Characteristics of individuals who received post-exposure prophylaxis and HIV seroconversion in Malawi: an analysis of national routine HIV testing data

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-06-26 DOI:10.1002/jia2.26473

Hannock Tweya, Tiwonge Chimpandule, William Wu, Leah Goeke, Zhouyun Zheng, Stone Mbiriyawanda, Tobias Masina, Washington Ozitiosauka, Martha Muyaso, Anna Drabko, Dominik Bilicki, Jiehua Chen, Rose Nyirenda, Andreas Jahn

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Abstract

Introduction

In Malawi, where HIV prevalence remains high at 6.7%, post-exposure prophylaxis (PEP) has been implemented as one of the HIV prevention strategies. However, there is limited data on the characteristics of PEP users and HIV seroconversion. Using national routine HIV testing services (HTS) programme data, we described the demographic characteristics and risk of exposure to HIV for HTS clients reporting PEP use and determined HIV seroconversion rates among those with baseline HIV-negative results.

Methods

We conducted a descriptive cross-sectional study of individuals aged 2 years and older accessing HTS who reported PEP use. A subset was included in a retrospective cohort to determine HIV seroconversion rates. The risk of exposure to HIV was classified as high, ongoing, low and not assessed. HTS encounters data were extracted from a national HTS data repository. Some HTS clients had multiple HTS encounters. Descriptive statistics were reported for the study populations and Poisson regression model with an offset was used to estimate HIV seroconversion rates.

Results

Between November 2022 and July 2023, there were 21,298 HTS encounters where PEP use was reported any time prior. Of the 21,298 encounters, 1847 (8.7%) HTS clients with a baseline HIV-negative status were included in the cohort study component. The median follow-up time was 30 days (interquartile range 30–61). Of the 1847 HTS clients, 1055 (57.1%) were males and 928 (50.2%) were aged 20 and 29 years. A total of 329 (17.8%) HTS clients reported a high-risk HIV exposure event in the past 3 months, 581 (31.5%) had an ongoing risk of exposure to HIV, 892 (48.3%) had low risk of exposure to HIV and 45 (2.4%) assessment was not done. Overall, five individuals seroconverted, yielding a seroconversion rate of 2.08 (0.87−4.99) per 100 person-years.

Conclusions

The majority of PEP users were young adults and males. A sizeable proportion had an ongoing risk of exposure to HIV. The HIV seroconversion rate was high. Targeted efforts should focus on promoting condom use, encouraging partner testing and expanding access to PEP for those with ongoing HIV exposure.

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马拉维接受暴露后预防和艾滋病毒血清转化的个体特征：对国家常规艾滋病毒检测数据的分析

在马拉维，艾滋病毒流行率仍然高达6.7%，暴露后预防（PEP）已被作为艾滋病毒预防战略之一实施。然而，关于PEP使用者的特征和HIV血清转化的数据有限。利用国家常规艾滋病毒检测服务（HTS）项目数据，我们描述了报告PEP使用的HTS客户的人口统计学特征和暴露于艾滋病毒的风险，并确定了基线艾滋病毒阴性结果的艾滋病毒血清转化率。方法：我们对2岁及以上使用PEP的HTS患者进行了描述性横断面研究。一个子集被纳入回顾性队列以确定HIV血清转换率。暴露于艾滋病毒的风险被分为高、持续、低和未评估。高温高温天气数据是从国家高温高温天气数据库中提取的。一些HTS客户多次遇到HTS。报告了研究人群的描述性统计数据，并使用带偏移量的泊松回归模型来估计HIV血清转化率。结果在2022年11月至2023年7月期间，有21,298例HTS病例报告此前任何时间使用PEP。在21,298例就诊中，1847例（8.7%）基线hiv阴性的HTS患者被纳入队列研究。中位随访时间为30天（四分位数范围30 - 61）。在1847名HTS患者中，1055名（57.1%）为男性，928名（50.2%）年龄在20至29岁之间。在过去3个月内，共有329名（17.8%）HTS客户报告了高风险HIV暴露事件，581名（31.5%）有持续的HIV暴露风险，892名（48.3%）有低风险暴露，45名（2.4%）未进行评估。总体而言，5人血清转化，血清转化率为2.08(0.87 - 4.99)/ 100人年。结论PEP使用者以青壮年和男性居多。相当大比例的人有持续接触艾滋病毒的风险。HIV血清转换率高。有针对性的努力应侧重于促进避孕套的使用，鼓励伴侣检测，并扩大艾滋病毒感染者获得PEP的机会。

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.