Very high HIV prevalence and incidence among men who have sex with men and transgender women in Indonesia: a retrospective observational cohort study in Bali and Jakarta, 2017–2020

IF 4.6 1区医学 Q2 IMMUNOLOGY Journal of the International AIDS Society Pub Date : 2024-10-24 DOI:10.1002/jia2.26386

Brigitta Dhyah Kunthi Wardhani, Andrew E. Grulich, Nurhayati H. Kawi, Yogi Prasetia, Hendry Luis, Gede Benny S. Wirawan, Putu Erma Pradnyani, John Kaldor, Matthew Law, Sudarto Ronoatmodjo, Erik Parulian Sihotang, Pande Putu Januraga, Benjamin R. Bavinton

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Abstract

Introduction

There are no longitudinal HIV incidence data among men who have sex with men (MSM) and transgender women (TGW) in Indonesia. We aimed to estimate HIV prevalence and incidence and identify associated factors among clinic attendees in Jakarta and Bali.

Methods

We conducted a retrospective cohort study using medical records from five clinics. We reviewed HIV tests among MSM/TGW aged ≥18 years who attended the clinics between 1 January 2018 to 31 December 2020 in Jakarta and 1 January 2017 to 31 December 2019 in Bali. HIV prevalence was measured at the first test. Those with an HIV-negative test and ≥1 follow-up test/s were included in the person-years (PY) at risk to determine HIV incidence. The PY at risk calculation started at the first negative test until the last recorded negative test or seroconversion. Multivariate Poisson regression was used to determine factors associated with HIV acquisition.

Results

Among 5203 and 2815 individuals with an HIV test result in Jakarta and Bali, respectively, at the first HIV test, 1205 and 616 were HIV positive (HIV prevalence 23.2% and 21.9%). The longitudinal sample included 1418 and 873 individuals, respectively. The median number of tests among repeat testers was 3 in Jakarta (interquartile range [IQR] = 2–4) and 3 in Bali (IQR = 2–5). At baseline, about one-quarter were aged <25 years, >90% were MSM and >35% had been tested for HIV previously. In Jakarta, there were 127 HIV seroconversions in 1353 PY (incidence 9.39/100 PY, 95% CI = 7.89–11.17), and in Bali, 71 seroconversions in 982 PY (incidence 7.24/100 PY, 95% CI = 5.73–9.13). Compared to those aged 18–24 years, the incidence rate was lower in older patients (Jakarta—30–39 years: aRR = 0.56, 95% CI = 0.34–0.92; 40+ years: aRR = 0.34, 95% CI = 0.14–0.81; Bali—25–29 years: aRR = 0.44, 95% CI = 0.25–0.79; 30–39 years: aRR = 0.33, 95% CI = 0.18–0.61; 40+ years: aRR = 0.06, 95% CI = 0.01–0.48). In Jakarta, incidence was lower in those with university education than in those without (aRR = 0.66, 95% CI = 0.45–0.96). In Bali, those who had been referred by outreach workers had a higher incidence than those who self-presented for testing (aRR = 1.85, 95% CI = 1.12–3.07).

Conclusions

We observed very high HIV prevalence and incidence rate estimates. Measures to encourage regular testing and effective use of HIV prevention, including pre-exposure prophylaxis scale-up and demand creation, are needed.

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印度尼西亚男男性行为者和变性女性中极高的艾滋病毒流行率和发病率：2017-2020 年巴厘岛和雅加达的回顾性观察队列研究。

导言：在印度尼西亚，男男性行为者（MSM）和变性女性（TGW）中没有纵向的 HIV 感染率数据。我们旨在估算雅加达和巴厘岛诊所就诊者中的 HIV 感染率和发病率，并确定相关因素：我们利用五家诊所的医疗记录开展了一项回顾性队列研究。我们回顾了 2018 年 1 月 1 日至 2020 年 12 月 31 日在雅加达和 2017 年 1 月 1 日至 2019 年 12 月 31 日在巴厘岛诊所就诊的年龄≥18 岁的 MSM/TGW 的 HIV 检测情况。艾滋病毒感染率在首次检测时进行测量。HIV 检测阴性且后续检测次数≥1 次的人被纳入风险年（PY），以确定 HIV 感染率。风险年的计算从第一次检测阴性开始，直到最后一次检测阴性或血清转换为止。多变量泊松回归用于确定与 HIV 感染相关的因素：在雅加达和巴厘岛分别有 5203 人和 2815 人在第一次 HIV 检测时检测出 HIV 阳性，其中 1205 人和 616 人呈阳性（HIV 感染率分别为 23.2% 和 21.9%）。纵向样本分别包括 1418 人和 873 人。雅加达重复检测者的检测次数中位数为 3 次（四分位数间距 [IQR] = 2-4），巴厘岛为 3 次（四分位数间距 [IQR] = 2-5）。在基线期，约四分之一的人年龄在 90 岁以上，90% 的人是男男性行为者，35% 以上的人以前接受过艾滋病毒检测。在雅加达，1353 人中有 127 人血清转换为 HIV 感染者（发生率为 9.39/100，95% CI = 7.89-11.17）；在巴厘岛，982 人中有 71 人血清转换为 HIV 感染者（发生率为 7.24/100，95% CI = 5.73-9.13）。与 18-24 岁的患者相比，年龄较大的患者发病率较低（雅加达-30-39 岁：aRR = 0.56，95% CI = 0.34-0.92；40 岁以上：aRR = 0.34，95% CI = 0.14-0.81；巴厘岛-25-29 岁：aRR = 0.44，95% CI = 0.25-0.79；30-39 岁：aRR = 0.33，95% CI = 0.18-0.61；40 岁以上：aRR = 0.06，95% CI = 0.01-0.48）。在雅加达，受过大学教育者的发病率低于未受过大学教育者（aRR = 0.66，95% CI = 0.45-0.96）。在巴厘岛，由外展工作者转介的人群比自行前来检测的人群发病率更高（aRR = 1.85，95% CI = 1.12-3.07）：我们观察到的艾滋病流行率和发病率估计值都非常高。需要采取措施鼓励定期检测和有效预防艾滋病，包括扩大暴露前预防和创造需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.