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MSM sex workers maintain a high HIV-1 incidence over time in Mombasa, Kenya
M. Mwangome1, H.S. Okuku1, G. Fegan1,2, A. Muhaari1, E.M. van der Elst1, K. Awuondo1, M.A. Price3, S.M. Graham1,4, N. Peshu1, E.J. Sanders1,5
1Kenya Medical Research Institute (KEMRI)- Kilifi, Kilifi, Kenya, 2London School of Hygiene and Tropical Medicine, Infectious Disease Epidemiology Unit, London, United Kingdom, 3International AIDS Vaccine Initiative, New York, United States, 4University of Washington, International AIDS Research and Training Program, Seattle, United States, 5University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine, Oxford, United Kingdom
Background: HIV-1 incidence in MSM sex workers (MSM-SW) in Africa has rarely been reported, but their role as a potential trial population has been recognised. We aimed to assess HIV-1 incidence over time in risk groups considered for intervention trials in Coastal Kenya.
Methods: From July 2005 -December 2008, MSM-SW, female sex workers (FSW), and strictly heterosexual men (HM) who had multiple partners and denied sex work were enrolled in an open cohort, provided with 3-monthly HIV counselling and testing, and STI screening and treatment. HIV-1 infection was determined using 2 rapid assays, and confirmed by ELISA in case of discrepant test results. HIV-1 incidence was observed in four 6-month follow up (FU) periods.
Results: A total of 277 MSM-SW, 226 FSW, and 85 HM enrolled in the cohort. Median age (IQR) at enrolment was 26 (23-32), 27 (24-31), and 30 (26-38) years, respectively. Overall HIV-1 incidence was 5.7 (CI: 4.2 - 7.9) per 100 person years of observation; 8.6 (CI: 5.9 - 12.7) for MSM-SW; 3.2 (CI: 1.6 - 6.5) for FSW; and 3.6 (CI: 1.4 - 9.6) for HM. Incidence after six months FU was reduced in MSM-SW and FSW. While FSW showed further reductions over time, incidence remained high for MSM-SW. HM had no clear pattern.
Conclusions: MSM-SW and FSW constitute potential risk groups to evaluate HIV-1 interventions, but reductions of HIV-1 incidence over time in FSW challenge efficacy trial participation. The sustained high HIV-1 incidence in MSM-SW presents huge challenges for HIV-1 risk reduction interventions and calls for urgent public health action.
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