Impact of immediate initiation of antiretroviral therapy among men who have sex with men infected with HIV in Chengdu, southwest China: trends analysis, 2008-2018

Inequality and heterogeneity in medical resources for children with autism spectrum disorders: a study in the ethnic minority region of southern China

BACKGROUND

In recent years, medical interventional treatment for children with autism spectrum disorder (ASD) has been gradually introduced in medical institutions in the Guangxi Zhuang Autonomous Region in southern China. However, the allocation of these medical resources has been uneven. This study describes the spatial allocation of medical resources for children with ASD in Guangxi, evaluates their supply and utilization, and expounds on their correlations with socioeconomic and demographic conditions.

METHODS

This study was based on a special survey conducted from 2021 to 2022 by the Guangxi Disabled Rehabilitation Research Center. The number of medical institutions for children with ASD (MIIs), average number of ASD technicians per 10,000 target people (CTPP), and coverage rate of medical interventions (CMI) were set as dependent variables, while population density, proportion of town residents, total retail sales of consumer goods, disposable income per capita gross domestic product per capita (GDPpc), and number of enterprises above designated size were set as independent variables, all of which were included in the spatial statistical model. The main analysis methods was multiscale geographically weighted regression (MGWR).

RESULTS

The allocation of MIIs (Moran's I = 0.119, p = 0.007), CTPP (Moran's I = 0.208, p = 0.017), and CMI (Moran's I = 0.251, p = 0.004) in Guangxi showed significant spatial autocorrelation. The medical resources formed high-value hot spots in major districts of core cities, while the medical resources were scarce in some remote ethnic minority counties and densely populated areas in southeastern Guangxi. MIIs showed significant spatial correlations with population density (EV=-0.225, p = 0.001), proportion of town residents (EV = 0.255, p = 0.002), total retail sales of consumer goods (EV = 0.806, p < 0.001), and disposable income per capita (EV=-0.267, p < 0.001). CTPP showed significant correlations with population density (EV = 0.211, p = 0.019), GDPpc (EV = 0.267, p = 0.002), total retail sales of consumer goods (EV = 0.382, p < 0.001), and number of enterprises above designated size (EV=-0.242, p = 0.005). CMI showed a significant association with proportion of town residents (EV = 0.415, p < 0.001), total retail sales of consumer goods (EV = 0.273, p = 0.006), and number of enterprises above designated size (EV=-0.236, p = 0.003).

CONCLUSIONS

The spatial allocation of medical resources for children with ASD in Guangxi is heterogeneous, and correlates varyingly with regional socioeconomic conditions as well as urbanization and demographic conditions.

The impact of a comprehensive strategy on HIV treatment continuum in a highly endemic area of China: an interrupted time series analysis

BACKGROUND

A comprehensive strategy encompassing universal testing and strengthened treatment was promoted to address the severe HIV epidemic in Liangshan. This study aimed to assess the impact of this strategy on HIV treatment continuum.

METHODS

Interrupted time series (ITS) analysis was utilized to evaluate the impact of a comprehensive strategy on HIV treatment outcomes in Liangshan from 2014 to 2021 utilizing data from China's HIV/AIDS Comprehensive Response Information Management System (CRIMS). Poisson or quasi-Poisson segmented regression models were applied to estimate the trends and immediate changes in key outcomes, including the proportion of 30-day antiretroviral therapy (ART) initiation, the proportion of 6-month follow-up, and the proportion of viral suppression, following the strategy's implementation in January 2018. The analysis was stratified by sex, age, transmission route, and region, with areas classified as key areas and non-key areas based on an HIV prevalence threshold of 1%.

RESULTS

A total of 37,888 people living with HIV (PLHIV) were identified during the study period, with an increase in diagnoses following comprehensive strategy implementation. Most cases involved males, aged 15-34 years, residents of key areas, and individuals infected through heterosexual transmission. There was a significant increase of 2.50-fold in 30-day ART initiation (incidence rate ratio [IRR] 2.501, 95% CI: 1.694-3.694), 34.0% in 6-month follow-up (1.340, 95% CI: 1.234-1.456), and 17.7% in viral suppression (1.177, 95% CI: 1.068-1.296) in the first month of comprehensive strategy implementation. Over time, all three indicators displayed an upward trend, and by December 2021, their predicted values significantly increased, exceeding the expected levels by 60.3% (IRR 1.603, 95% CI: 1.108-2.318), 62.9% (1.629, 95% CI: 1.430-1.855), and 50.6% (1.506, 95% CI: 1.223-1.855), respectively. Subgroup analysis revealed that while the strategy's effects on these outcomes were generally consistent, the magnitude of improvement varied. Residents of key areas exhibited more significant increases in 30-day ART initiation, while residents of non-key areas, particularly those aged ≥ 60 years, displayed smaller increases in the proportion of 6-month follow-up, and no significant change in the proportion of viral suppression, with a slightly lower average.

CONCLUSIONS

The implementation of a comprehensive strategy substantially improved timely ART initiation, follow-up care after ART and viral suppression for PLHIV in Liangshan, with consistent enhancements across various subpopulations. It is imperative to strengthen comprehensive strategy in non-key areas of Liangshan, and to promote these strategies in other similar regions in order to enhance health benefits for patients.

Impact of COVID-19 epidemic on temporal pattern of new HIV diagnoses in Italy, 2021 database

BACKGROUND

New HIV diagnoses in Italy decreased drastically in 2020 due to COVID-19 related effects: 50% fewer diagnoses were reported by the National HIV Surveillance System. COVID-19 pandemic impact on HIV surveillance is unclear. We estimated the expected number of new HIV diagnoses in 2020 in order to isolate the impact of the COVID-19 pandemic.

METHODS

We analyzed 29 697 new HIV infections diagnosed from 2012 to 2020, reported to the National HIV Surveillance System. We assessed temporal trends of new HIV diagnoses applying negative binomial mixed effects models. We estimated the COVID-19 impact as the difference between the model-estimated slopes from 2012 to 2019 and the change reported in the diagnoses. The expected number of new HIV diagnoses in 2020 was also estimated and compared with the reported count.

RESULTS

Based on the historical trend, we expected a 15% (95% CI: 5-25%) decline of new HIV diagnoses in 2020. We reported, however, a 49% decrease, yielding to a 34% net decrease in the number of new diagnoses. The strongest impact was estimated in northern regions (-40%) and MSM (-38%). We estimated 761 (95% prediction interval: 350-1277) missed diagnoses during 2020, the majority of them occurring in the North (465 cases), among MSM (416) and heterosexual males (217).

CONCLUSIONS

In 2020, when excluding 15% decrease of new diagnoses attributable to the expected reduction, an additional 34% decrease was observed, representing a large decline in new HIV diagnoses associated with the COVID-19 pandemic.

Immediate and long-term outcomes after treat-all among people living with HIV in China: an interrupted time series analysis

BACKGROUND

In 2003, China implemented free antiretroviral therapy (ART) for people living with HIV (PLHIV), establishing an eligibility threshold of CD4 < 200 cells/μl. Subsequently, the entry criteria were revised in 2012 (eligibility threshold: CD4 ≤ 350 cells/μl), 2014 (CD4 ≤ 500 cells/μl), and 2016 (treat-all). However, the impact of treat-all policy on HIV care and treatment indicators in China is unknown. We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China.

METHODS

Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019, from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China. We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators: monthly proportion of 30-day ART initiation, mean CD4 counts (cells/μl) at ART initiation, and mean estimated time from infection to diagnosis (year). We built separate models according to gender, age, route of transmission and region.

RESULTS

Monthly data on ART initiation and collection were available for 75,516 individuals [gender: 83.8% males; age: median 39 years, interquartile range (IQR): 28-53; region: 18.5% Northern China, 10.9% Northeastern China, 17.5% Southern China, 49.2% Southwestern China]. In the first month of treat-all, compared with the contemporaneous counterfactual, there was a significant increase in proportion of 30-day ART initiation [+ 12.6%, incidence rate ratio (IRR) = 1.126, 95% CI: 1.033-1.229; P = 0.007] and mean estimated time from infection to diagnosis (+ 7.0%, IRR = 1.070, 95% CI: 1.021-1.120; P = 0.004), while there was no significant change in mean CD4 at ART initiation (IRR = 0.990, 95% CI: 0.956-1.026; P = 0.585). By December 2019, the three outcomes were not significantly different from expected levels. In the stratified analysis, compared with the contemporaneous counterfactual, mean CD4 at ART initiation showed significant increases in Northern China (+ 3.3%, IRR = 1.033, 95% CI: 1.001-1.065; P = 0.041) and Northeastern China (+ 8.0%, IRR = 1.080, 95% CI: 1.003-1.164; P = 0.042) in the first month of treat-all; mean estimated time from infection to diagnosis showed significant increases in male (+ 5.6%, IRR = 1.056, 95% CI: 1.010-1.104; P = 0.016), female (+ 14.8%, IRR = 1.148, 95% CI: 1.062-1.240; P < 0.001), aged 26-35 (+ 5.3%, IRR = 1.053, 95% CI: 1.001-1.109; P = 0.048) and > 50 (+ 7.8%, IRR = 1.078, 95% CI: 1.000-1.161; P = 0.046), heterosexual transmission (+ 12.4%, IRR = 1.124, 95% CI: 1.042-1.213; P = 0.002) and Southwestern China (+ 12.9%, IRR = 1.129, 95% CI: 1.055-1.208; P < 0.001) in the first month of treat-all.

CONCLUSIONS

The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes. To advance the work of rapid ART, efforts should be made to streamline the testing and ART initiation process, provide comprehensive support services, and address the issue of uneven distribution of medical resources.

Perceptions toward antiretroviral therapy and delayed ART initiation among people living with HIV in Changsha, China: mediating effects of treatment willingness

Introduction

Delayed antiretroviral therapy (ART) initiation is associated with poor HIV outcomes and a higher likelihood of HIV transmission.

Methods

This cross-sectional study assessed the proportion of delayed ART initiation which was defined as initiating ART after 30 days of HIV diagnosis, and evaluated the pathways influencing ART initiation among adult PLWH in Changsha, China who were diagnosed between 2014 and 2022.

Results

Of 518 participants, 37.8% delayed in initiating ART. Based on the theory of reasoned action (TRA), delayed initiation was indirectly associated with perceptions toward ART through the mediating pathway of patients' treatment willingness, with treatment willingness significantly being the full mediator.

Discussion

The findings may guide the development of interventions to improve timely uptake of ART in people who are newly diagnosed with HIV.

Instruments to assess adherence to medication in people living with HIV: a scoping review

OBJECTIVE

To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy.

METHODS

Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards.

RESULTS

Three publications were included in the qualitative synthesis. Following were the instruments identified "Questionário para Avaliação da Adesão ao Tratamento Antirretroviral" (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the "Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids" (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the "WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil" (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities.

CONCLUSION

The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.

Universal Health Coverage for Antiretroviral Treatment: A Review

Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers' inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship.

Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study

BACKGROUND

The main goal of this study was to analyze the HIV epidemic temporally and spatially among young people living in Pará, Brazil, from 2007 to 2018.

METHODS

For the temporal analysis, we employed an integrated autoregression of moving averages model associated with the seasonal trend using the LOESS decomposition method, which allowed for predictions to be made. In the spatial analysis, the techniques of autocorrelation, spatial and spatio-temporal risk analysis, and geographically weighted regression were used.

RESULTS

During the study period, there were 8143 notifications of HIV/AIDS cases. The temporal prediction indicated a trend of growth in the incidence rate in the 20-24-year-old group from January 2019 to December 2022 and a trend of stability in the 15- to 19-year-old and 25- to 29-year-old groups. There was a territorial expansion of the HIV epidemic in Pará. Novo Progresso and the Metropolitan Region of Belém (RMB) were the zones with the highest spatial and spatio-temporal risk for HIV. Social determinants including the Basic Education Development Index, the number of physicians per 10,000 inhabitants, and the municipal high school abandonment rate in the municipalities were associated with the risk of HIV/AIDS among young people in Pará.

CONCLUSIONS

To eliminate HIV among young people in Pará, the access to treatment, diagnosis, and preventive healthcare services should be expanded. Sexual and reproductive health education should be reinforced in schools and communities. Furthermore, it is necessary to promote social equity and fight HIV stigma.

Temporal trend and spatial analysis of the HIV epidemic in young men who have sex with men in the second largest Brazilian Amazonian province

Background

After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis.

Methods

We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran’s spatial autocorrelation, spatial scan, and spatial regression techniques were used.

Results

A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education.

Conclusion

The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.