HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study
Introduction Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to ch...
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creator | Twahirwa Rwema, Jean Olivier Lyons, Carrie E Herbst, Sara Liestman, Benjamin Nyombayire, Julien Ketende, Sosthenes Mazzei, Amelia Olawore, Oluwasolape Nsanzimana, Sabin Mugwaneza, Placidie Kagaba, Aflodis Sullivan, Patrick S Allen, Susan Karita, Etienne Baral, Stefan D |
description | Introduction
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.
Methods
MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.
Results
A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p |
doi_str_mv | 10.1002/jia2.25604 |
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fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7527755</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A641376767</galeid><sourcerecordid>A641376767</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</originalsourceid><addsrcrecordid>eNp9kt2K1DAUx4so7ofe-AASEGQRZ2zSj7ReCMOi7uiCIOptOE1O2wxtsjbtjnPnIwi-oU9iOl3XGRkk0JRzfvnn5H9OEDyi4ZyGIXux0sDmLEnD-E5wTHmSzViasLs7_0fBiXOrMExZFuf3g6MoCsMwp-w4-Hmx_EK0KVH22hoCRhE0FVTYoul9gox5CR36j5OgkEBrTUV8mqxrS2q4RuLwG1nrvt5GR4m-A-MqNAo7srZj1Cu91xU0-jn5uPYIvCRAZGed-_X9h5tuh4a4flCbB8G9EhqHD2_20-Dzm9efzi9mlx_eLs8XlzOZZHE8y2KloCxizEuusCiZSgsVpcCiXFHFIUsURyppiYVMWR4lWKYxzQAjb0mBGJ0Grybdq6FoUUn_4g4acdXpFrqNsKDFfsboWlT2WvCEcZ4kXuDsRqCzXwd0vWi1k9g0YNAOTrA45lmU5pR79Mk_6MoOnX_yRMVpmnP6l_JOofBtsf5eOYqKha894qlfnpodoLzd6Iu0Bkvtw3v8_AAPYzdbLQ8eeLpzoEZo-trZZhib5PbBZxO47WSH5a15NBTjbIpxNsV2Nj38eNfuW_TPMHqATsDa17P5j5R4t1ywSfQ37v7u5g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2447466971</pqid></control><display><type>article</type><title>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Wiley-Blackwell Open Access Titles</source><source>Wiley Online Library All Journals</source><source>PubMed Central</source><creator>Twahirwa Rwema, Jean Olivier ; Lyons, Carrie E ; Herbst, Sara ; Liestman, Benjamin ; Nyombayire, Julien ; Ketende, Sosthenes ; Mazzei, Amelia ; Olawore, Oluwasolape ; Nsanzimana, Sabin ; Mugwaneza, Placidie ; Kagaba, Aflodis ; Sullivan, Patrick S ; Allen, Susan ; Karita, Etienne ; Baral, Stefan D</creator><creatorcontrib>Twahirwa Rwema, Jean Olivier ; Lyons, Carrie E ; Herbst, Sara ; Liestman, Benjamin ; Nyombayire, Julien ; Ketende, Sosthenes ; Mazzei, Amelia ; Olawore, Oluwasolape ; Nsanzimana, Sabin ; Mugwaneza, Placidie ; Kagaba, Aflodis ; Sullivan, Patrick S ; Allen, Susan ; Karita, Etienne ; Baral, Stefan D</creatorcontrib><description>Introduction
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.
Methods
MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.
Results
A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.
Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.
Conclusions
These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</description><identifier>ISSN: 1758-2652</identifier><identifier>EISSN: 1758-2652</identifier><identifier>DOI: 10.1002/jia2.25604</identifier><identifier>PMID: 33000912</identifier><language>eng</language><publisher>Switzerland: International AIDS Society</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Aged ; AIDS ; Care and treatment ; Chlamydia trachomatis ; Community ; Continuity of Patient Care ; Cross-Sectional Studies ; Diagnosis ; Disease prevention ; Evaluation ; Female ; Gender identity ; Gonorrhea - epidemiology ; Health aspects ; HIV ; HIV care continuum ; HIV infections ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; HIV Infections - therapy ; Homosexuality, Male ; Human immunodeficiency virus ; Humans ; Infections ; Kigali ; Laboratories ; Male ; Mass Screening ; Medical care quality ; men who have sex with men ; Middle Aged ; MSM (Men who have sex with men) ; Neisseria gonorrhoeae ; Prevalence ; Questionnaires ; Rwanda ; Rwanda - epidemiology ; Sexual and Gender Minorities ; Sexual Behavior ; Sexually Transmitted Diseases - epidemiology ; Sexually Transmitted Diseases - therapy ; structural determinants ; Supplement ; Supplement: s ; Syphilis - epidemiology ; Transgender people ; Transgender Persons ; Viral Load ; Women ; Young Adult</subject><ispartof>Journal of the International AIDS Society, 2020-10, Vol.23 (S6), p.e25604-n/a</ispartof><rights>2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.</rights><rights>COPYRIGHT 2020 International AIDS Society</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</citedby><cites>FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</cites><orcidid>0000-0001-8127-0704 ; 0000-0002-7954-1736 ; 0000-0002-8954-6426 ; 0000-0002-7728-0587 ; 0000-0002-5482-2419</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527755/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527755/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,1416,11561,27923,27924,45573,45574,46051,46475,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33000912$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Twahirwa Rwema, Jean Olivier</creatorcontrib><creatorcontrib>Lyons, Carrie E</creatorcontrib><creatorcontrib>Herbst, Sara</creatorcontrib><creatorcontrib>Liestman, Benjamin</creatorcontrib><creatorcontrib>Nyombayire, Julien</creatorcontrib><creatorcontrib>Ketende, Sosthenes</creatorcontrib><creatorcontrib>Mazzei, Amelia</creatorcontrib><creatorcontrib>Olawore, Oluwasolape</creatorcontrib><creatorcontrib>Nsanzimana, Sabin</creatorcontrib><creatorcontrib>Mugwaneza, Placidie</creatorcontrib><creatorcontrib>Kagaba, Aflodis</creatorcontrib><creatorcontrib>Sullivan, Patrick S</creatorcontrib><creatorcontrib>Allen, Susan</creatorcontrib><creatorcontrib>Karita, Etienne</creatorcontrib><creatorcontrib>Baral, Stefan D</creatorcontrib><title>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</title><title>Journal of the International AIDS Society</title><addtitle>J Int AIDS Soc</addtitle><description>Introduction
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.
Methods
MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.
Results
A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.
Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.
Conclusions
These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS</subject><subject>Care and treatment</subject><subject>Chlamydia trachomatis</subject><subject>Community</subject><subject>Continuity of Patient Care</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis</subject><subject>Disease prevention</subject><subject>Evaluation</subject><subject>Female</subject><subject>Gender identity</subject><subject>Gonorrhea - epidemiology</subject><subject>Health aspects</subject><subject>HIV</subject><subject>HIV care continuum</subject><subject>HIV infections</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - therapy</subject><subject>Homosexuality, Male</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Kigali</subject><subject>Laboratories</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical care quality</subject><subject>men who have sex with men</subject><subject>Middle Aged</subject><subject>MSM (Men who have sex with men)</subject><subject>Neisseria gonorrhoeae</subject><subject>Prevalence</subject><subject>Questionnaires</subject><subject>Rwanda</subject><subject>Rwanda - epidemiology</subject><subject>Sexual and Gender Minorities</subject><subject>Sexual Behavior</subject><subject>Sexually Transmitted Diseases - epidemiology</subject><subject>Sexually Transmitted Diseases - therapy</subject><subject>structural determinants</subject><subject>Supplement</subject><subject>Supplement: s</subject><subject>Syphilis - epidemiology</subject><subject>Transgender people</subject><subject>Transgender Persons</subject><subject>Viral Load</subject><subject>Women</subject><subject>Young Adult</subject><issn>1758-2652</issn><issn>1758-2652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kt2K1DAUx4so7ofe-AASEGQRZ2zSj7ReCMOi7uiCIOptOE1O2wxtsjbtjnPnIwi-oU9iOl3XGRkk0JRzfvnn5H9OEDyi4ZyGIXux0sDmLEnD-E5wTHmSzViasLs7_0fBiXOrMExZFuf3g6MoCsMwp-w4-Hmx_EK0KVH22hoCRhE0FVTYoul9gox5CR36j5OgkEBrTUV8mqxrS2q4RuLwG1nrvt5GR4m-A-MqNAo7srZj1Cu91xU0-jn5uPYIvCRAZGed-_X9h5tuh4a4flCbB8G9EhqHD2_20-Dzm9efzi9mlx_eLs8XlzOZZHE8y2KloCxizEuusCiZSgsVpcCiXFHFIUsURyppiYVMWR4lWKYxzQAjb0mBGJ0Grybdq6FoUUn_4g4acdXpFrqNsKDFfsboWlT2WvCEcZ4kXuDsRqCzXwd0vWi1k9g0YNAOTrA45lmU5pR79Mk_6MoOnX_yRMVpmnP6l_JOofBtsf5eOYqKha894qlfnpodoLzd6Iu0Bkvtw3v8_AAPYzdbLQ8eeLpzoEZo-trZZhib5PbBZxO47WSH5a15NBTjbIpxNsV2Nj38eNfuW_TPMHqATsDa17P5j5R4t1ywSfQ37v7u5g</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Twahirwa Rwema, Jean Olivier</creator><creator>Lyons, Carrie E</creator><creator>Herbst, Sara</creator><creator>Liestman, Benjamin</creator><creator>Nyombayire, Julien</creator><creator>Ketende, Sosthenes</creator><creator>Mazzei, Amelia</creator><creator>Olawore, Oluwasolape</creator><creator>Nsanzimana, Sabin</creator><creator>Mugwaneza, Placidie</creator><creator>Kagaba, Aflodis</creator><creator>Sullivan, Patrick S</creator><creator>Allen, Susan</creator><creator>Karita, Etienne</creator><creator>Baral, Stefan D</creator><general>International AIDS Society</general><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8127-0704</orcidid><orcidid>https://orcid.org/0000-0002-7954-1736</orcidid><orcidid>https://orcid.org/0000-0002-8954-6426</orcidid><orcidid>https://orcid.org/0000-0002-7728-0587</orcidid><orcidid>https://orcid.org/0000-0002-5482-2419</orcidid></search><sort><creationdate>202010</creationdate><title>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</title><author>Twahirwa Rwema, Jean Olivier ; Lyons, Carrie E ; Herbst, Sara ; Liestman, Benjamin ; Nyombayire, Julien ; Ketende, Sosthenes ; Mazzei, Amelia ; Olawore, Oluwasolape ; Nsanzimana, Sabin ; Mugwaneza, Placidie ; Kagaba, Aflodis ; Sullivan, Patrick S ; Allen, Susan ; Karita, Etienne ; Baral, Stefan D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS</topic><topic>Care and treatment</topic><topic>Chlamydia trachomatis</topic><topic>Community</topic><topic>Continuity of Patient Care</topic><topic>Cross-Sectional Studies</topic><topic>Diagnosis</topic><topic>Disease prevention</topic><topic>Evaluation</topic><topic>Female</topic><topic>Gender identity</topic><topic>Gonorrhea - epidemiology</topic><topic>Health aspects</topic><topic>HIV</topic><topic>HIV care continuum</topic><topic>HIV infections</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Infections - therapy</topic><topic>Homosexuality, Male</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infections</topic><topic>Kigali</topic><topic>Laboratories</topic><topic>Male</topic><topic>Mass Screening</topic><topic>Medical care quality</topic><topic>men who have sex with men</topic><topic>Middle Aged</topic><topic>MSM (Men who have sex with men)</topic><topic>Neisseria gonorrhoeae</topic><topic>Prevalence</topic><topic>Questionnaires</topic><topic>Rwanda</topic><topic>Rwanda - epidemiology</topic><topic>Sexual and Gender Minorities</topic><topic>Sexual Behavior</topic><topic>Sexually Transmitted Diseases - epidemiology</topic><topic>Sexually Transmitted Diseases - therapy</topic><topic>structural determinants</topic><topic>Supplement</topic><topic>Supplement: s</topic><topic>Syphilis - epidemiology</topic><topic>Transgender people</topic><topic>Transgender Persons</topic><topic>Viral Load</topic><topic>Women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Twahirwa Rwema, Jean Olivier</creatorcontrib><creatorcontrib>Lyons, Carrie E</creatorcontrib><creatorcontrib>Herbst, Sara</creatorcontrib><creatorcontrib>Liestman, Benjamin</creatorcontrib><creatorcontrib>Nyombayire, Julien</creatorcontrib><creatorcontrib>Ketende, Sosthenes</creatorcontrib><creatorcontrib>Mazzei, Amelia</creatorcontrib><creatorcontrib>Olawore, Oluwasolape</creatorcontrib><creatorcontrib>Nsanzimana, Sabin</creatorcontrib><creatorcontrib>Mugwaneza, Placidie</creatorcontrib><creatorcontrib>Kagaba, Aflodis</creatorcontrib><creatorcontrib>Sullivan, Patrick S</creatorcontrib><creatorcontrib>Allen, Susan</creatorcontrib><creatorcontrib>Karita, Etienne</creatorcontrib><creatorcontrib>Baral, Stefan D</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the International AIDS Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Twahirwa Rwema, Jean Olivier</au><au>Lyons, Carrie E</au><au>Herbst, Sara</au><au>Liestman, Benjamin</au><au>Nyombayire, Julien</au><au>Ketende, Sosthenes</au><au>Mazzei, Amelia</au><au>Olawore, Oluwasolape</au><au>Nsanzimana, Sabin</au><au>Mugwaneza, Placidie</au><au>Kagaba, Aflodis</au><au>Sullivan, Patrick S</au><au>Allen, Susan</au><au>Karita, Etienne</au><au>Baral, Stefan D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</atitle><jtitle>Journal of the International AIDS Society</jtitle><addtitle>J Int AIDS Soc</addtitle><date>2020-10</date><risdate>2020</risdate><volume>23</volume><issue>S6</issue><spage>e25604</spage><epage>n/a</epage><pages>e25604-n/a</pages><issn>1758-2652</issn><eissn>1758-2652</eissn><abstract>Introduction
Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.
Methods
MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.
Results
A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.
Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.
Conclusions
These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</abstract><cop>Switzerland</cop><pub>International AIDS Society</pub><pmid>33000912</pmid><doi>10.1002/jia2.25604</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8127-0704</orcidid><orcidid>https://orcid.org/0000-0002-7954-1736</orcidid><orcidid>https://orcid.org/0000-0002-8954-6426</orcidid><orcidid>https://orcid.org/0000-0002-7728-0587</orcidid><orcidid>https://orcid.org/0000-0002-5482-2419</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1758-2652 |
ispartof | Journal of the International AIDS Society, 2020-10, Vol.23 (S6), p.e25604-n/a |
issn | 1758-2652 1758-2652 |
language | eng |
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subjects | Acquired immune deficiency syndrome Adolescent Adult Aged AIDS Care and treatment Chlamydia trachomatis Community Continuity of Patient Care Cross-Sectional Studies Diagnosis Disease prevention Evaluation Female Gender identity Gonorrhea - epidemiology Health aspects HIV HIV care continuum HIV infections HIV Infections - epidemiology HIV Infections - prevention & control HIV Infections - therapy Homosexuality, Male Human immunodeficiency virus Humans Infections Kigali Laboratories Male Mass Screening Medical care quality men who have sex with men Middle Aged MSM (Men who have sex with men) Neisseria gonorrhoeae Prevalence Questionnaires Rwanda Rwanda - epidemiology Sexual and Gender Minorities Sexual Behavior Sexually Transmitted Diseases - epidemiology Sexually Transmitted Diseases - therapy structural determinants Supplement Supplement: s Syphilis - epidemiology Transgender people Transgender Persons Viral Load Women Young Adult |
title | HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-11T11%3A42%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=HIV%20infection%20and%20engagement%20in%20HIV%20care%20cascade%20among%20men%20who%20have%20sex%20with%20men%20and%20transgender%20women%20in%20Kigali,%20Rwanda:%20a%20cross%E2%80%90sectional%20study&rft.jtitle=Journal%20of%20the%20International%20AIDS%20Society&rft.au=Twahirwa%20Rwema,%20Jean%20Olivier&rft.date=2020-10&rft.volume=23&rft.issue=S6&rft.spage=e25604&rft.epage=n/a&rft.pages=e25604-n/a&rft.issn=1758-2652&rft.eissn=1758-2652&rft_id=info:doi/10.1002/jia2.25604&rft_dat=%3Cgale_pubme%3EA641376767%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2447466971&rft_id=info:pmid/33000912&rft_galeid=A641376767&rfr_iscdi=true |