Baseline variables associated with subsequent HIV seroconversion among gay, bisexual and other men who have sex with men and transgender women: a prospective, multicenter PrEP demonstration study (ImPrEP)

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-04-25 DOI:10.1016/j.lana.2025.101098

Carlos F. Caceres , Heather Pines , Kelika A. Konda , Annick Borquez , Ronaldo Moreira , Iuri Leite , Pedro Amparo , Marcelo Cunha , Thiago S. Torres , Juan V. Guanira , Jean-Pierre Jirón , Brenda Hoagland , Heleen Vermandere , Marcos Benedetti , Hamid Vega , Carlos M. Benites , Cristina Pimenta , Beatriz Grinztejn , Valdiléa Veloso , Karen Campos

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引用次数: 0

Abstract

Background

Ongoing implementation of HIV pre-exposure prophylaxis (PrEP) in Latin America should consider lessons learned from implementation projects such as ImPrEP (Brazil/Mexico/Peru, 2018–2021). In this analysis we assessed the effect of variables ascertained in early appointments on HIV seroconversion among ImPrEP participants.

Methods

ImPrEP enrolled HIV-negative men who have sex with men and transgender women (MSM/TGW) aged 18+ years reporting recent condomless anal sex, anal sex with HIV-positive partners, transactional sex, or sexually transmitted infections (STI). Participants received a 30-day PrEP supply; at the 30-day visit and quarterly thereafter they completed behavioural assessments, underwent HIV testing, and received 3-month PrEP supplies if HIV-negative. PrEP adherence was measured using the medication possession ratio (MPR) at the 30-day visit. We used Cox's proportional hazards regression to examine the effect of our sociodemographic, behavioural, STI, and early PrEP care engagement variables of interest on time to HIV seroconversion.

Findings

Compared to participants in Brazil, the hazard ratio for HIV seroconversion was higher among those in Peru (HR = 7.91, 95% CI: 4.74–13.20). Compared to participants aged ≥35 years, the HR for HIV seroconversion was higher for those aged 18–24 (aHR = 4.84, 95% CI: 2.55–9.17 and 25–34 (aHR = 2.43, 95% CI: 1.21–4.91). HIV seroconversion was also associated with transgender identity (aHR = 2.28, 95% CI: 1.12–4.66), transactional sex (aHR = 1.88, 95% CI: 1.18–2.99), receptive condomless anal sex (aHR = 2.42, 95% CI: 1.42–4.12), STI diagnosis (aHR = 1.93, 95% CI: 1.25–2.99), and a MPR < 0.6 (aHR = 2.64, 95% CI: 1.52–4.60).

Interpretation

While moderate-high, HIV incidence among ImPrEP participants represented a considerable reduction from figures observed among MSM/TGW not using PrEP/PEP. Interventions to improve PrEP adherence are needed among new Latin American PrEP users, especially if baseline factors associated with seroconversion are present. Long-acting injectable PrEP can also become useful for this population.

Funding

This study was funded by UNITAID.

查看原文本刊更多论文

与男同性恋者、双性恋者和其他男男性行为者以及跨性别女性随后的HIV血清转化相关的基线变量：一项前瞻性、多中心PrEP示范研究（ImPrEP）

背景：在拉丁美洲实施艾滋病毒暴露前预防（PrEP）应考虑从ImPrEP（巴西/墨西哥/秘鲁，2018-2021）等实施项目中吸取的经验教训。在本分析中，我们评估了早期预约中确定的变量对ImPrEP参与者中HIV血清转化的影响。方法simprep招募了18岁以上报告近期无安全套肛交、与hiv阳性伴侣肛交、交易性行为或性传播感染（STI）的hiv阴性男男性行为者和变性女性（MSM/TGW）。参与者获得了30天的PrEP供应；在30天的访问期间和此后每季度，他们完成行为评估，接受艾滋病毒检测，如果艾滋病毒呈阴性，则接受3个月的PrEP供应。在30天的访问中，使用药物占有比（MPR）测量PrEP依从性。我们使用Cox比例风险回归来检验我们感兴趣的社会人口学、行为、性传播感染和早期PrEP护理参与变量对HIV血清转化时间的影响。与巴西的参与者相比，秘鲁的HIV血清转化风险比更高（HR = 7.91, 95% CI: 4.74-13.20）。与年龄≥35岁的参与者相比，18-24岁人群HIV血清转化的HR更高（aHR = 4.84, 95% CI: 2.55-9.17）， 25-34岁人群（aHR = 2.43, 95% CI: 1.21-4.91）。HIV血清转化还与变性身份（aHR = 2.28, 95% CI: 1.12-4.66）、交易性行为（aHR = 1.88, 95% CI: 1.18-2.99）、接受性无套肛交（aHR = 2.42, 95% CI: 1.42-4.12）、性传播感染诊断（aHR = 1.93, 95% CI: 1.25-2.99）和MPR <相关；0.6 （aHR = 2.64, 95% CI: 1.52-4.60）。与未使用PrEP/PEP的MSM/TGW相比，ImPrEP参与者的艾滋病毒感染率虽然中等，但却有相当大的降低。拉丁美洲PrEP新使用者需要采取干预措施来改善PrEP依从性，特别是在存在与血清转化相关的基线因素的情况下。长效注射PrEP也可能对这一人群有用。这项研究由国际药品采购机制资助。

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

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.