Why we need pre-exposure prophylaxis: incident HIV and syphilis among men, and transgender women, who have sex with men, Bangkok, Thailand, 2005–2015

Abstract

We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer ≥1:8) and confirmatory anti-Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the serocon-version interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4–5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 (p < 0.01) (Poisson with RCS function, p = 0.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9–4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok.

HIV prevalence and incidence in a cohort of South African men and transgender women who have sex with men: the Sibanye Methods for Prevention Packages Programme (MP3) project

“…Consistent with the interpretation of age‐specific HIV prevalence data, the HIV incidence among MSM and TGW aged 18 to 19 was over 21% per year – a staggering statistic, but one that is consistent with other data from across sub‐Saharan Africa and beyond that show much higher incidence among younger than in older MSM [4,6‐8]. The concentration of HIV risk among young MSM identified in South Africa is part of a larger global vulnerability of young MSM [10,25‐27]. There are unique challenges to providing HIV prevention services to MSM and TGW.…”

“…Outside sub‐Saharan Africa, data have consistently demonstrated higher HIV incidence among younger MSM [10]. To date, there are limited studies describing younger MSM given the complex ethical and legal barriers across sub‐Saharan Africa.…”

HIV incidence among men who have sex with men and transgender women in four provinces in Thailand

“…11 , 12 Results are consistent with incidence rates seen in recent studies using repeated HIV testing at mobile and VCT clinics and contributes to evidence to suggest a decline in HIV incidence in the highest risk population in Thailand. 12 , 20 However, there is still substantial room to improve the clinical cascade for MSM and TG in Thailand. In Bangkok, an estimated 26% of MSM living with HIV know their status, 54% are on treatment, and 65% are virally suppressed, but the estimates vary across the country.…”

Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand

“…Despite successes in human immunodeficiency virus (HIV) prevention in Thailand, including the elimination of mother-to-child HIV transmission in 2016, 1 high rates of HIV transmission continue to occur among men who have sex with men (MSM) and transgender women (TGW). 2 During 2011-2014, HIV prevalence among MSM in Bangkok, Thailand, was about 30%, 3 and HIV incidence was 4.8 per 100 personyears. 2 Daily oral pre-exposure prophylaxis (PrEP) has high efficacy to prevent HIV among MSM.…”

“…2 During 2011-2014, HIV prevalence among MSM in Bangkok, Thailand, was about 30%, 3 and HIV incidence was 4.8 per 100 personyears. 2 Daily oral pre-exposure prophylaxis (PrEP) has high efficacy to prevent HIV among MSM. 4 The Pre-exposure Prophylaxis Initiative (iPrEX) trial, which included a site in Thailand, found a 44% reduction in new HIV infections among MSM and TGW randomized to PrEP compared to those randomized to placebo.…”