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Abstract：
BACKGROUND: Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV).
METHODS: A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson\'s χ2 test, Fisher\'s exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05.
RESULTS: Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis.
CONCLUSIONS: We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.
METHODS: A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson\'s χ2 test, Fisher\'s exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05.
RESULTS: Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis.
CONCLUSIONS: We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.
摘要：
背景：在全球范围内，2020年估计有710万新梅毒感染,其中超过30%的新感染报告发生在塞拉利昂等非洲国家.尽管如此,塞拉利昂没有HIV特异性梅毒筛查项目.因此，需要数据来告知公共卫生实践。在这项研究中,我们旨在确定HIV感染者(PLHIV)中梅毒血清阳性的患病率和与梅毒血清阳性相关的因素.
方法：在塞拉利昂的10个医疗机构进行了一项横断面研究，在感染艾滋病毒的成年人中，18岁或以上，从2022年9月到2023年1月。收集了感兴趣的参数，包括年龄，性别,婚姻,抗逆转录病毒治疗（ART）方案，HIV病毒载量,ART治疗的持续时间，和医院水平的护理。梅毒抗体是通过基于免疫色谱法的快速测试来检测的。使用R软件版本4.2.3(R核心团队，维也纳,奥地利)。皮尔森χ2检验，Fisher精确检验和Kruskal-WallisH检验用于评估各组间梅毒血清阳性的差异。单因素logistic回归和多因素logistic回归分析用于评估梅毒血清阳性相关因素。具有统计学意义的水平设为P<0.05。
结果：在我们研究的3082例HIV感染者中，2294名（74.4%）女性和2867名（93.0%）接受ART。平均年龄为36岁，211（6.8%，95%CI6.0-7.7)梅毒阳性。60岁及以上人群梅毒患病率最高(21.1%,95CI14.7-29.2），其次是50-60岁的人(15.5%，95CI11.9-19.9）和丧偶人口（11.9％，95CI8.9-15.8）。梅毒血清阳性在性别之间没有差异，ART状态,ART方案，艺术的持续时间，艾滋病毒病毒载量和医院护理水平。年龄（50-60岁：校正OR3.49，95CI2.09-5.85P<0.001；60-100岁：校正OR4.28，95CI2.21-8.17，P<0.001）是梅毒血清阳性的独立预测因子。
结论：我们观察到梅毒在PLHIV中的患病率很高。老年人和丧偶人群的梅毒血清阳性率较高。年龄是梅毒阳性的独立预测因素。因此,我们呼吁梅毒筛查的整合，艾滋病毒服务中的治疗和预防。
方法：在塞拉利昂的10个医疗机构进行了一项横断面研究，在感染艾滋病毒的成年人中，18岁或以上，从2022年9月到2023年1月。收集了感兴趣的参数，包括年龄，性别,婚姻,抗逆转录病毒治疗（ART）方案，HIV病毒载量,ART治疗的持续时间，和医院水平的护理。梅毒抗体是通过基于免疫色谱法的快速测试来检测的。使用R软件版本4.2.3(R核心团队，维也纳,奥地利)。皮尔森χ2检验，Fisher精确检验和Kruskal-WallisH检验用于评估各组间梅毒血清阳性的差异。单因素logistic回归和多因素logistic回归分析用于评估梅毒血清阳性相关因素。具有统计学意义的水平设为P<0.05。
结果：在我们研究的3082例HIV感染者中，2294名（74.4%）女性和2867名（93.0%）接受ART。平均年龄为36岁，211（6.8%，95%CI6.0-7.7)梅毒阳性。60岁及以上人群梅毒患病率最高(21.1%,95CI14.7-29.2），其次是50-60岁的人(15.5%，95CI11.9-19.9）和丧偶人口（11.9％，95CI8.9-15.8）。梅毒血清阳性在性别之间没有差异，ART状态,ART方案，艺术的持续时间，艾滋病毒病毒载量和医院护理水平。年龄（50-60岁：校正OR3.49，95CI2.09-5.85P<0.001；60-100岁：校正OR4.28，95CI2.21-8.17，P<0.001）是梅毒血清阳性的独立预测因子。
结论：我们观察到梅毒在PLHIV中的患病率很高。老年人和丧偶人群的梅毒血清阳性率较高。年龄是梅毒阳性的独立预测因素。因此,我们呼吁梅毒筛查的整合，艾滋病毒服务中的治疗和预防。
