Spatial distribution of HIV, HCV, and co-infections among drug users in the southwestern border areas of China (2004-2014): a cohort study of a national methadone maintenance treatment program

Insights into the spatial epidemiology of hepatitis C infection: systematic synthesis of area-level determinants and spatiotemporal analyses

BACKGROUND

Hepatitis C virus (HCV) stands at the forefront of global elimination endeavors by 2030, highlighting the need for a nuanced exploration into disparities and vulnerabilities using innovative spatial epidemiological approaches. This study aimed to systematically review existing literature to summarize area-level factors associated with HCV infection and to examine the application of spatial and spatiotemporal analyses in HCV research.

METHODS

A systematic search following PRISMA guidelines was conducted for peer-reviewed literature published between 2000 and 2023 using PubMed, Web of Science, Scopus, and Embase databases. The synthesis of area-level factors was organized according to four distinct categories of risk environments: social, economic, policy, and physical environments.

RESULTS

Sixty-five studies were selected for this systematic review. 60% of the studies focused on the general population, while 20% of the studies targeted people who inject drugs. The area-level factors explored predominantly were characteristics of the social and economic risk environments. For instance, areas with a higher level of socioeconomic disadvantage, lower education attainment, higher population density, and located more remotely were associated with higher HCV infection rates. Additionally, some studies noted a significant correlation between the accessibility to harm reduction and healthcare services and HCV occurrence, testing, and treatment rates. Furthermore, spatial data exploration and cluster analysis methods were the predominant methods used to explore the nuanced spatial distribution of HCV infection.

CONCLUSION

This review emphasizes the imperative of deciphering the complex interplay of area-level factors in HCV infection dynamics. Understanding the potential risk environment landscape of HCV could facilitate identifying vulnerable areas and communities. Additionally, the limited application of spatial analytics in HCV research highlights the untapped potential, emphasizing the need for enhanced spatial techniques to pinpoint priority areas for intervention.

Implementation of HIV non-occupational post-exposure prophylaxis for men who have sex with men in 2 cities of Southwestern China

ABSTRACT

Non-occupational post-exposure prophylaxis (nPEP) has often relied on the joint work of emergency physicians and infectious disease specialists in busy emergency departments and human immunodeficiency virus (HIV)/sexually transmitted infections clinics abroad, where adherence education and follow-up are invariably reactive. In our pilot study, community-based organizations (CBOs) were invited to together implement the nPEP tailored to men who have sex with men (MSM) in 2 cities of Guangxi in Southwestern China, of which experiences and lessons drawn from would be provided to the promotion of nPEP in China.The study population enrolled MSM individuals prescribed nPEP from September 2017 to December 2019. One-to-one follow-ups by CBOs were applied through the treatment. Predictors of treatment completion were assessed by logistic regression.Of 271 individuals presented for nPEP, 266 MSM with documented treatment completion or non-completion, 93.6% completed the 28-day course of medication. Completion was associated with reporting side effects (aOR = .10; 95% CI: 0.02-0.38; P = .001). The follow-up rate of 91.9% was achieved based on the definition of loss to follow-up. No documented nPEP failures were found, although 1 MSM subsequently seroconverted to HIV due to ongoing high-risk behavior.CBOs' engagement in HIV nPEP, especially the "one-to-one" follow-up supports by peer educators partly ensure adherence and retention to nPEP. Tailored interventions are needed to address the subsequent high-risk behaviors among the MSM population.

HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China: Results of 3 cross-sectional surveys from 2013 to 2015

To assess human immunodeficiency virus (HIV), syphilis, and behavioral risk factors among men who have sex with men (MSM) in southwestern China, where HIV started as a drug-driven epidemic, and shifted to mainly heterosexual transmission.These cross-sectional studies were conducted yearly in 2013, 2014, and 2015 in Guangxi, China. A total of 1,996, 1,965, and 1,697 participants were recruited in 2013, 2014, and 2015, respectively. The data included demographic and sexual behavioral variables. Other variables included individuals who used illegal drugs, and who received HIV counseling, testing, and free condoms, and peer education. Participants were tested for HIV, syphilis, and hepatitis C virus (HCV) with whole blood specimens. Questionnaires and laboratory testing data were double entered, and validated with EpiData software. The data were then transferred into SPSS software (SPSS Inc, Chicago, IL) and Chi-square test performed.The prevalence of HIV was 6.6% in 2013, 8.4% in 2014, and 11.2% in 2015. The prevalence of syphilis was 9.3% in 2013, 9.8% in 2014, and 6.1% in 2015. And HCV prevalence was 0.5% in 2013 and remained stable at 0.4% in 2014, and 2015. HIV infection, and associated factors among MSM in these 3 annual cross-sectional survey showed that HIV-infected MSM were significantly, more likely, to perform unprotected anal intercourse with any commercial male partners in the past 6 months (adjusted odds ratio [AOR] = 1.81, 95% CI: 1.50-2.20), had sex with any female partners in the past 6 months (AOR = 1.31, 95% CI: 1.01-1.71), used drugs in the past (AOR = 2.73, 95% CI: 1.30-5.71), and are syphilis infected (AOR = 3.53, 95% CI: 2.77-4.49).There is an urgent need for intervention strategies like condom distribution, HIV counseling, free testing, and education regarding safe sex, HIV, and other sex-related diseases in Guangxi to curb, and prevent HIV among MSM.