@article{3d09c1aea0b5434b9b794b9726497bd5,
title = "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 seroconversion 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.",
keywords = "HIV, Men who have sex with men, epidemiology, syphilis",
author = "Holtz, {T. H.} and W. Wimonsate and Mock, {P. A.} and S. Pattanasin and W. Chonwattana and W. Thienkrua and W. Sukwicha and Curlin, {M. E.} and A. Chitwarakorn and Dunne, {E. F.}",
note = "Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The US Centers for Disease Control and Prevention funded the research. Funding Information: We wish to acknowledge the Silom Community Clinic, including the staff, clients, and our community partners, who work tirelessly to serve populations at risk for HIV infection in Bangkok, Thailand. The authors kindly acknowledge and thank for the support of the personnel of the Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, the SCC (now SCC @TropMed), the Department of Disease Control, Thailand MOPH, the Rainbow Sky Association of Thailand, and the Service Workers in Group Foundation. We dedicate this work to the memory of Mrs Supaporn Chaikummao and to Mr Patrick J. Flaherty who were both devoted to HIV prevention at SCC. The data in this study have been presented previously at the HIV Research for Prevention conference, Chicago, IL, 17?21 October 2016, abstract OA05.04, and at the HIV Research for Prevention conference, Cape Town, South Africa, 28?31 October 2014. Funding Information: We wish to acknowledge the Silom Community Clinic, including the staff, clients, and our community partners, who work tirelessly to serve populations at risk for HIV infection in Bangkok, Thailand. The authors kindly acknowledge and thank for the support of the personnel of the Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, the SCC (now SCC @TropMed), the Department of Disease Control, Thailand MOPH, the Rainbow Sky Association of Thailand, and the Service Workers in Group Foundation. We dedicate this work to the memory of Mrs Supaporn Chaikummao and to Mr Patrick J. Flaherty who were both devoted to HIV prevention at SCC. The data in this study have been presented previously at the HIV Research for Prevention conference, Chicago, IL, 17–21 October 2016, abstract OA05.04, and at the HIV Research for Prevention conference, Cape Town, South Africa, 28–31 October 2014. Publisher Copyright: {\textcopyright} The Author(s) 2019.",
year = "2019",
month = apr,
day = "1",
doi = "10.1177/0956462418814994",
language = "English (US)",
volume = "30",
pages = "430--439",
journal = "International Journal of STD and AIDS",
issn = "0956-4624",
publisher = "SAGE Publications Ltd",
number = "5",
}