High Rates of Pre-exposure Prophylaxis Eligibility and Associated HIV Incidence in a Population With a Generalized HIV Epidemic in Rakai, Uganda.
High Rates of Pre-exposure Prophylaxis Eligibility and Associated HIV Incidence in a Population With a Generalized HIV Epidemic in Rakai, Uganda.
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DOI：
10.1097/qai.0000000000002946
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发表时间：
2022-07-01
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文本中提供了补充数字内容。在撒哈拉以南非洲地区，尚未充分研究使用暴露前预防 (PrEP) 资格评估来确定一般人群的资格的效用。我们使用 Rakai 社区队列研究进行横断面分析来估计 PrEP 资格，并使用队列分析来估计与 PrEP 资格相关的 HIV 发病率。根据乌干达国家 PrEP 资格工具，我们将资格定义为在过去 12 个月内报告至少一种以下 HIV 风险：与超过一名 HIV 状况未知的伴侣发生性行为；不戴安全套的非婚性行为；以性行为换取金钱、商品或服务；或经历生殖器溃疡。我们使用对数二项式和修正泊松模型分别估计 PrEP 资格和 HIV 发病率的患病率。我们确定了 12,764 名参与者来估计 PrEP 资格患病率，并确定了 11,363 名参与者进行了 17,381 次随访和 30,721 人年 (pys) 的观察来估计 HIV 发病率。总体而言，29% 的人至少满足其中一项资格标准。符合 PrEP 资格的参与者与不符合 PrEP 资格的参与者相比，HIV 发病率显着较高（0.91/100 pys 与 0.41/100 pys；P < 0.001），并且与不符合 PrEP 资格的女性参与者相比，HIV 发病率独立较高（1.18/100 pys 与 0.50/100 pys；P < 0.001）。在未接受包皮环切的男性参与者中，符合 PrEP 资格的参与者的 HIV 发病率显着高于不符合 PrEP 资格的参与者（1.07/100 pys vs 0.27/100 pys；P = 0.001），但接受过包皮环切的男性参与者没有显着差异。在目前公认的高危重点人群之外的普遍艾滋病毒流行中实施 PrEP 作为标准艾滋病毒预防工具，可以进一步减少艾滋病毒感染并有助于流行病控制工作。
Supplemental Digital Content is Available in the Text. The utility of using pre-exposure prophylaxis (PrEP) eligibility assessments to identify eligibility in general populations has not been well studied in sub-Saharan Africa. We used the Rakai Community Cohort Study to conduct a cross-sectional analysis to estimate PrEP eligibility and a cohort analysis to estimate HIV incidence associated with PrEP eligibility. Based on Uganda's national PrEP eligibility tool, we defined eligibility as reporting at least one of the following HIV risks in the past 12 months: sexual intercourse with more than one partner of unknown HIV status; nonmarital sex act without a condom; sex engagement in exchange for money, goods, or services; or experiencing genital ulcers. We used log-binomial and modified Poisson models to estimate prevalence ratios for PrEP eligibility and HIV incidence, respectively. We identified 12,764 participants among whom to estimate PrEP eligibility prevalence and 11,363 participants with 17,381 follow-up visits and 30,721 person-years (pys) of observation to estimate HIV incidence. Overall, 29% met at least one of the eligibility criteria. HIV incidence was significantly higher in PrEP-eligible versus non–PrEP-eligible participants (0.91/100 pys versus 0.41/100 pys; P < 0.001) and independently higher in PrEP-eligible versus non–PrEP-eligible female participants (1.18/100 pys versus 0.50/100 pys; P < 0.001). Among uncircumcised male participants, HIV incidence was significantly higher in PrEP-eligible versus non–PrEP-eligible participants (1.07/100 pys versus 0.27/100 pys; P = 0.001), but there was no significant difference for circumcised male participants. Implementing PrEP as a standard HIV prevention tool in generalized HIV epidemics beyond currently recognized high-risk key populations could further reduce HIV acquisition and aid epidemic control efforts.