Dynamics of Pre-Exposure (PrEP) Eligibility Because of Waxing and Waning of HIV Risk in Rakai, Uganda.
Dynamics of Pre-Exposure (PrEP) Eligibility Because of Waxing and Waning of HIV Risk in Rakai, Uganda.
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DOI：
10.1097/qai.0000000000003182
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发表时间：
2023-06-01
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文本中提供了补充数字内容。我们进行了一项基于人群的回顾性研究，以描述符合暴露前预防 (PrEP) 资格的重大 HIV 危险行为 (SHR) 的患病率、发生率、中断、恢复和持续时间的纵向模式。这项研究是在 2011 年 8 月至 2018 年 6 月期间参加 Rakai 社区队列研究各轮调查的 15-49 岁 HIV 阴性研究参与者中进行的。根据乌干达国家 PrEP 资格，将重大 HIV 风险定义为报告与超过 1 名 HIV 状况不明的伴侣发生性行为、不戴避孕套的非婚性行为、患有生殖器溃疡或进行性交易。恢复 SHR 是指停止 SHR 后恢复 SHR，而持续 SHR 是指连续就诊超过 1 次时进行 SHR。我们使用具有对数二项式回归模型和稳健方差的广义估计方程来估计特定调查的患病率；使用改进的泊松回归模型和稳健方差的广义估计方程来估计 PrEP 资格的发生率、中止和恢复的发生率。 PrEP 资格的发生率从第一个调查期间的 11.4/100 人年 (pys) 增加至 13.9/100 pys（调整后的发生率比 = 1.28；95%CI = 1.10–1.30），并下降至 12.6/100 pys（调整后的发生率比 = 1.06；95%CI = 0.98–1.15）在第二和第三次调查期间分别。因 PrEP 资格而停止 SHR 的比率保持稳定（范围为 34.9/100 pys–37.3/100 pys；P = 0.207），而恢复率则从 25.0/100 pys 降至 14.5/100 pys（P < 0.001）。 PrEP 资格事件持续的中位时间为 20 个月 (IQR = 10–51)。暴露前预防的使用应根据 PrEP 资格的动态性质进行调整。应采用预防有效的依从性来评估 PrEP 计划中的损耗。
Supplemental Digital Content is Available in the Text. We conducted a retrospective population-based study to describe longitudinal patterns of prevalence, incidence, discontinuation, resumption, and durability of substantial HIV risk behaviors (SHR) for pre-exposure prophylaxis (PrEP) eligibility. The study was conducted among HIV-negative study participants aged 15–49 years who participated in survey rounds of the Rakai Community Cohort Study between August 2011 and June 2018. Substantial HIV risk was defined based on the Uganda national PrEP eligibility as reporting sexual intercourse with >1 partner of unknown HIV status, nonmarital sex without a condom, having genital ulcers, or having transactional sex. Resumption of SHR meant resuming of SHR after stopping SHR, whereas persistence of SHR meant SHR on >1 consecutive visit. We used generalized estimation equations with log-binomial regression models and robust variance to estimate survey-specific prevalence ratios; Generalized estimation equations with modified Poisson regression models and robust variance to estimate incidence ratios for incidence, discontinuation, and resumption of PrEP eligibility. Incidence of PrEP eligibility increased from 11.4/100 person-years (pys) in the first intersurvey period to 13.9/100 pys (adjusted incidence rate ratios = 1.28; 95%CI = 1.10–1.30) and declined to 12.6/100 pys (adjusted incidence rate ratios = 1.06; 95%CI = 0.98–1.15) in the second and third intersurvey periods, respectively. Discontinuation rates of SHR for PrEP eligibility were stable (ranging 34.9/100 pys–37.3/100 pys; P = 0.207), whereas resumption reduced from 25.0/100 pys to 14.5/100 pys (P < 0.001). PrEP eligibility episodes lasted a median time of 20 months (IQR = 10–51). Pre-exposure prophylaxis use should be tailored to the dynamic nature of PrEP eligibility. Preventive-effective adherence should be adopted for assessment of attrition in PrEP programs.