High syphilis incidence among PrEP-adherent men who have sex with men and transgender women in Peru

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-08-27 DOI:10.1002/jia2.70002

Silver K. Vargas, Kelika A. Konda, Ronaldo I. Moreira, Iuri C. Leite, Marcelo Cunha, Brenda Hoagland, Juan V. Guanira, Marcos Benedetti, Cristina Pimenta, Beatriz Grinztejn, Valdiléa G. Veloso, Carlos F. Caceres

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引用次数: 0

Abstract

Introduction

Syphilis remains a public health concern in Peru. Pre-exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi-country PrEP demonstration project; however, this analysis focuses on Peru.

Methods

Between April 2018 and June 2021, 2292 HIV-negative MSM/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged ≥18 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis/symptoms) and/or transactional sex. Quarterly follow-up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive-treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed / #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre-COVID-19 lockdown (up to 16 March 2020) and during COVID-19-lockdown (17 March 2020−June 2021).

Results

We enrolled 2039 cisgender-MSM and 253 TW, with a median follow-up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases/100 person-years (p.y.) (95% CI: 7.9−10.4), 14.7/100 p.y. (95% CI: 10.5−20.1) among TW and 8.3/100 p.y (95% CI: 7.1−10.0) among cisgender-MSM. During the COVID-19 pre-lockdown period, syphilis incidence was 10.0/100 p.y. (95% CI: 8.3−12.1) and 8.1/100 p.y. (95% CI: 6.6−10.0) during-lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP-adherent participants (MPR≥0.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08−1.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11−2.11]) and TW (aIRR: 1.64 [95% CI: 1.08−2.51]). Syphilis incidence pre-lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43−3.86]); during-lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67−4.36]).

Conclusions

Syphilis incidence is high among PrEP-adherent MSM/TW, those reporting receptive-CAS and among TW. Health systems implementing PrEP should strengthen existing STI prevention strategies and incorporate new ones, like Doxy-PEP for PrEP-adherent MSM, TW and individuals engaging in receptive-CAS. MPR may be a tool to identify PrEP users at risk for syphilis.

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秘鲁与男性发生性行为的prep依从男性和变性女性中梅毒发病率高

梅毒仍然是秘鲁的一个公共卫生问题。拉丁美洲暴露前预防（PrEP）实施规划需要评估其对性传播感染的影响及其可行性。我们评估了参加多国PrEP示范项目ImPrEP的男男性行为者（MSM）和变性女性（TW）的PrEP依从性与梅毒发病率之间的关系；然而，本分析的重点是秘鲁。方法在2018年4月至2021年6月期间，在秘鲁STI诊所就诊的2292名hiv阴性MSM/TW入组并进行ImPrEP随访。参与者必须年龄≥18岁，并报告最近的无安全套肛交（CAS）、与感染艾滋病毒的伴侣发生性关系、性传播感染史（诊断/症状）和/或交易性行为。每季度随访包括PrEP分发、行为评估、HIV和梅毒筛查（如果入组时梅毒阴性，则进行梅毒螺旋体试验和快速血浆反应素[RPR]；如果基线时梅毒螺旋体试验阳性，则进行快速血浆反应素[RPR]）。使用药物持有比（MPR：处方药片数/就诊间隔天数）评估PrEP依从性。使用广义估计方程（GEE）泊松回归模型评估与梅毒发病率相关的因素，并评估了两个时期的梅毒发病率：covid -19封锁前（截至2020年3月16日）和covid -19封锁期间（2020年3月17日至2021年6月）。结果纳入2039名男同性恋者和253名男同性恋者，中位随访时间为514天；在185人中发现205例梅毒病例。梅毒总发病率为9.1例/100人年（年）。（95% CI: 7.9 - 10.4），在男同性恋者中为14.7/100 (95% CI: 10.5 - 20.1)，在男同性恋者中为8.3/100 （95% CI: 7.1 - 10.0）。在COVID-19封锁前期间，梅毒发病率为每年10.0/100 (95% CI: 8.3 - 12.1)，封锁期间为每年8.1/100 （95% CI: 6.6 - 10.0）。多因素GEE分析显示，prep患者（MPR≥0.6）（调整后发病率比[aIRR]: 1.46 [95% CI: 1.08 ~ 1.99]）、接受性CAS患者（aIRR: 1.53 [95% CI: 1.11 ~ 2.11]）和TW患者（aIRR: 1.64 [95% CI: 1.08 ~ 2.51]）的梅毒发病率较高。报告接受性CAS的参与者在封锁前的梅毒发病率更高（aIRR: 2.35 [95% CI: 1.43−3.86]）；在封锁期间，在入组时被诊断为梅毒的患者中，梅毒发病率较高（aIRR: 2.70 [95% CI: 1.67−4.36]）。结论prep -依从性MSM/TW人群、接受性cas人群和TW人群中梅毒发病率较高。实施PrEP的卫生系统应加强现有的性传播感染预防战略，并纳入新的战略，如针对遵循PrEP的男男性行为者、同性性行为者和参与接受性cas的个人的Doxy-PEP。MPR可能是确定PrEP使用者有梅毒风险的工具。

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.