ilom community clinic

1. ilom community clinic Three years of follow up in the Bangkok MSM Cohort Study: evidence of an explosive epidemic of HIV infection Abstract # TUAC0301

2. Background: HIV prevalence among MSM in Bangkok, 2003 - 2009 HIV Prevalence (%) 2003 2005 2007 2009 Year Presented by Kladsawas et al, IAC 2010, TUAC0203

3. คลินิก ชุมชน สีลม THE COHORT STUDY

4. Study design • Longitudinal cohort study with 3-5 years follow up at 4 monthly intervals • Sample size of ~1,350 men, 17% HIV prevalence, 3% incidence, 95% CI +/-1% • Prevalence of HIV and sexually transmitted infections at baseline • At every study visit: • All men completed ACASI questionnaire and received risk reduction counseling • HIV negative men were tested for incident HIV infection using oral fluid, and acute HIV infection using nucleic acid and 4th generation EIA testing • HIV positive men underwent CD4 and viral load evaluation for clinical monitoring

5. Eligibility criteria • Thai national • Male at birth • Resident of Bangkok • At least 18 years of age • Oral or anal sex with another man in the preceding six months • Availability and commitment for at least 36 months of follow-up at 4 months intervals

6. Statistics • HIV prevalence (number HIV positive / total number enrolled x 100) • Kaplan-Meier analysis to estimate cumulative HIV incidence • Logistic regression analysis to evaluate risk factors for prevalent HIV infection • Cox proportional hazard analysis to evaluate risk factors for incident HIV infection

7. Baseline demographic characteristicsApril 2006 – January 2008, N=1,292

8. Prevalence of HIV and sexually transmitted infections at baseline % infected HIV HBV HAV HCV HSV-1 HSV-2 TP CT NG

9. HIV-prevalence at baseline by enrollment period Overall HIV prevalence 22% HIV prevalence (%) Enrollment period

10. Yearly HIV incidence density in the HIV-negative fraction of the cohort Number of seroconversions: 135 Mean age at seroconversion: 26.4 yrs Median: 26 years Per 100 person-years

11. Cumulative HIV incidence (Kaplan-Meier method) in the HIV-negative fraction of the cohort 89 78 75 71

12. Multivariate analysis of risk factors for prevalent and incident HIV infection Prevalent HIV Incident HIV

13. Multivariate analysis for risk factors ofprevalent and incident HIV infection Prevalent HIV Incident HIV *at baseline

14. Multivariate analysis of risk factors for prevalent and incident HIV infection Prevalent HIV Incident HIV

15. Multivariate analysis for risk factors ofprevalent and incident HIV infection Prevalent HIV Incident HIV *at baseline

16. Conclusions • A preparatory HIV cohort study was successfully started among MSM in Bangkok • High HIV prevalence and continuing high HIV incidence • Risk factor analysis suggests that interventions should include/target • - younger MSM • - drug use for sexual pleasure • - receptive anal intercourse • - lack of condom use • - STI control • Bangkok MSM are an appropriate population for the evaluation and implementation of HIV biomedical and behavioral interventions

17. Acknowledgements Co-authors; Division of HIV/AIDS Prevention, US CDC; Bureau of AIDS, TB and STI, Thailand MOPH; Rainbow Sky Association; MSM-CAB; Bangkok Christian Hospital;MSM volunteers in this study Silom Community Clinic and support staff

18. Disclaimer The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention

19. Follow-up rates in the HIV-negative fraction of the cohort Follow-up rate 24M 12M Months of follow-up

20. HIV-prevalence at baseline by age group Overall HIV prevalence 22% HIV prevalence (%) Age group

21. Background: HIV prevalence among MSM in Bangkok, 2003 - 2009 All ages 15-22 years HIV Prevalence (%) 2003 2005 2007 2009 Year Presented by Kladsawas et al, IAC 2010, TUAC0203