Using population attributable risk to choose HIV prevention strategies in men who have sex with men
Using population attributable risk to choose HIV prevention strategies in men who have sex with men
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DOI：
10.1186/1471-2458-11-247
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发表时间：
2011-04-19
影响因子：
4.5
通讯作者：
Kaldor, John M.
中科院分区：
文献类型：
--
作者：
Guy, Rebecca J.;Wand, Handan;Kaldor, John M.
背景：在澳大利亚，艾滋病毒主要集中在男男性行为者（MSM）中，并且在过去十年中，艾滋病毒感染率稳步上升。理想的情况是，健康促进战略应了解正在改变的因素的普遍性以及它们带来的风险的大小。我们对澳大利亚悉尼男男性行为者（MSM）中修改关键艾滋病毒风险因素可能产生的潜在人口影响和成本节约进行了分析。方法：采用比例风险分析方法，对1426名HIV-1感染者进行队列研究，分析过去6个月内的性行为与性传播感染之间的关系。2001年至2004年期间主要从社区来源招募的阴性MSM，并随访至2007年中期。然后，我们使用控制因素间混杂的人群归因风险（PAR）方法，估计了如果特定因素不再存在于人群中，则可以预防的HIV感染比例。我们还通过估计感染后的临床护理和治疗相关成本并按3%贴现，计算了与特定因素相关的艾滋病毒感染所产生的平均终身医疗保健成本（1%和5%敏感度）。有5%的男性报告与已知HIV阳性伴侣发生无保护肛交（UAI），风险比（HR）为16.1（95% CI：6.4 - 40.5），PAR为34%（95% CI：24 - 44%），与HIV阳性伴侣的UAI相关的平均终生HIV相关医疗费用为1.02亿澳元（不确定性范围：9300 - 1.14亿澳元）。25%的男性报告了伴侣艾滋病毒状况未知的UAI，HR为4.4（95%CI：1.8 - 11.2），PAR为33%（95%CI：26 - 42%），终生发生的费用为9900万澳元。肛门疣患病率为4%，HR为5.2（95%CI：2.4 - 11.2），PAR为13%（95%CI：9 - 19%），生命周期产生的成本为3900万澳元。我们的分析发现，尽管与艾滋病毒阳性性伴侣的UAI是一种相对低流行率的行为，（5%的男性报告），如果人口中不存在这种行为，感染人数将减少三分之一。没有任何其他单一行为或性传播感染导致更大比例的感染和艾滋病毒相关医疗费用。
Background: In Australia, HIV is concentrated in men who have sex with men (MSM) and rates have increased steadily over the past ten years. Health promotion strategies should ideally be informed by an understanding of both the prevalence of the factors being modified, as well as the size of the risk that they confer. We undertook an analysis of the potential population impact and cost saving that would likely result from modifying key HIV risk factors among men who have sex with men (MSM) in Sydney, Australia.Methods: Proportional hazard analyses were used to examine the association between sexual behaviours in the last six months and sexually transmissible infections on HIV incidence in a cohort of 1426 HIV-negative MSM who were recruited primarily from community-based sources between 2001 and 2004 and followed to mid-2007. We then estimated the proportion of HIV infections that would be prevented if specific factors were no longer present in the population, using a population attributable risk (PAR) method which controls for confounding among factors. We also calculated the average lifetime healthcare costs incurred by the HIV infections associated with specific factors by estimating costs associated with clinical care and treatment following infection and discounting at 3% (1% and 5% sensitivity) to present value.Results: Unprotected anal intercourse (UAI) with a known HIV-positive partner was reported by 5% of men, the hazard ratio (HR) was 16.1 (95% CI: 6.4-40.5), the PAR was 34% (95% CI: 24-44%) and the average lifetime HIV-related healthcare costs attributable to UAI with HIV-positive partners were $AUD102 million (uncertainty range: $93-114 m). UAI with unknown HIV status partners was reported by 25% of men, the HR was 4.4 (95% CI: 1.8-11.2), the PAR was 33% (95% CI: 26-42%) and the lifetime incurred costs were $AUD99 million. Anal warts prevalence was 4%, the HR was 5.2 (95% CI: 2.4-11.2), the PAR was 13% (95% CI: 9-19%) and the lifetime incurred costs were $AUD39 million.Conclusions: Our analysis has found that although UAI with an HIV-positive sexual partner is a relatively low-prevalence behaviour (reported by 5% of men), if this behaviour was not present in the population, the number of infections would be reduced by one third. No other single behaviour or sexually transmissible infections contributes to a greater proportion of infections and HIV-related healthcare costs.