HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study.
HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study.
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卢旺达基加利男男性行为者和变性妇女的艾滋病毒感染和艾滋病毒护理参与：一项横断面研究。
DOI：
10.1002/jia2.25604
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发表时间：
2020-10
影响因子：
6
通讯作者：
Baral SD
中科院分区：
文献类型：
--
作者：
Twahirwa Rwema JO;Lyons CE;Herbst S;Liestman B;Nyombayire J;Ketende S;Mazzei A;Olawore O;Nsanzimana S;Mugwaneza P;Kagaba A;Sullivan PS;Allen S;Karita E;Baral SD
鉴于交叉的生物学、网络和结构风险，男男性行为者（MSM）和变性妇女（TGW）一直都有很高的艾滋病毒负担。虽然男男性行为者是卢旺达的关键人群，但指导规划的流行病学数据有限。本研究旨在描述基加利MSM和TGW之间的艾滋病毒流行和护理级联。2018年3月至8月在基加利采用受访者驱动抽样（RDS）方法招募了年龄≥18岁的MSM和TGW。参与者接受了结构化访谈，包括个人、网络和结构决定因素的测量。检测艾滋病毒和性传播感染（STI），包括梅毒、淋病奈瑟菌（NG）和沙眼衣原体（CT）。对感染艾滋病毒的男男性行为者进行病毒载量测定。鲁棒泊松回归用于表征HIV感染和参与HIV治疗级联的决定因素。共有736名参与者被纳入研究。平均年龄27岁（18 ~ 68岁），14%（106例）为TGW。HIV患病率为10% （RDS校正后：9.2% (95% CI: 6.4 - 12.1)）。未经调整的任何性传播感染患病率为20% (147)；梅毒：5.7%（42例）；CT: 9.1%（67例），NG: 8.8%（65例）。预期柱头（41%）、感知柱头（36%）和制定柱头（45%）在TGW中常见且更高（p < 0.001）。在多变量RDS调整分析中，较高的年龄（aPR: 1.08 (95% CI: 1.05至1.12)）和曾经与女性发生过性行为（aPR: 3.39 (95% CI: 1.31至8.72)）与艾滋病毒流行呈正相关。包皮环切术（aPR: 0.52 (95% CI: 0.28至0.9)）与HIV流行感染呈负相关。总体而言，61%（45/74）的应答者报告知道自己的艾滋病毒阳性状况。其中，98%（44/45）报告使用抗逆转录病毒治疗（ART）；75%（33/44）的病毒被抑制，切断量<200拷贝/mL。在29名没有报告任何HIV诊断或使用ART的参与者中，38%（11/29）的病毒受到抑制。累积起来，59%（44/74）的艾滋病毒感染者的病毒被抑制。这些数据表明，卢旺达基加利的男男性行为者/同性恋妇女的艾滋病毒负担很高。双性恋并发性行为很常见，并且与艾滋病毒的流行有关，这表明在卢旺达提供全面的艾滋病毒预防服务时，需要对所有性行为和性偏好进行全面筛查。病毒抑制低于联合国艾滋病规划署的目标，表明依从性差和潜在的抗逆转录病毒治疗耐药性。为了优化卢旺达男男性行为者与艾滋病毒相关的结果，需要提供依从性支持、筛查初级和次级抗逆转录病毒药物耐药性以及减轻耻辱感的干预措施。
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.
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影响因子：
3.7
作者：
Adedimeji, Adebola;Sinayobye, Jean d'Amour;Anastos, Kathryn M.
通讯作者：
Anastos, Kathryn M.
影响因子：
11.1
作者：
Johnston, Lisa G.;Sabin, Miriam Lewis;Raymond, H. Fisher
通讯作者：
Raymond, H. Fisher
影响因子：
168.9
作者：
Beyrer, Chris;Baral, Stefan D.;van Griensven, Frits;Goodreau, Steven M.;Chariyalertsak, Suwat;Wirtz, Andrea L.;Brookmeyer, Ron
通讯作者：
Brookmeyer, Ron
影响因子：
3.6
作者：
Beyrer, Chris;Trapence, Gift;Baral, Stefan
通讯作者：
Baral, Stefan
DOI：
10.1097/qai.0000000000001512
发表时间：
2017-11-01
影响因子：
3.6
作者：
Kunzweiler, Colin P.;Bailey, Robert C.;Otieno, Fredrick O.
通讯作者：
Otieno, Fredrick O.