背景:同性恋,双性恋,和其他男男性行为者(MSM)不成比例地受到艾滋病毒的影响。在非洲,MSM在艾滋病毒预防和治疗方面面临结构性障碍,这增加了他们对艾滋病毒感染和传播的脆弱性,并破坏艾滋病毒的反应。在这次系统审查中,我们的目标是探索增加艾滋病毒检测的进展,改善对艾滋病毒治疗级联的参与,非洲男男性行为者的艾滋病毒发病率下降。
方法:我们搜索了Embase,MEDLINE,全球卫生,Scopus,和WebofScience报告艾滋病毒检测的横断面和纵向研究,地位知识,care,抗逆转录病毒疗法(ART)的使用,病毒抑制,1980年1月1日至2023年3月3日发表的非洲MSM中的艾滋病毒发病率。我们使用贝叶斯广义线性混合效应模型汇总调查,使用元回归来评估时间趋势,并比较了MSM与所有男性的HIV发病率估计值。
结果:在确定的9278篇文章中,我们纳入了2005-23年发表的152项独特研究.在2020年,我们估计73%(95%可信区间[CrI]62-87)的MSM曾经检测过HIV。在过去的12个月中,随着时间的推移,中部地区的艾滋病毒检测有所增加,西方,东方,和南部非洲(每年赔率比[ORyear]1·23,95%CrI1·01-1·51,n=46),2020年估计82%(70-91)在过去12个月中进行了测试,但是,只有51%(30-72)的MSM感染艾滋病毒知道他们的艾滋病毒状况。随着时间的推移,中部和西部(ORyear1·41,1·08-1·93,n=9)以及东部和南部非洲(ORyear1·37,1·04-1·84,n=17)的当前ART使用增加。我们估计,2020年,在非洲所有携带艾滋病毒的MSM中有73%(47-88)目前正在接受抗逆转录病毒疗法。然而,我们没有找到强有力的证据表明病毒抑制增加,据估计,在2020年,只有69%(38-89)的MSM携带艾滋病毒的人受到病毒抑制。我们发现,随着时间的推移,HIV发病率下降的证据不足(每年发病率为0·96,95%CrI0·63-1·50,n=39),2020年艾滋病毒发病率仍然很高(每100人年6·9,95%CrI3·1-27·6),并且比所有男性高得多(高27-199倍)。
结论:艾滋病毒发病率仍然很高,随着时间的推移,非洲的MSM可能不会减少,尽管艾滋病毒检测和ART使用有所增加。实现UNAIDS95-95-95诊断目标,治疗,对所有人来说,公平地抑制病毒需要重新关注这一关键人群。迫切需要对男男性行为者采取综合干预措施,以减少艾滋病毒发病率的差异,并解决社会问题。结构,以及使MSM容易感染艾滋病毒的行为因素。
背景:美国国立卫生研究院,英国医学研究委员会,加拿大卫生研究院,和魁北克-圣托基金会。
■有关摘要的法语翻译,请参见补充材料部分。
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment that increase their vulnerability to HIV acquisition and transmission, and undermine the HIV response. In this systematic
review, we aimed to explore progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa.
We searched Embase, MEDLINE, Global Health, Scopus, and Web of Science for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and HIV incidence among MSM in Africa published between Jan 1, 1980, and March 3, 2023. We pooled surveys using Bayesian generalised linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men.
Of 9278 articles identified, we included 152 unique studies published in 2005-23. In 2020, we estimate that 73% (95% credible interval [CrI] 62-87) of MSM had ever tested for HIV. HIV testing in the past 12 months increased over time in central, western, eastern, and southern Africa (odds ratio per year [ORyear] 1·23, 95% CrI 1·01-1·51, n=46) and in 2020 an estimated 82% (70-91) had tested in the past 12 months, but only 51% (30-72) of MSM living with HIV knew their HIV status. Current ART use increased over time in central and western (ORyear 1·41, 1·08-1·93, n=9) and eastern and southern Africa (ORyear 1·37, 1·04-1·84, n=17). We estimated that, in 2020, 73% (47-88) of all MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence to suggest that viral suppression increased, with only 69% (38-89) of MSM living with HIV estimated to be virally suppressed in 2020. We found insufficient evidence of a decrease in HIV incidence over time (incidence ratio per year 0·96, 95% CrI 0·63-1·50, n=39), and HIV incidence remained high in 2020 (6·9 per 100 person-years, 95% CrI 3·1-27·6) and substantially higher (27-199 times higher) than among all men.
HIV incidence remains high, and might not be decreasing among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition.
US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, and Fonds de Recherche du Québec-Santé.
For the French translation of the abstract see Supplementary Materials section.