HIV Prevention and Health Poverty Alleviation - Liangshan Prefecture, Sichuan Province, China, 2017-2020

Temporal and Spatial Trends in HIV Positivity Rate for VCT Clinics - China, 2015-2022

Introduction

Human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) clinics play a critical role in identifying and diagnosing HIV cases. This study aimed to describe the trend of HIV positivity rate (HPR) among Chinese VCT clinics between 2015 and 2022.

Methods

This study utilized data from the China Information System for Disease Control and Prevention to analyze the trend in the HPR for VCT clinics from 2015 to 2022. The HPR was calculated by dividing the number of newly-reported HIV cases by the number of HIV tests, multiplied by 100%. To identify temporal and spatial trends in the HPR, we employed joinpoint regression analysis and the Getis-Ord hotspot analysis.

Results

From 2015 to 2022, VCT clinics in China performed a total of 22,075,386 HIV tests, leading to the identification of 260,353 HIV cases, resulting in a HPR of 1.18%. The HPR consistently declined over the study period, with an average annual percent change (AAPC) of -7.5% (95% confidence interval: -12.6%, -2.2%, P<0.05). The number of HPR hotspots also decreased from 41 in 2015 to 23 in 2022. These HPR hotspots were primarily located in Yunnan, Sichuan, Guangdong, and Guangxi provincial-level administrative divisions (PLADs). Among the 31 PLADs, 16 showed a significant decrease in HPR during the study period (AAPC<0, PAAPC<0.05).

Conclusions

VCT clinics in China have played a significant role in identifying HIV cases. The declining HPR observed in these clinics may indicates the progress has been made in some degree in mitigating HIV among high-risk populations. Therefore, it is crucial to further improving the utilization of VCT clinics for HIV testing.

Prevalence and analysis of acquired and transmitted integrase strand transfer inhibitor-associated HIV-1 drug resistance in Chongqing, China

In this study, we examined the occurrence of acquired and transmitted drug resistance to integrase strand transfer inhibitor (INSTI) in HIV-1 strains in Chongqing (China) for guiding for the routine testing of INSTI-associated HIV-1 genotype resistance. Plasma samples were obtained from HIV-1 patients at Chongqing Public Health Medical Center from July 2019 to August 2022. Besides, amplification, sequence, and analysis of the portion of the HIV-1 pol gene that encodes the integrase protein were implemented to identify INSTI resistance. Integrase sequence data was harvested for a comprehensive cohort of 1032 patients infected with HIV-1. This cohort consisted of 564 ART-naive patients, 465 ART-treated patients, and 3 patients with an unknown treatment history. Within the study group, we identified INSTI resistance in 21 patients (2.03%, 21/1032), including 17 ART-treated patients (3.66%, 17/465). Among the ART-treated patients, 12 were INSTI-treated (11.76%, 12/102), 5 were INSTI-naive (1.38%, 5/363), and 4 were ART-ineffective patients (0.71%, 4/564). The prevalent major resistance mutation was Q148R (0.48%, 5/1032), while the most prevalent accessory resistance mutation was E157Q (1.65%, 17/1032). In light of the above, it is recommended that the incidence of accessory genotype analysis should be considered before starting any future INSTI-based therapy, especially in patients with drug resistance to NRTIs and NNRTIs and the reduction of INSTI sensitivity should be carefully monitored and investigated. Regular monitoring for resistance should be implemented after the use of INSTIs, and, importantly, ongoing monitoring of the decreasing susceptibility to INSTIs is crucial following the initiation of treatment with INSTIs.

The Update of HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV Recent Infection Among Four Sub-Groups in Sichuan, China During Surveillance Period Between 2016 and 2022

Background

Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare.

Objective

The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022.

Results

Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots.

Conclusion

The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.

Status and factors associated with patient activation and its relationship with HIV clinic outcomes among Yi minority people living with HIV in Liangshan, China: a cross-sectional study

INTRODUCTION

Patient activation is determined by an individual's knowledge, skills and confidence in managing his/her health. It is vital for people living with HIV (PLWH) to enhance their self-management skills and health outcomes, especially those from low- and middle-income regions, since they are at higher risk of worse health outcomes. However, literature from those regions is limited, especially in China.

OBJECTIVES

This study aimed to explore the status and factors associated with patient activation among Yi minority PLWH in Liangshan, China and to determine whether patient activation is associated with HIV clinic outcomes.

METHODS

This cross-sectional study included 403 Yi minority people living with HIV in Liangshan between September and October 2021. All participants completed an anonymous survey measuring sociodemographic characteristics, HIV-related information, patient activation and illness perception. Multivariate linear regression and multivariate binary logistic regression were used to explore factors associated with patient activation and the association between patient activation and HIV outcomes, respectively.

RESULTS

The Patient Activation Measure (PAM) score was low (mean = 29.8, standard deviation = 4.1). Participants with negative illness perception, low income, and self-rated antiretroviral therapy (ART) effect based on self-perception were most likely to have a lower PAM score (β = -0.3, -0.2, -0.1, respectively; all p < 0.05); those with having disease knowledge learning experiences and an HIV-positive spouse were more likely to have a higher PAM score (β = 0.2, 0.2, respectively; both p < 0.001). A higher PAM score (AOR=1.08, 95% CI: 1.02, 1.14) was associated with viral suppression, mediated by gender (AOR=2.25, 95% CI: 1.38, 3.69).

CONCLUSION

Low patient activation level among Yi minority PLWH impacts HIV care. Our findings indicate patient activation is associated with viral suppression for minority PLWH in low- and middle-income settings, suggesting that tailored interventions enhancing patient activation may improve viral suppression.

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.

Molecular Transmission Network of Newly Reported HIV Infections in Pengzhou, Sichuan Province: A Study Based on Genomics and Spatial Epidemiology

OBJECTIVE

The objective of this study was to understand the molecular transmission characteristics of newly reported HIV infections in the city of Pengzhou, Sichuan Province, to analyze the risk factors of transmission network and spatial clustering and the transmission characteristics, and to provide a scientific basis for precision prevention and intervention.

METHODS

Anticoagulated whole blood was collected from newly reported HIV infections in Pengzhou from March 2019 to August 2021. After the plasma was isolated, the HIV-1 pol gene was amplified and sequenced by reverse transcriptase polymerase chain reaction (PCR). The obtained gene sequences were used to construct a maximum likelihood phylogenetic tree for the analysis of virus subtypes, and a molecular transmission network was constructed using the genetic distance method to evaluate the transmission pattern of people living with HIV/AIDS in Pengzhou. A logistic regression model was used to find out the potential risk factors for entering the molecular transmission network with the number of nodes ≥ 2. Spatial analysis is used to show the geographical pattern of the proportion of newly reported HIV infections entering the molecular transmission network, and a flow map is used to show the intensity of transmission within and between townships.

RESULTS

A total of 463 newly reported HIV-infection sequences were obtained in this study, including 237 cases (51.19%) of CRF01_ AE, 159 cases (34.34%) of CRF07_BC, 45 cases (9.72%) of B, 15 cases (3.24%) of CRF08_BC and 7 cases (1.5%) of others. The number of clusters was the highest when the gene distance was 0.009, with a total of 246 sequences entering the network, forming 54 clusters, and the network entry rate was 55.36%. There were 170 sequences with more than two nodes in the network sequence. The logistic regression showed that compared with age < 50 years old, age ≥ 50 years old has a higher risk of transmission (OR = 3.43, 95% CI = 2.06-5.71); compared with farmers, the risk of transmission within industry is lower (OR = 0.046, 95% CI = 0.25-0.87); and compared with CRF07_BC, CRF01_AE (OR = 6.09, 95% CI = 3.60-10.30) and B (OR = 20.31, 95% CI = 8.94-46.13) had a higher risk of transmission. Men aged ≥ 50 years are mainly clustered with women between 50 and 70 years of age. In addition to being clustered with gay men, there are nine (50%) and three (16.7%) chains of transmission between gay men and heterosexual men and women, respectively. In the geographical space, there is no hot spot clustering of the molecular propagation network. The subtype B was mainly distributed in the town of Tianpeng and formed transmission networks in eastern Pengzhou;0020CRF01_AE is mainly distributed in the town of Lichun and formed transmission networks in the west and north of Pengzhou.

CONCLUSION

This study reveals the characteristics and influencing factors of molecular network transmission in the region, as well as the spatial transmission characteristics of newly reported HIV infections in recent years, and reveals the geographical differences in HIV-1 transmission. The results provide a scientific basis for the development of local AIDS-specific intervention measures.