Assessing the performance of international pre-exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016.
Assessing the performance of international pre-exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016.
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DOI：
10.1002/jia2.25653
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发表时间：
2020-12
影响因子：
6
通讯作者：
Siegler AJ
中科院分区：
文献类型：
--
作者：
Hall EW;Wang L;Huang X;Sullivan PS;Siegler AJ
PrEP是一种强有力的HIV预防工具，当地相关的合格标准对于优化PrEP的预防效果是必要的。我们评估了现有的国家和国际PrEP合格标准的性能，以预测中国北京MSM人群未来的HIV血清转换。受试者为2009年7月至2016年3月期间入组队列研究的年龄≥18岁的MSM。参与者在每次随访时完成HIV检测，梅毒检测和最近性健康行为的问卷调查，并随访至HIV血清转化或脱落。我们在最终研究访视前的最近一次随访访视时评估了PrEP合格性。参与者根据欧洲，韩国，南非，台湾，英国，美国和世界卫生组织的指南标准被分类为PrEP（或不）。为了比较指南的性能，我们计算了灵敏度、特异性、约登指数（YI）、马修相关系数（MCC）、F1评分和诊断比值比。对于每个指南，通过随机选择与所示比例相等的参与者比例，将性能指标与PrEP的随机分配进行比较。在1663名MSM中，有287人（17.33%）发生了HIV血清转换。根据不同指南，接受PrEP治疗的男性人数从556人（33 - 4%）到1569人（94 - 2%）不等。与随机分配相比，算法预测血清转化的灵敏度范围从略差（-4 7%）到比随机分配好30 2%。然而，就绝对值而言，与随机分配相比，灵敏度值均未增加超过11%。对于所有指南，特异性并没有显著优于随机分配。没有任何指南具有较高的二元分类性能指标。国际适应症指南在该样本中的表现仅略好于随机分配。使用这些指南筛选出MSM自我识别为对PrEP感兴趣可能会导致资源分配不当，并导致PrEP的良好候选人被拒绝访问。对于国际指南表现不佳的情况，应考虑替代适应症方法。
PrEP is a powerful HIV prevention tool, and locally relevant eligibility criteria are necessary to optimize the prevention impact of PrEP. We assessed performance of existing national and international PrEP eligibility criteria to predict future HIV seroconversion among MSM in Beijing, China. Participants were MSM aged ≥18 years who enrolled in a cohort study between July 2009 and March 2016. Participants completed HIV testing, syphilis testing, and a questionnaire on recent sexual health behaviours at each follow‐up visit and were followed until HIV seroconversion or dropout. We assessed PrEP eligibility at the most recent follow‐up visit prior to the final study visit. Participants were classified as indicated for PrEP (or not) based on criteria from guidelines from Europe, Korea, South Africa, Taiwan, the United Kingdom, United States and the World Health Organization. To compare guideline performance, we calculated sensitivity, specificity, Youden’s Index (YI), Matthew’s Correlation Coefficient (MCC), F1 scores and diagnostic odds ratios. For each guideline, performance measures were compared to random allocation of PrEP by randomly selecting a proportion of participants equal to the proportion indicated. There were 287 (17∙3%) incident HIV seroconversions among 1663 MSM. The number of men indicated for PrEP from different guidelines ranged from 556 (33∙4%) to 1569 (94∙2%). Compared to random allocation, sensitivity of algorithms to predict seroconversion ranged from slightly worse (−4∙7%) to 30∙2% better than random. However, in absolute terms, none of the sensitivity values increased by more than 11% when compared to random allocation. For all guidelines, specificity was not meaningfully better than random allocation. No guidelines had high binary classification performance measures. The performance of international indication guidelines in this sample was only slightly better than random allocation. Using such guidelines to screen out MSM self‐identifying as interested in PrEP could lead to misallocation of resources and to good candidates for PrEP being denied access. For settings in which international guidelines perform poorly, alternative indication approaches should be considered.
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影响因子：
1.7
作者：
Bekker, Linda-Gail;Rebe, Kevin;Eakles, Robyn
通讯作者：
Eakles, Robyn
DOI：
10.1016/0005-2795(75)90109-9
发表时间：
1975-01-01
期刊：
BIOCHIMICA ET BIOPHYSICA ACTA
影响因子：
--
作者：
MATTHEWS, BW
通讯作者：
MATTHEWS, BW
影响因子：
3.7
作者：
Kelley CF;Rosenberg ES;O'Hara BM;Frew PM;Sanchez T;Peterson JL;Del Rio C;Sullivan PS
通讯作者：
Sullivan PS
影响因子：
3.7
作者：
Chen A;Dowdy DW
通讯作者：
Dowdy DW
DOI：
10.3760/cma.j.issn.0254-6450.2017.10.026
发表时间：
2017-10-10
影响因子：
--
作者：
Li, L L;Jiang, Z;He, N
通讯作者：
He, N