High HIV incidence indicates need for increased interventions for MSM and TGW

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Researchers from the HIV Prevention Trials Network (HPTN) have presented results from the HPTN 075 Study at the HIV Research for Prevention (HIVR4P) conference in Madrid, Spain. The study evaluated the feasibility of HIV prevention research among men who have sex with men (MSM) and transgender women (TGW) in three countries in sub-Saharan Africa.

Findings from the study showed participants were at an alarming risk for getting HIV. The incidence among study participants was substantially higher than the estimated incidence among heterosexual men and women in the general population in the same countries.

“Several studies have shown the burden of HIV is quite high among MSM and TGW, but little is known about the rate of new infections, or HIV incidence, among these groups in sub-Saharan Africa,” said Dr Theo Sandfort HPTN 075 protocol chair and research scientist, HIV Centre for Clinical and Behavioural Studies at the New York State Psychiatric Institute and Columbia University in New York. “The exceptionally high HIV incidence we found indicates an urgent need for increased access to HIV prevention approaches that consider all the factors that put this vulnerable population at such high risk.”

A total of 401 MSM and TGW, regardless of HIV infection status, were enrolled at four sites in Kenya, Malawi and South Africa. Each participant was followed for 12 months, during which five study visits were conducted. These visits included interviewing participants about behaviours that may put them at risk for HIV infection, medical examinations and collection of blood samples. Of the 401 enrolled, 329 were HIV-negative at the time of enrolment. By the end of the study, 21 of them had become infected with HIV. This translates to an overall incidence rate of 6.96 per 100 person-years. Incidence rates differed substantially by study site: Malawi: 1.3; Kenya: 3.75; Soweto, South Africa: 8.97; and Cape Town, South Africa: 14.44.

“HPTN 075 provides compelling findings that indicate an urgent need for further HIV prevention studies for men who have sex with men and transgender women in sub-Saharan Africa,” said Dr Wafaa El-Sadr, HPTN co-principal investigator and professor of epidemiology and medicine at Columbia University in New York. “These studies must examine the realities in which these groups exist and develop integrated intervention strategies that are effective and feasible.”

“MSM and TGW in sub-Saharan Africa face distinct structural barriers to accessing HIV prevention and treatment,” said Dr Myron Cohen, HPTN co-principal investigator and director of the University of North Carolina at Chapel Hill Institute for Global Health and Infectious Diseases in Chapel Hill, NC. “The HPTN is poised to tackle these barriers as we prioritise this population in our prevention agenda.”

Background: Sub-Saharan African men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV infection. Several studies have shown an elevated HIV prevalence in these groups, but little is known about HIV incidence in this population. We assessed HIV incidence over 12-months in a prospective cohort of MSM and TGW in sub-Saharan Africa.
Methods: Participants enrolled at four sites in Kenya, Malawi, and South Africa were followed for one year with five-study visits. All were assigned male sex at birth. Demographic, psychosocial and behavioral data were collected using a structured questionnaire. HIV testing was conducted every 3 months. Correlates of seroconversion were examined using univariate and multivariate Cox Proportional Hazard models with 95% confidence intervals (Cl).
Results: Of 400 participants, 329 were HIV-uninfected at enrollment. Mean age was 23.8 years (standard deviation: 5.17) and educational level varied (34.9% low, 42.6% middle, 22.5% high). Overall, 17.6% identified as female or transgender; sexually, 60.2% identified as gay, and the rest as bisexual/other. Participant retention was 93% at 12 months. Over 301.8 person years (PY), 21 participants seroconverted [incidence rate: 6.96 per 100-PY (95% Cl: 4.31,10.64)]. Incidence rates differed substantially by site: Malawi: 1.34 (95% Cl: 0.03, 7.49); Kenya: 3.75 (95% Cl: 0.77,10.95); Soweto: 8.97 (95% Cl: 3.61,18.48); Cape Town: 14.44 (95% Cl: 6.92, 26.55). Seroconversion was independently associated with testing positive for a rectal STI at enrollment (hazard ratio: 2.68, 95% Cl: 1.06, 6.80, p=.038).
Conclusions: MSM and TGW in sub-Saharan Africa are at alarming risk for HIV acquisition, substantially higher than the risk among other groups in the region, such as young women. The exceptionally high HIV incidence indicates an urgent need for increased access to HIV prevention interventions that take into account individual, social, and structural factors affecting sexual health in this vulnerable population.

Theo GM Sandfort, Xu Guo, Erica L Hamilton, Ying Q Chen, Vanessa Cummings, Charlotte Gaydos, Wairimu Chege, Michael Stirratt, Blessings Madiwati, Arthur Ogendo, Ravindre Panchia, DoerieyahReynolds, Susan H Eshleman

HIVR4P Conference material
HIVR4P conference abstract

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