Journal of the International AIDS Society最新文献_第9页

Sustaining HIV service delivery to key population clients using client-centered models during the debate and enactment of the Anti-Homosexuality Act in Uganda 在乌干达辩论和颁布《反同性恋法》期间，利用以客户为中心的模式，持续向重点人群客户提供艾滋病毒防治服务

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-07 DOI: 10.1002/jia2.26253

Vamsi Vasireddy, Natalie E. Brown, Neha Shah, Trevor A. Crowell

Punitive and discriminatory laws against key populations (KP), particularly men who have sex with men (MSM), have been on the rise for over a decade [1, 2]. Studies have shown these laws to be associated with healthcare avoidance, decreased HIV testing and increased HIV prevalence [3-5]. These laws further marginalize groups that are disproportionately affected by HIV [6-7] and imperil the achievement of the UNAIDS 95-95-95 targets [8].

In Uganda, same-sex relationships have been illegal since the early 20th century. In 2010, a newspaper infamously outed 100 alleged homosexuals, driving many into hiding [9]. The 2014 Anti-Homosexuality Act (AHA), colloquially known as the “Kill the Gays” bill, penalized consensual same-sex sexual acts with death or life imprisonment, but was struck down by the Constitutional Court. Ugandan media started discussing a possible new AHA in December 2022. On 21 March 2023, Parliament overwhelmingly passed a new AHA, which was signed into law on 26 May 2023. The 2023 AHA criminalizes same-sex sexual acts with sentences ranging from 10-year imprisonment to death. It also criminalizes the promotion of homosexuality, which is broad enough to include routine public health activities, such as HIV prevention, safer sex education and community engagement. This creates opportunities for abuse, puts organizations delivering healthcare to MSM in danger of prosecution and impedes access to KP-friendly services. On 3 April 2024, following a lengthy legal challenge, the Ugandan Constitutional Court upheld the majority of the AHA, leaving in place problematic sections of AHA including the prohibition against “promotion of homosexuality,” the use of the death penalty for repeat offenders engaging in consensual sexual contact and allowing for “rehabilitation” of LGBTQI+ persons.

The United States President's Emergency Plan for AIDS Relief (PEPFAR) supports over 1.3 million Ugandans on antiretroviral therapy (ART). In 2023, PEPFAR supported 84 drop-in-centres (DICs) across Uganda that provided comprehensive HIV prevention and treatment services for KP clients. The DICs were unnamed/unidentified to create confidential and safe spaces for KP clients, including MSM, female sex workers (FSWs) and transgender persons. DICs were strategically situated for easy access and staffed by at least one nurse and a mix of community health workers, including peers within the KP communities. Service delivery data from DICs were de-identified, disaggregated by type of KP clients and services, and uploaded to a central database. Following concerns raised by KP clients regarding healthcare access, we initiated monitoring of AHA impacts on HIV service delivery and implemented new adaptations to support care delivery.

This report focuses on three DICs operated by a single agency that provided consistent data and served a representative population of KP clients. A larger sa

十多年来，针对重点人群（KP），尤其是男男性行为者（MSM）的惩罚性和歧视性法律不断增加[1, 2]。研究表明，这些法律与逃避医疗保健、减少 HIV 检测和增加 HIV 感染率有关 [3-5]。这些法律进一步边缘化了受艾滋病毒影响尤为严重的群体[6-7]，并危及联合国艾滋病规划署 95-95-95 目标的实现[8]。2010 年，一份报纸臭名昭著地揭露了 100 名所谓的同性恋者，导致许多人躲藏起来[9]。2014 年的《反同性恋法》（AHA），俗称 "杀死同性恋 "法案，规定对双方同意的同性性行为处以死刑或终身监禁，但被宪法法院驳回。2022 年 12 月，乌干达媒体开始讨论可能的新 AHA 法案。2023 年 3 月 21 日，议会以压倒性多数通过了新的《法案》，并于 2023 年 5 月 26 日签署成为法律。2023 年《阿富汗人法案》将同性性行为定为刑事犯罪，刑期从 10 年监禁到死刑不等。它还将宣传同性恋定为刑事犯罪，其范围之广足以包括日常的公共卫生活动，如艾滋病预防、安全性行为教育和社区参与。这为滥用职权创造了机会，使为男男性行为者提供医疗保健的组织面临被起诉的危险，并阻碍了他们获得对金伯利进程友好的服务。2024 年 4 月 3 日，经过漫长的法律挑战，乌干达宪法法院维持了《艾滋病法案》的大部分内容，保留了《艾滋病法案》中存在问题的部分，包括禁止 "宣传同性恋"、对从事自愿性接触的惯犯使用死刑以及允许 LGBTQI+ 人士 "康复"。2023 年，美国总统艾滋病紧急救援计划（PEPFAR）为乌干达各地的 84 个救助中心（DICs）提供了支持，这些中心为金伯利进程客户提供全面的艾滋病毒预防和治疗服务。这些救助中心不公开姓名/身份，为包括男男性行为者、女性性工作者 (FSW) 和变性人在内的金感染者创造保密和安全的空间。社区信息中心的地理位置优越，交通便利，工作人员至少有一名护士和多名社区卫生工作者，包括金伯利进程社区内的同龄人。来自社区信息中心的服务提供数据已去除身份标识，按金伯利进程客户和服务类型分列，并上传到中央数据库。在 KP 客户就医疗保健服务提出担忧后，我们开始监控 AHA 对 HIV 服务提供的影响，并实施了新的调整措施以支持护理服务的提供。本报告重点关注由一家机构运营的三个 DIC，这些机构提供的数据一致，服务的 KP 客户群也具有代表性。由于数据访问的不一致性以及 DIC 所在地和运营的敏感性，我们无法进行更大规模的抽样调查。我们注意到，随着反同性恋情绪和媒体报道的不断升级，社区信息中心的访问量急剧下降（图 1）。在此期间，至少有四家 DIC 因安全事故而关闭。许多男男性行为者报告说，他们被逐出住所并遭到殴打。如下文所述，PEPFAR 项目迅速调整了其支持 KP 客户的模式。通过这些项目调整，本文分析的 DIC 开始看到 KP 客户的回归，并一直维持到 2023 年 11 月观察结束。然而，据传闻，并非所有地区信息中心的效果都一致，其他地区信息中心的客户回流情况也不尽相同。地区信息中心分布在乌干达各地，社区的参与度和抵触情绪各不相同。一些社区由于害怕被识别，不希望从 DIC 报告数据。PEPFAR 尊重了这些社区的意愿。由于金伯利进程社区继续面临污名化、歧视和惩罚性立法，PEPFAR 必须做出调整，以维持救生医疗服务的提供。尽管 AHA 带来了负面影响，但 PEPFAR 仍继续每周监测服务的提供和利用情况，以确保迅速调整服务。我们在乌干达的经验可以为其他国家面对日益增多的惩罚性和歧视性立法时，为金伯利进程客户维持弹性医疗保健系统和服务提供参考。面临这种情况的国家可能会采用类似的监测程序，并实施类似的计划调整，以减轻有害立法的影响。如果客户害怕去医疗机构就医，那么社区的参与和投入对于通过外联方法接触客户的对金伯利进程友好的服务至关重要。计划和资助者必须具有灵活性，以便迅速调整提供服务的举措，避免繁文缛节。

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引用次数: 0

Experiences of oral pre-exposure prophylaxis use among heterosexual men accessing sexual and reproductive health services in South Africa: a qualitative study 南非接受性健康和生殖健康服务的异性恋男子使用口服暴露前预防药物的经历：一项定性研究

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26249

Fatima Abegail Cholo, Siphokazi Dada, Catherine Elizabeth Martin, Saiqa Mullick

Introduction

South African men face a substantial burden of HIV and are less likely to test for HIV and initiate antiretroviral therapy if tested positive and more likely to die from AIDS-related causes than women. In addition to condoms and circumcision, guidelines provide for the use of daily oral pre-exposure prophylaxis (PrEP) as an HIV prevention intervention for any men who recognize their need and request PrEP. However, heterosexual men have not been a focus of PrEP programmes, and since its introduction, there is limited literature on PrEP use among men in South Africa. This study explores the experiences, motivators and barriers to oral PrEP use among heterosexual men accessing primary healthcare services in South Africa.

Methods

This study forms part of a mixed-methods implementation science study aimed at generating evidence for oral PrEP introduction and conducted in primary healthcare clinics in South Africa since 2018. Men aged ≥15 years who initiated oral PrEP and enrolled in a parent cohort study were purposefully invited to participate in an in-depth interview (IDI). Between March 2020 and May 2022, 30 men participated in IDIs exploring their motivators for PrEP use, and experiences with accessing health services. Interviews were audio recorded, transcribed and analysed thematically.

Results

The final analysis included 28 heterosexual men (18–56 years old). Motivations to initiate PrEP included fear of acquiring HIV, self-perceived vulnerability to HIV and mistrust in relationships; health systems factors which motivated PrEP use included the influence of healthcare providers, educational materials and mobile services. Perceived reduction in HIV vulnerability and changing proximity to partners were reasons for PrEP discontinuation. Side effects, daily-pill burden and stigma were noted as challenges to PrEP use. Health system barriers to PrEP use included limited PrEP availability, school and work demands, and inconsistent mobile clinic schedules.

Conclusions

Our study reports on the experiences of heterosexual men accessing oral PrEP in real-world settings and contributes to the limited literature among this population. We highlight multiple levels which could be strengthened to improve men's PrEP use, including individual support, education among partners and communities, and addressing health system barriers to access.

导言南非男性面临着巨大的艾滋病毒负担，与女性相比，他们不太可能接受艾滋病毒检测，如果检测结果呈阳性，也不太可能开始接受抗逆转录病毒疗法，而且更有可能死于与艾滋病相关的原因。除了安全套和包皮环切手术外，指南还规定，对于认识到自己的需要并提出申请的男性，可使用每日口服暴露前预防疗法（PrEP）作为预防艾滋病的干预措施。然而，异性恋男性并不是 PrEP 计划的重点，而且自该计划推出以来，有关南非男性使用 PrEP 的文献十分有限。本研究探讨了南非接受初级医疗服务的异性恋男性使用口服 PrEP 的经历、动机和障碍。方法本研究是一项混合方法实施科学研究的一部分，旨在为口服 PrEP 的引入提供证据，自 2018 年起在南非的初级医疗保健诊所开展。有目的地邀请已开始口服 PrEP 并加入父队列研究的年龄≥15 岁的男性参与深度访谈 (IDI)。2020 年 3 月至 2022 年 5 月期间，30 名男性参加了深度访谈，探讨他们使用 PrEP 的动机以及获得医疗服务的经历。对访谈进行了录音、转录和专题分析。结果最终分析包括 28 名异性恋男性（18-56 岁）。启动 PrEP 的动机包括害怕感染 HIV、自我感觉容易感染 HIV 以及对人际关系的不信任；促使使用 PrEP 的医疗系统因素包括医疗服务提供者的影响、教育材料和移动服务。认为对艾滋病毒的易感性降低和与伴侣的亲近程度改变是停止使用 PrEP 的原因。使用 PrEP 所面临的挑战包括副作用、每日服药负担和耻辱感。使用 PrEP 所面临的卫生系统障碍包括 PrEP 供应有限、学校和工作需求以及流动诊所时间安排不一致。结论我们的研究报告了异性恋男性在现实环境中使用口服 PrEP 的经历，为这一人群中有限的文献做出了贡献。我们强调了可以加强的多个层面，以改善男性使用 PrEP 的情况，包括个人支持、伴侣和社区教育，以及解决医疗系统在使用方面的障碍。

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引用次数: 0

Prevalence and incidence of anal high-grade squamous intraepithelial lesions in a cohort of cisgender men and transgender women who have sex with men diagnosed and treated during acute HIV acquisition in Bangkok, Thailand 泰国曼谷同性性行为者和变性女性中肛门高级别鳞状上皮内病变的流行率和发病率，这些人在感染艾滋病毒急性期接受了诊断和治疗

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26242

Supanat Thitipatarakorn, Nipat Teeratakulpisarn, Siriporn Nonenoy, Aphakan Klinsukontakul, Sujittra Suriwong, Jirat Makphol, Piranun Hongchookiat, Thanyapat Chaya-ananchot, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Carlo Sacdalan, Kultida Poltavee, Tippawan Pankam, Stephen J. Kerr, Reshmie Ramautarsing, Donn Colby, Nittaya Phanuphak

Introduction

Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored.

Methods

Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits.

Results

A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03–18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57–29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27–14.14), syphilis infection (aHR 4.67, 95% CI 1.10–19.90) and CD4 count <350 cells/mm³ (aHR 3.09, 95% CI 1.28–7.48).

Conclusions

With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.

导言男男性行为者（MSM），尤其是艾滋病毒感染者，罹患肛门癌的风险增加。在急性艾滋病感染期间开始接受抗逆转录病毒治疗的男男性行为者中，肛门癌的前体--肛门高级别鳞状上皮内病变（HSILs）的患病率和发病率尚有待研究。方法在泰国曼谷的一个急性 HIV 感染队列中，招募了同意参加本研究的参与者。所有参与者均在感染艾滋病病毒的急性期确诊并开始接受抗逆转录病毒治疗。在基线和 6 个月一次的访问中进行了人类乳头瘤病毒 (HPV) 基因分型和高分辨率肛门镜检查，随后根据需要进行了肛门活检。结果共有 89 名男男性行为者和 4 名变性女性被纳入分析。入组年龄中位数为 26 岁。肛门HSIL组织学基线发病率为11.8%。在总共 147.0 人年的随访中，组织学意义上的肛门 HSIL 初次发病率为每 100 人年 19.7 例。与肛门HSIL事件相关的因素有肛门HPV16（调整后危险比[aHR]4.33，95% CI 1.03-18.18）、肛门HPV18/45（aHR 6.82，95% CI 1.57-29.51）、其他肛门高危HPV16（调整后危险比[aHR]4.33，95% CI 1.03-18.18）。51）、其他肛门高危 HPV（aHR 4.23，95% CI 1.27-14.14）、梅毒感染（aHR 4.67，95% CI 1.10-19.90）和 CD4 细胞数<350 cells/mm3 （aHR 3.09，95% CI 1.28-7.48）。结论我们发现，在急性 HIV 感染期间开始抗逆转录病毒治疗后，顺性别男性和变性男男性行为者中肛门 HSIL 的发病率与未感染 HIV 的人群相似。随后的肛门HSIL发病率虽然低于长期感染艾滋病病毒者，但仍高于未感染艾滋病病毒者。肛门HSIL的筛查和管理应成为所有男男性行为者长期艾滋病护理的重要组成部分。

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引用次数: 0

Population impacts of conditional financial incentives and a male-targeted digital decision support application on the HIV treatment cascade in rural KwaZulu Natal: findings from the HITS cluster randomized clinical trial 有条件的经济激励措施和针对男性的数字决策支持应用程序对夸祖鲁-纳塔尔农村地区艾滋病毒治疗级联的人口影响：HITS 群组随机临床试验的结果

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26248

Maxime Inghels, Hae-Young Kim, Thulile Mathenjwa, Maryam Shahmanesh, Janet Seeley, Sally Wyke, Philippa Matthews, Oluwafemi Adeagbo, Dickman Gareta, Nuala McGrath, H. Manisha Yapa, Ann Blandford, Thembelihle Zuma, Adrian Dobra, Till Bärnighausen, Frank Tanser

Introduction

In South Africa, the HIV care cascade remains suboptimal. We investigated the impact of small conditional financial incentives (CFIs) and male-targeted HIV-specific decision-support application (EPIC-HIV) on the HIV care cascade.

Methods

In 2018, in uMkhanyakude district, 45 communities were randomly assigned to one of four arms: (i) CFI for home-based HIV testing and linkage to care within 6 weeks (R50 [US$3] food voucher each); (ii) EPIC-HIV which are based on self-determination theory; (iii) both CFI and EPIC-HIV; and (iv) standard of care. EPIC-HIV consisted of two components: EPIC-HIV 1, provided to men through a tablet before home-based HIV testing, and EPIC-HIV 2, offered 1 month later to men who tested positive but had not yet linked to care. Linking HITS trial data to national antiretroviral treatment (ART) programme data and HIV surveillance programme data, we estimated HIV status awareness after the HITS trial implementation, ART status 3 month after the trial and viral load suppression 1 year later. Analysis included all known individuals living with HIV in the study area including those who did not participated in the HITS trial.

Results

Among the 33,778 residents in the study area, 2763 men and 7266 women were identified as living with HIV by the end of the intervention period and included in the analysis. After the intervention, awareness of HIV-positive status was higher in the CFI arms compared to non-CFI arms (men: 793/908 [87.3%] vs. 1574/1855 [84.9%], RR = 1.03 [95% CI: 0.99−1.07]; women: 2259/2421 [93.3%] vs. 4439/4845 [91.6%], RR = 1.02 [95% CI: 1.00−1.04]). Three months after the intervention, no differences were found for linkage to ART between arms. One year after the intervention, only 1829 viral test results were retrieved. Viral suppression was higher but not significant in the EPIC-HIV intervention arms among men (65/99 [65.7%] vs. 182/308 [59.1%], RR = 1.11 [95% CI: 0.88−1.40]).

Conclusions

Small CFIs can contribute to achieve the first step of the HIV care cascade. However, neither CFIs nor EPIC-HIV was sufficient to increase the number of people on ART. Additional evidence is needed to confirm the impact of EPIC-HIV on viral suppression.

导言：在南非，艾滋病护理流程仍然不够理想。我们调查了小额有条件经济激励（CFIs）和针对男性的 HIV 决策支持应用程序（EPIC-HIV）对 HIV 护理级联的影响。方法 2018 年，在 uMkhanyakude 区，45 个社区被随机分配到四个臂膀中的一个：(i) 基于家庭的 HIV 检测和 6 周内的护理链接的 CFI（每人 50 兰特[3 美元]食品券）；(ii) 基于自我决定理论的 EPIC-HIV；(iii) CFI 和 EPIC-HIV；(iv) 标准护理。EPIC-HIV 包括两个部分：EPIC-HIV 1 在家庭艾滋病毒检测前通过药片提供给男性，EPIC-HIV 2 在 1 个月后提供给检测呈阳性但尚未接受护理的男性。通过将 HITS 试验数据与国家抗逆转录病毒治疗（ART）计划数据和 HIV 监测计划数据联系起来，我们估算了 HITS 试验实施后的 HIV 感染状况知晓率、试验实施 3 个月后的抗逆转录病毒治疗状况以及 1 年后的病毒载量抑制率。分析对象包括研究地区所有已知的 HIV 感染者，包括未参加 HITS 试验的人。结果在研究地区的 33778 名居民中，有 2763 名男性和 7266 名女性在干预期结束时被确认为艾滋病毒感染者并纳入分析。干预结束后，CFI 治疗组与非 CFI 治疗组相比，对 HIV 阳性的认知度更高（男性：793/908 [87.3%] vs. 1574/1855 [84.9%]，RR = 1.03 [95% CI：0.99-1.07]；女性：2259/2421 [93.3%] vs. 4439/4845 [91.6%]，RR = 1.02 [95% CI：1.00-1.04]）。干预三个月后，各干预组在抗逆转录病毒疗法的联系方面没有发现差异。干预一年后，只收回了 1829 份病毒检测结果。EPIC-HIV干预组男性患者的病毒抑制率更高，但并不显著（65/99 [65.7%] vs. 182/308 [59.1%]，RR = 1.11 [95% CI: 0.88-1.40]）。结论小型 CFIs 可以为实现 HIV 护理级联的第一步做出贡献。然而，无论是 CFIs 还是 EPIC-HIV 都不足以增加接受抗逆转录病毒疗法的人数。还需要更多证据来证实 EPIC-HIV 对病毒抑制的影响。

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引用次数: 0

Impact of simplified HCV diagnostic strategies on the HCV epidemic among men who have sex with men in the era of HIV oral pre-exposure prophylaxis in Taiwan: a modelling study 台湾口服艾滋病暴露前预防疗法时代，简化的丙型肝炎病毒诊断策略对男男性行为者中丙型肝炎病毒流行的影响：一项模型研究

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26251

Huei-Jiuan Wu, Sophy TingFang Shih, Tanya L. Applegate, Jisoo A. Kwon, Evan B. Cunningham, Jason Grebely, Richard T. Gray

Introduction

Simplified hepatitis C virus (HCV) diagnostic strategies have the potential to improve HCV diagnoses and treatment. We aimed to investigate the impact of simplified HCV diagnostic strategies on HCV incidence and its effect on HCV diagnosis and treatment among men who have sex with men (MSM) regardless of HIV status and use of HIV pre-exposure prophylaxis (PrEP) in Taiwan.

Methods

A compartmental deterministic model was developed to describe the natural history of HCV disease progression, the HCV care cascade and the HIV status and PrEP using among MSM. The model was calibrated to available data for HCV and HIV epidemiology and population demographics in Taiwan. We simulated the epidemic from 2004 and projected the impact of simplified testing strategies on the HCV epidemic among MSM over 2022–2030.

Results

Under the current testing approach in Taiwan, total HCV incidence would increase to 12.6 per 1000 person-years among MSM by 2030. Single-visit point-of-care RNA testing had the largest impact on reducing the number of new HCV infections over 2022–2030, with a 31.1% reduction (interquartile range: 24.9%−32.8%). By 2030, single-visit point-of-care HCV testing improved HCV diagnosis to 90.9%, HCV treatment to 87.7% and HCV cure to 81.5% among MSM living with HCV. Compared to status quo, prioritized simplified HCV testing for PrEP users and MSM living with diagnosed HIV had considerable impact on the broader HCV epidemic among MSM. A sensitivity analysis suggests that reinfection risk would have a large impact on the effectiveness of each point-of-care testing scenario.

Conclusions

Simplified HCV diagnostic strategies could control the ongoing HCV epidemic and improve HCV testing and treatment among Taiwanese MSM. Single-visit point-of-care RNA testing would result in large reductions in HCV incidence and prevalence among MSM. Efficient risk-reduction strategies will need to be implemented alongside point-of-care testing to achieve HCV elimination among MSM in Taiwan.

导言：简化丙型肝炎病毒（HCV）诊断策略有可能改善 HCV 诊断和治疗。我们旨在调查简化 HCV 诊断策略对台湾男男性行为者（MSM）HCV 发病率的影响及其对 HCV 诊断和治疗的影响，无论其是否感染 HIV 和是否使用 HIV 暴露前预防（PrEP）。方法建立了一个分区确定性模型来描述男男性行为者中 HCV 疾病进展的自然史、HCV 护理级联以及 HIV 感染状况和 PrEP 的使用情况。该模型根据台湾现有的 HCV 和 HIV 流行病学数据以及人口统计数据进行了校准。我们模拟了 2004 年的疫情，并预测了 2022-2030 年期间简化检测策略对 MSM 中 HCV 流行的影响。结果按照台湾目前的检测方法，到 2030 年，男男性行为者中的 HCV 总发病率将增至每千人年 12.6 例。单次就诊护理点 RNA 检测对减少 2022-2030 年间新感染 HCV 的人数影响最大，可减少 31.1%（四分位数间距：24.9%-32.8%）。到 2030 年，在感染 HCV 的 MSM 患者中，单次就诊点 HCV 检测将 HCV 诊断率提高到 90.9%，HCV 治疗率提高到 87.7%，HCV 治愈率提高到 81.5%。与现状相比，对 PrEP 使用者和已确诊感染 HIV 的 MSM 患者优先进行简化 HCV 检测，对 MSM 中更广泛的 HCV 流行产生了相当大的影响。敏感性分析表明，再感染风险对每种护理点检测方案的有效性都有很大影响。结论简化 HCV 诊断策略可控制 HCV 在台湾 MSM 中的持续流行，并改善 HCV 检测和治疗。单次就诊的护理点 RNA 检测将大幅降低 MSM 中的 HCV 发病率和流行率。在实施护理点检测的同时，还需要实施有效的风险降低策略，以消除台湾 MSM 中的 HCV 感染。

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引用次数: 0

Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa 探索少女和年轻妇女的 PrEP 用户概况：对南非开普敦差异化 PrEP 交付平台选择和参与的定性见解

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26254

Elzette Rousseau, Kathleen J. Sikkema, Robin F. Julies, Katelyn Mazer, Gabrielle O'Malley, Renee Heffron, Jennifer F. Morton, Rachel Johnson, Connie Celum, Jared M. Baeten, Linda-Gail Bekker

Introduction

Adolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre-exposure prophylaxis (PrEP). With ongoing PrEP scale-up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms.

Methods

The POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16−25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community-based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light-touch PrEP refill services incorporating rapid HIV self-testing. We conducted in-depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP-use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision-making and habits related to PrEP access to inform market segmentation.

Results

We interviewed 26 AGYW (median age 20) PrEP-users between November 2020 and March 2021. AGYW PrEP-users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The “Social PrEP-user” preferred PrEP delivery in peer spaces, such as youth clubs or adolescent-friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The “Convenient PrEP-user” favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception-PrEP refill visits (mobile and government clinic). The “Independent PrEP-user” preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The “Discreet PrEP-user” highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self-testing had minimal influence on PrEP delivery choice.

Conclusions

Market segmentation of AGYW characterizes different types of PrEP-users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with th

引言青春期少女和年轻女性（AGYW）是非洲艾滋病预防的重点人群，她们对接触前预防疗法（PrEP）表现出浓厚的兴趣，但却难以持续有效地使用这种疗法。目前，PrEP 的推广重点是提高普及率，因此了解是什么因素影响了少女和年轻女性对 PrEP 传播平台的选择就显得尤为重要。方法在开普敦开展的 POWER 实施研究在 2017 年至 2020 年期间，通过四种不同的递送平台（移动诊所、政府机构、快递递送或社区青年俱乐部）为年龄在 16-25 岁的年轻女性提供 PrEP。政府诊所和流动诊所的医疗服务提供者提供的 PrEP（启动和补充）是全面、综合的性健康和生殖健康服务的一部分。快递员和青年俱乐部平台提供的是轻触式 PrEP 补充服务，其中包括快速 HIV 自我检测。我们对使用 PrEP 服务≥3 个月、使用过≥2 个 PrEP 服务平台的 AGYW 进行了深度访谈。专题分析探讨了 AGYW 在获得 PrEP 方面的偏好、决策和习惯，为市场细分提供了信息。结果在 2020 年 11 月至 2021 年 3 月期间，我们采访了 26 名年龄在 20 岁以下的年轻女性（中位数为 20 岁）PrEP 用户。据报告，PrEP 的 AGYW 用户使用了不同的服务，其中 24 人使用流动诊所，17 人使用快递，9 人使用政府卫生机构，6 人在青年俱乐部补充 PrEP。定性研究结果强调了四种潜在的行为特征。社交型 PrEP 用户 "更喜欢在青少年俱乐部或青少年友好型流动诊所等同龄人场所提供 PrEP 服务，以寻求对继续使用 PrEP 的肯定和社会支持。方便的 PrEP 用户 "喜欢在交通便利的地点提供 PrEP 服务，提供快速（快递）或综合避孕药具-PrEP 补充服务（流动诊所和政府诊所）。独立的 PrEP 用户 "更喜欢可以根据自己的日程安排控制送货时间的 PrEP 送货服务，如快递服务。谨慎的 PrEP 用户 "非常重视其使用 PrEP 的隐私（快递服务），并避免选择可能会无意中泄露信息的送药方式（青年俱乐部）。对艾滋病毒自我检测的舒适度对 PrEP 送货选择的影响微乎其微。结论对 AGYW 进行市场细分可确定不同类型的 PrEP 使用者的特征，并有可能加强针对特定人群的有针对性的信息传播和宣传活动，从而提高 PrEP 的持续使用率和艾滋病预防效果。

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引用次数: 0

Urine tenofovir testing for real-time PrEP adherence feedback: a qualitative study involving transgender women in Uganda 尿液替诺福韦检测用于实时反馈 PrEP 的坚持情况：一项涉及乌干达变性妇女的定性研究

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-05-02 DOI: 10.1002/jia2.26255

Andrew Mujugira, Beyonce Karungi, Jackson Mugisha, Agnes Nakyanzi, Olivia Nampewo, Faith Naddunga, Brenda Kamusiime, Rogers Nsubuga, Kikulwe R. Nyanzi, Timothy R. Muwonge, Monique A. Wyatt, Norma C. Ware, Monica Gandhi, Jessica E. Haberer

Introduction

Adherence counselling with point-of-care (POC) drug-level feedback using a novel tenofovir assay may support pre-exposure prophylaxis (PrEP) adherence; however, perceptions of urine testing and its impact on adherence are not well studied. We qualitatively examined how POC tenofovir testing was experienced by transgender women (TGW) in Uganda.

Methods

Within a cluster randomized trial of peer-delivered HIV self-testing, self-sampling for sexually transmitted infections and PrEP among HIV-negative TGW showing overall low PrEP prevention-effective adherence (NCT04328025), we conducted a nested qualitative sub-study of the urine POC assay among a random sample of 30 TGW (August 2021−February 2022). TGW interviews explored: (1) experiences with POC urine tenofovir testing and (2) perceptions of PrEP adherence counselling with drug-level feedback. We used an inductive content analytic approach for analysis.

Results

Median age was 21 years (interquartile range 20–24), and 70% engaged in sex work. Four content categories describe how TGW experienced POC urine tenofovir testing: (1) Urine tenofovir testing was initially met with scepticism: Testing urine to detect PrEP initially induced anxiety, with some perceptions of being intrusive and unwarranted. With counselling, however, participants found POC testing acceptable and beneficial. (2) Alignment of urine test results and adherence behaviours: Drug-level feedback aligned with what TGW knew about their adherence. Concurrence between pill taking and tenofovir detection in urine reinforced confidence in test accuracy. (3) Interpretation of urine tenofovir results: TGW familiar with the interpretation of oral-fluid HIV self-tests knew that two lines on the test device signified positivity (presence of HIV). However, two lines on the urine test strip indicated a positive result for non-adherence (absence of tenofovir), causing confusion. Research nurses explained the difference in test interpretation to participants’ satisfaction. (4) White coat dosing: Some TGW deliberately chose not to attend scheduled clinic appointments to avoid detecting their PrEP non-adherence during urine testing. They restarted PrEP before returning to clinic, a behaviour called “white coat dosing.”

Conclusions

Incorporating POC urine testing into routine PrEP adherence counselling was acceptable and potentially beneficial for TGW but required attention to context. Additional res

导言：通过使用新型替诺福韦检测方法进行护理点（POC）药物水平反馈的依从性咨询可支持暴露前预防疗法（PrEP）的依从性；然而，对尿液检测的看法及其对依从性的影响却没有进行深入研究。我们对乌干达变性女性（TGW）如何体验 POC 替诺福韦检测进行了定性研究。方法在一项由同伴提供 HIV 自我检测、性传播感染自我采样和 PrEP 的群组随机试验（NCT04328025）中，我们对 30 名 TGW 进行了尿液 POC 检测的嵌套定性子研究（2021 年 8 月至 2022 年 2 月）。对 TGW 的访谈探讨了：(1) POC 尿液替诺福韦检测的经验；(2) 对带有药物水平反馈的 PrEP 依从性咨询的看法。我们采用归纳内容分析法进行分析。结果中位年龄为 21 岁（四分位数区间为 20-24 岁），70% 从事性工作。四个内容类别描述了 TGW 如何体验 POC 尿液替诺福韦检测：（1）尿液替诺福韦检测最初受到怀疑：检测尿液以检测 PrEP 最初会引起焦虑，有些人认为这是一种侵扰，而且是不必要的。然而，通过咨询，参与者发现 POC 检测是可以接受和有益的。(2) 尿液检测结果与坚持治疗行为相一致：药物层面的反馈与 TGW 对其坚持服药情况的了解相吻合。服药与尿液中检测到替诺福韦之间的一致性增强了对检测准确性的信心。(3) 对尿液中替诺福韦检测结果的解释：熟悉口服液艾滋病毒自我检测解读的 TGW 知道，检测设备上的两条线表示阳性（存在艾滋病毒）。然而，尿液检测条上的两条线却表示阳性结果，即未坚持治疗（未检出替诺福韦），这引起了混淆。研究护士解释了测试解释的差异，使参与者感到满意。(4) 白大褂配药：一些 TGW 故意不参加预定的门诊预约，以避免在尿检时发现自己未坚持 PrEP。他们在返回诊所前重新开始使用 PrEP，这种行为被称为 "白大褂用药"。结论将 POC 尿液检测纳入常规的 PrEP 依从性咨询是可以接受的，而且可能对 TGW 有利，但需要注意具体情况。需要开展更多的研究来确定有效的策略，以优化对这一人群的依从性监测和咨询。

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引用次数: 0

Injection network drivers of HIV prevention service utilization among people who inject drugs: results of a community-based sociometric network cohort in New Delhi, India 注射毒品者利用艾滋病毒预防服务的注射网络驱动因素：印度新德里社区社会计量网络队列的结果

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-04-17 DOI: 10.1002/jia2.26241

Neia S. Prata Menezes, Shruti H. Mehta, Amy Wesolowski, Steven J. Clipman, Aylur K. Srikrishnan, Muniratnam S. Kumar, Katie J. C. Zook, Gregory M. Lucas, Carl Latkin, Sunil S. Solomon

Introduction

Injection drug networks may influence their network members’ health-seeking behaviours. Using data from a sociometric injecting partner network of people who inject drugs (PWID) in New Delhi, India, we assessed the role of injecting partner (alter) behaviours on individual engagement in HIV prevention services.

Methods

We enumerated injecting partner linkages among 2512 PWID using coupon referrals and biometric data from November 2017 to March 2020. Participants completed interviewer-administered questionnaires and provided information on injection behaviours, injecting partners, HIV/hepatitis C (HCV) testing and service engagement. Multilevel multiple-membership models (MMMM) evaluated individual PWID HIV testing, medication for opioid use disorder (MOUD) and syringe service engagement as a function of alter attributes, accounting for membership across multiple ego-networks. Logistic regression models assessed parallel associations among socially proximal injecting peers, defined as PWID ≤3 path length from ego.

Results

Median age was 26 years; 99% were male. PWID had median 2 injecting partners and 8 socially proximal peers; 14% reported HIV testing, 33% accessed MOUD and 13% used syringe services 6 months prior. In MMMM analyses, PWID with ≥1 versus 0 injecting partners who received HIV testing were significantly more likely to report HIV testing (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.68–3.16), MOUD (aOR: 1.99, 95% CI: 1.60–2.53) and syringe service use (aOR: 1.66, 95% CI: 1.21–2.39). We observed similar findings for individual MOUD and syringe service use. Having ≥1 versus 0 HIV-positive partners was associated with decreased HIV testing and MOUD but increased syringe service use (aOR: 1.54, 95% CI: 1.09–2.17). PWID with ≥1 versus 0 socially proximal peers who used non-sterile injection equipment reported increased HIV testing (aOR: 1.39, 95% CI: 1.01–1.92), MOUD (aOR: 1.40, 95% CI: 1.10–1.77) and syringe service use (aOR: 1.82, 95% CI: 1.23–2.68).

Conclusions

We found differential associative relationships between individual HIV prevention service engagement and the health or risk behaviours of direct and indirect alters. Characterizing network exposure beyond direct injecting partnerships provided important context on possible mechanisms of behavioural influence. Findings could be leveraged to design peer-based interventions that promote network diffusion of heal

导言：注射毒品网络可能会影响其网络成员的健康寻求行为。我们利用印度新德里注射吸毒者（PWID）的社会计量注射伙伴网络数据，评估了注射伙伴（改变）行为对个人参与 HIV 预防服务的作用。方法我们利用 2017 年 11 月至 2020 年 3 月期间的优惠券转介和生物特征数据，对 2512 名注射吸毒者的注射伴侣联系进行了统计。参与者填写了由访谈者主持的问卷，并提供了有关注射行为、注射伴侣、HIV/丙型肝炎（HCV）检测和服务参与的信息。多层次多重成员模型（MMMM）评估了作为改变属性函数的个体注射吸毒者艾滋病毒检测、阿片类药物使用障碍（MOUD）和注射服务参与情况，并考虑了多个自我网络的成员资格。逻辑回归模型评估了社会近距离注射同伴之间的平行关联，社会近距离注射同伴是指与自我的路径长度≤3的PWID。结果中位年龄为 26 岁；99% 为男性。吸毒者中位数为 2 个注射伴侣和 8 个社会近距离同伴；14% 的吸毒者报告接受过 HIV 检测，33% 的吸毒者使用过 MOUD，13% 的吸毒者在 6 个月前使用过注射器服务。在 MMMM 分析中，接受过 HIV 检测的注射伙伴≥1 对 0 的吸毒者更有可能报告 HIV 检测（调整赔率 [aOR]：2.27，95% 置信区间 [CI]：1.68-3.16）、MOUD（aOR：1.99，95% CI：1.60-2.53）和使用注射器服务（aOR：1.66，95% CI：1.21-2.39）。我们在个人 MOUD 和使用注射器服务方面观察到了类似的结果。拥有≥1 对 0 个 HIV 阳性伴侣与 HIV 检测和 MOUD 的减少有关，但与注射器服务使用的增加有关（aOR：1.54，95% CI：1.09-2.17）。与使用非无菌注射设备的 0 个社会亲近同伴相比，≥1 个社会亲近同伴的吸毒者报告的 HIV 检测率（aOR：1.39，95% CI：1.01-1.92）、MOUD（aOR：1.40，95% CI：1.10-1.77）和注射器服务使用率（aOR：1.82，95% CI：1.23-2.68）均有所增加。结论我们发现个人参与 HIV 预防服务与直接和间接改变者的健康或危险行为之间存在不同的关联关系。对直接注射伙伴关系之外的网络接触进行描述，为可能的行为影响机制提供了重要的背景。研究结果可用于设计基于同伴的干预措施，促进寻求健康行为的网络传播。

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引用次数: 0

Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe 津巴布韦女性和非女性变性男男性行为者样本中艾滋病毒易感性的社会和结构驱动因素

IF 6 1区医学 Q1 Medicine

Journal of the International AIDS Society

Pub Date : 2024-04-16 DOI: 10.1002/jia2.26231

Lauren E. Parmley, Sophia S. Miller, Innocent Chingombe, Munyaradzi Mapingure, Owen Mugurungi, John H. Rogers, Godfrey Musuka, Chesterfield Samba, Avi J. Hakim, Tiffany G. Harris

Introduction

We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation.

Methods

A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation.

Results

Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20–26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05).

Conclusions

Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.

导言我们试图描述津巴布韦变性女性（TGW）易感染艾滋病的社会和结构性驱动因素，并探索女性表现形式在易感染性方面的差异。调查对象包括来自津巴布韦两个城市的男男性行为者、变性女性和出生时被指定为男性的性别独特者。调查问卷收集了与社会人口统计学、性行为和药物使用行为以及获得艾滋病服务的社会和结构性障碍相关的信息。二次分析仅限于确认为女性、变性女性或跨性别女性的参与者（236/1538），且未加权。使用描述性统计来计算样本估计值，使用卡方检验和费雪精确检验来评估不同女性易感性的差异。结果在 236 名 TGW 中，近一半（45.3%）在调查前 6 个月内表现为女性，8.5% 曾使用荷尔蒙来确认自己的性别认同。女性同性恋者的年龄中位数为 23 岁（四分位数间距：20-26）。在我们的样本中，表现为女性的 TGW 被逮捕（15.9% 对 3.9%）、被家人/朋友排斥（38.3% 对 14.0%）、被解雇（11.2% 对 3.9%）、被拒绝就业（14.0% 对 3.9%）、被拒绝接受医疗服务（16.8% 对 2.3%）、被殴打、性侵犯或性虐待的发生率较高。3%）、身体、性或语言骚扰或虐待（59.8% vs. 34.1%）、酒精依赖（32.7% vs. 12.4%）、最近与男性或 TGW 伴侣发生性交易（30.8% vs. 13.3%）以及最近使用非注射毒品（38.3% vs. 20.2%）（所有 p 值均为 0.05）。结论研究结果表明，TGW，尤其是表现为女性的 TGW，经历了社会和结构性的不平等，这可能会导致其易感染艾滋病毒。旨在解决不平等问题的干预措施，包括对服务提供者进行变性能力培训，以及为 TGW 提供性别肯定、社会心理和法律支持服务，可能会降低风险。

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