乌鲁木齐市男男同性性行为人群人乳头瘤病毒队列失访及影响因素研究

Loss to follow-up and its influencing factors in the men who have sex with men human papilloma virus cohort in Urumqi

目的了解新疆维吾尔自治区乌鲁木齐市男男同性性行为人群(men who have sex with men,MSM)人乳头瘤病毒(human papilloma virus,HPV)队列失访发生情况,探讨失访发生的相关影响因素。方法2017年3月—2021年6月,本研究基于乌鲁木齐市社会组织招募MSM建立动态队列,每6个月随访1次,基线和随访均进行问卷调查,使用棉拭子采集肛周脱落细胞检测HPV DNA;利用Cox回归模型探讨失访发生的影响因素。结果本研究纳入MSM 822名,随访1433人年,总失访发生率为42.31/100人年。随访第1年失访发生率最高,为53.05(47.36~59.18)/100人年,随访第5年失访发生率最低,为7.04(2.19~16.36)/100人年。多因素分析显示,年龄>30岁[风险比(hazard ration,HR)=0.60,95%置信区间(confidence interval,CI):0.41~0.89]和乌鲁木齐市户口(HR=0.74,95%CI:0.53~1.04)的MSM不易失访;近1年性伙伴性别男女均有者(HR=0.23,95%CI:0.06~0.98)未做过HIV咨询检测(HR=1.90,95%CI:1.22~2.94)是失访发生的危险因素;与近6个月有肛交性行为者(HR=0.50,95%CI:0.25~0.99),有2~4个性伴的MSM更不易失访(HR=0.45,95%CI:0.21~0.97)。结论乌鲁木齐市MSM队列失访发生率较高,今后可通过加强新入组研究对象宣传教育,强化与研究对象间的信任关系,考虑MSM行为特征与参与研究动机之间的联系,重新评估队列保留策略,加强随访管理,提高随访率。

Objective To investigate the incidence of loss to follow-up in human papilloma virus(HPV)cohort among men who have sex with men(MSM)in Urumqi,and to explore the influencing factors of loss to followup.Methods From March 2017 to June 2021,MSM were recruited by non-government organizations(NGO)in Urumqi to establish a dynamic cohort and followed up every 6 months.Questionnaire interview was conducted at both baseline and follow-up,and perianal exfoliated cells were collected with cotton swabs to detect HPV DNA.Loss to follow-up was defined as failure to attend follow-up on time twice in a row after baseline survey.Cox regression model was used to explore the influencing factors of loss to follow-up.Results A total of 822 MSM were included,followed up for a total of 1433 person-years.The overallincidence of loss to follow-up was 42.31/100 person-years,being the highest in the first year of follow-up[53.05(47.36-59.18)/100 person-years]and the lowest in the fifth year[7.04(2.19-16.36)/100 person-years].Multivariable analysis showed that MSM aged>30 years(HR=0.60,95%CI:0.41-0.89)and being registered Urumqi residents(HR=0.74,95%CI:0.53-1.04)were less likely to be lost to follow-up,sexual partners of both genders in the past year(HR=0.23,95%CI:0.06-0.98)while having not had an HIV counseling test(HR=1.90,95%CI:1.22-2.94)was a risk factor for loss to follow-up.Engaged in anal intercourse(HR=0.50,95%CI:0.25-0.99)MSM with 2-4 sexual partners were also less likely to be lost to follow-up in the last 6 months(HR=0.45,95%CI:0.21-0.97).Conclusions The incidence of loss to follow-up in the MSM cohort in Urumqi is high.In the future,follow-up rate may be elevated by strengthening publicity and education among newly enrolled participants for building stronger trust with them,and by reassessing the cohort retention strategy with full consideration of the link between behavioral characteristics of the MSM and the motivation to participate in the study.