Syphilis among pre-exposure prophylaxis initiators in selected districts of Nepal


BACKGROUND: HIV prevention services are crucial to achieve the goal of ending AIDS by 2030. In Nepal, the U.S. President''s Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID)-supported Meeting Targets and Maintaining Epidemic Control (EpiC) project support provision of pre-exposure prophylaxis (PrEP) to key populations (KPs) such as female sex workers (FSWs), men who have sex with men (MSM), and transgender people. The project offers integrated PrEP and syphilis screening, as well education on risk reduction. We report syphilis prevalence among these KPs at PrEP initiation and follow-up in the 19 EpiC-supported sites.
METHODS: Syphilis prevalence was measured at baseline among all clients initiated on PrEP from October 2020 through March 2021, and incidence was measured during follow-up visits in EpiC Nepal's STI clinic during April through September 2021. Syphilis was diagnosed through rapid plasma reagin and treponema pallidum particle agglutination performed by trained laboratory personnel. Those who tested positive received treatment. These data were collected through the individual reporting system used by EpiC Nepal.
RESULTS: From October 2020 to March 2021, 1,780 KPs (43% FSWs, 34% MSM, 23% transgender people) were initiated on PrEP. Almost half (43%) were ages 15'24 years. Seventy percent of those who initiated PrEP continued to take it, whereas 30% discontinued PrEP. At the time of PrEP initiation, 13% (n=232) tested positive for syphilis (23% FSW, 42% MSM, 34% TG). At follow-up (April'September 2021), 0.56% (n=7) of those who continued PrEP services and 0.75% (n=4) of those who discontinued the services tested positive for syphilis. Among the KP individuals who continued PrEP, 0.24% (n=3) tested positive for syphilis at baseline and follow-up.
CONCLUSIONS: KPs are not only at risk of HIV infection, but also other STIs, including syphilis. Our findings showed a significant decrease in the number of syphilis cases over the time among the PrEP initiators. Since both PrEP and STI services are provided at the same sites, there is an opportunity to conduct comprehensive STI prevention, screening, and care among PrEP initiators.

Download the e-Poster (PDF)