Epidemiological factors associated with recent HIV infection among newly-diagnosed cases in Singapore, 2013–2017

BMC Public Health

Yee Sin Leo¹  Chen Seong Wong²  Sophia Archuleta³  Carmen Low⁴  Raymond Tzer-Pin Lin⁵  Li Wei Ang⁶  Irving Charles Boudville⁶  Matthias Paul Han Sim Toh⁷  Angela Chow⁸  Vernon Jian Ming Lee⁹ 

[1] Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore;Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore;National Centre for Infectious Diseases, Singapore, Singapore;Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore;National HIV Programme, National Centre for Infectious Diseases, Singapore, Singapore;Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore;Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;National HIV Programme, National Centre for Infectious Diseases, Singapore, Singapore;Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore;National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore;National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore;Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore;National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore;National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore;Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore;National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore, Singapore;Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore;Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore;Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore;Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore;Communicable Diseases Division, Ministry of Health, Singapore, Singapore;

关键词: Recent HIV infection;    Newly diagnosed;    Epidemiology;    Risk factors;    HIV testing;    Modifiable behaviors;   

DOI  :  10.1186/s12889-021-10478-5

来源: Springer

【 摘 要 】

BackgroundEarly diagnosis is crucial in securing optimal outcomes in the HIV care cascade. Recent HIV infection (RHI) serves as an indicator of early detection in the course of HIV infection. Surveillance of RHI is important in uncovering at-risk groups in which HIV transmission is ongoing. The study objectives are to estimate the proportion of RHI among persons newly-diagnosed in 2013–2017, and to elucidate epidemiological factors associated with RHI in Singapore.MethodsAs part of the National HIV Molecular Surveillance Programme, residual plasma samples of treatment-naïve HIV-1 positive individuals were tested using the biotinylated peptide-capture enzyme immunoassay with a cutoff of normalized optical density ≤ 0.8 for evidence of RHI. A recent infection testing algorithm was applied for the classification of RHI. We identified risk factors associated with RHI using logistic regression analyses.ResultsA total of 701 newly-diagnosed HIV-infected persons were included in the study. The median age at HIV diagnosis was 38 years (interquartile range, 28–51). The majority were men (94.2%), and sexual route was the predominant mode of HIV transmission (98.3%). Overall, 133/701 (19.0, 95% confidence interval [CI] 16.2–22.0%) were classified as RHI. The proportions of RHI in 2015 (31.1%) and 2017 (31.0%) were significantly higher than in 2014 (11.2%). A significantly higher proportion of men having sex with men (23.4, 95% CI 19.6–27.6%) had RHI compared with heterosexual men (11.1, 95% CI 7.6–15.9%). Independent factors associated with RHI were: age 15–24 years (adjusted odds ratio [aOR] 4.18, 95% CI 1.69–10.31) compared with ≥55 years; HIV diagnosis in 2015 (aOR 2.36, 95% CI 1.25–4.46) and 2017 (aOR 2.52, 95% CI 1.32–4.80) compared with 2013–2014; detection via voluntary testing (aOR 1.91, 95% CI 1.07–3.43) compared with medical care; and self-reported history of HIV test(s) prior to diagnosis (aOR 1.72, 95% CI 1.06–2.81).ConclusionAlthough there appears to be an increasing trend towards early diagnosis, persons with RHI remain a minority in Singapore. The strong associations observed between modifiable behaviors (voluntary testing and HIV testing history) and RHI highlight the importance of increasing the accessibility to HIV testing for at-risk groups.

【 授权许可】

CC BY