Uptake of treatment as prevention for HIV and continuum of care among HIV-positive men who have sex with men in Nigeria.
Uptake of treatment as prevention for HIV and continuum of care among HIV-positive men who have sex with men in Nigeria.
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DOI：
10.1097/qai.0000000000000439
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发表时间：
2015-03-01
期刊：
影响因子：
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通讯作者：
TRUST Study Group
中科院分区：
文献类型：
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作者：
Charurat ME;Emmanuel B;Akolo C;Keshinro B;Nowak RG;Kennedy S;Orazulike I;Ake J;Njoku O;Baral S;Blattner W;TRUST Study Group
实验证据表明，使用抗逆转录病毒疗法 (ART) 治疗 HIV 感染可防止 HIV 异性传播给未感染的伴侣。然而，这一策略在“现实世界”中对男男性行为者 (MSM) 等关键人群的应用受到了限制。我们报告了尼日利亚阿布贾一家值得信赖的社区中心对感染 HIV 的 MSM 的治疗即预防 (TasP) 策略的可接受性的调查结果，该中心为 MSM 提供全面的 HIV 预防和治疗服务。使用受访者驱动抽样 (RDS)，年龄≥16 岁且在过去 12 个月内进行过接受性或插入性肛交的 MSM 被招募到一项前瞻性 HIV 预防和治疗联合研究 (TRUST) 中。入组后两周，进行了艾滋病毒检测和咨询。在每 3 个月的随访中，HIV 感染者接受临床和实验室评估，包括 CD4 计数、血浆 HIV 病毒载量、立即 3 周的 ART 准备疗程，然后根据 TasP 策略启动 ART，无论 CD4 计数如何。记录了不参与 TasP 前准备和 TasP 的原因。分别使用逻辑回归和 Cox 回归确定与 TasP 参与度和失访相关的特征。在招募的 186 名 HIV 阳性 MSM 中，58 名 (31.2%) 在招募时正在接受 ART，而 128 名 (68.8%) 则未接受过 ART，并提供了参与 TasP 的机会。其中，70 人（54.7%）从事 TasP。与未参与 TasP 的 MSM 相比，参与 TasP 的 MSM 平均 CD4 计数显着较低 (p=0.001)，更有可能是基督徒 (p=0.01)，并向家人 (p=0.02) 或医疗保健提供者 (p=0.02) 透露自己是 MSM。在多变量模型中，向医疗保健提供者披露自己是 MSM 仍然与 TasP 的摄取显着相关。在参与 TasP 的个人中，10% 的人在入组后 18 个月时失去后续护理。参与 TasP（相对风险 [RH]=0.08，p<0.001）和 ART（RH=0.17，p<0.001）与失访风险降低相关。尽管已经接受 ART 或参与 TasP 的个体对 HIV 检测的接受度较高，且随访损失率较低，但未参与 TasP 的比例高于预期，这表明需要定制治疗准备并增加有利环境，以支持这一关键人群获得 HIV 治疗。
Experimental evidence has shown treatment of HIV infection with antiretroviral therapy (ART) prevents heterosexual transmission of HIV to an uninfected partner. However, the “real world” application of this strategy to key populations such as men who have sex with men (MSM) has been limited. We report findings on acceptability of a treatment as prevention (TasP) strategy among HIV-infected MSM at a Trusted Community Center providing comprehensive HIV prevention and treatment services to MSM in Abuja, Nigeria. Using respondent driven sampling (RDS), MSM who were ≥16 years old and have engaged in either receptive or insertive anal intercourse within the previous 12 months were recruited into a prospective combination HIV prevention and treatment study (TRUST). Two weeks after enrollment, HIV testing and counseling was conducted. At each 3 month follow-up visits, HIV-infected individuals underwent clinical and laboratory evaluation, including CD4 count, plasma HIV viral load, immediate 3 weekly sessions of ART preparation, then ART initiation per TasP strategy irrespective of CD4 count. Reasons for not engaging in pre-TasP preparation and TasP were documented. Characteristics associated with TasP engagement and loss to follow-up were determined using logistic and Cox’s regression, respectively. Of 186 HIV positive MSM enrolled, 58 (31.2%) were on ART at the time of recruitment while 128 (68.8%) were ART-naïve and provided opportunity for engaging TasP. Of these, 70 (54.7%) engaged in TasP. Compared to MSM who did not engage in TasP, those who engaged had significantly lower mean CD4 count (p=0.001), were more likely to be Christian (p=0.01), and had disclosed being MSM to family (p=0.02) or health care providers (p=0.02). In multivariate models, disclosure of being MSM to health care providers remained significantly associated with uptake of TasP. Among individuals engaged in TasP, 10% were loss to follow-up in care at 18 months since enrollment. Being engaged in TasP (Relative Hazards [RH]=0.08, p<0.001) and on ART (RH=0.17, p<0.001) were associated with decreased risk of loss to follow-up. Although, there was high acceptance of HIV testing and low loss to follow-up among individuals who were already on ART or engaged in TasP, a higher than expected proportion did not engage in TasP, suggesting the need for customized treatment preparation and an increase in enabling environments to support HIV treatment access with this key population.