya D, Graham Susan M
Implementation Science Division, The Aurum Institute for Health Research, Parktown, South Africa
Dunn School of Pathology, University of Oxford, Oxford, UK.
BMJ Open. 2025 Aug 1;15(7):e098916. doi: 10.1136/bmjopen-2025-098916.
OBJECTIVES: To assess the prevalence, incidence and factors associated with (CT) and (NG) infection among HIV-negative men who have sex with men (MSM) and transgender women (TGW) in Kenya. DESIGN: Prospective cohort. SETTING: Kisumu, Nairobi and coastal Kenya. PARTICIPANTS: 650 young adult participants (570 MSM and 80 TGW) recruited at three research clinics. Inclusion criteria were HIV-negative status, age 18-29 years, assigned male sex at birth, identification as cisgender male or transgender female and reported anal intercourse with a man in the past 3 months. PRIMARY AND SECONDARY OUTCOME MEASURES: Urine, rectal and oropharyngeal samples were tested for CT/NG infection at two different time points (∼6 months apart), using nucleic acid amplification. We compared CT/NG prevalence and incidence in MSM versus TGW and used Poisson regression to compare risk for each group after adjustment for other correlates of prevalent and incident CT/NG infection. RESULTS: Prevalence of CT/NG infection at any anatomic site was 15.8% and 27.5% in MSM and TGW, respectively (p=0.009). CT/NG incidence was 27.2 (95% CI 21.3 to 34.7) and 24.5 (95% CI 12.3 to 49.0) per 100 person years for MSM and TGW, respectively (p=0.784). In multivariable analysis, there was no difference in prevalence or incidence by gender identity. Baseline CT/NG infection was more prevalent among TGW (adjusted prevalence ratio 1.61, 95% CI 0.99 to 2.62). Incident CT/NG infection was increased among participants with baseline CT/NG infection (adjusted incidence rate ratio (aIRR) 3.14, 95% CI 1.94 to 5.07) and self-reported pre-exposure prophylaxis use (aIRR 1.75, 95% CI 1.04 to 2.93). CONCLUSION: Despite higher prevalence of CT/NG infections among TGW at baseline, there were no differences in CT/NG prevalence and incidence between TGW and MSM, after adjustment for potential confounders. Improved condom use, effective partner notification and treatment, and new strategies such as doxycycline post-exposure prophylaxis are needed to reduce CT/NG infections in both MSM and TGW in settings where regular testing is not possible.
目的：评估肯尼亚男男性行为者（MSM）和变性女性（TGW）中艾滋病毒阴性者沙眼衣原体（CT）和淋病奈瑟菌（NG）感染的患病率、发病率及相关因素。 设计：前瞻性队列研究。 地点：肯尼亚的基苏木、内罗毕和沿海地区。 参与者：在三家研究诊所招募了650名年轻成年参与者（570名MSM和80名TGW）。纳入标准为艾滋病毒阴性、年龄18 - 29岁、出生时被指定为男性性别、自我认同为顺性别男性或变性女性且在过去3个月内有与男性肛交的经历。 主要和次要结局指标：在两个不同时间点（间隔约6个月）使用核酸扩增法对尿液、直肠和口咽样本进行CT/NG感染检测。我们比较了MSM和TGW中CT/NG的患病率和发病率，并在对CT/NG感染的流行和新发情况的其他相关因素进行调整后，使用泊松回归比较每组的风险。 结果：MSM和TGW中任何解剖部位CT/NG感染的患病率分别为15.8%和27.5%（p = 0.009）。MSM和TGW中CT/NG的发病率分别为每100人年27.2（95%可信区间21.3至34.7）和24.5（95%可信区间12.3至49.0）（p = 0.784）。在多变量分析中，按性别认同划分的患病率或发病率没有差异。基线CT/NG感染在TGW中更为普遍（调整后的患病率比值为1.61，95%可信区间0.99至2.62）。基线CT/NG感染的参与者中CT/NG新发感染增加（调整后的发病率比值（aIRR）为3.14，95%可信区间1.94至5.07），以及自我报告使用暴露前预防药物者（aIRR为1.75，95%可信区间1.04至2.93）。 结论：尽管TGW基线时CT/NG感染的患病率较高，但在对潜在混杂因素进行调整后，TGW和MSM之间CT/NG的患病率和发病率没有差异。在无法进行定期检测的环境中，需要改善避孕套的使用、有效的性伴通知和治疗，以及如多西环素暴露后预防等新策略，以减少MSM和TGW中的CT/NG感染。
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