Disparities in HIV Care Along the Path From Infection to Viral Suppression: A Cross-sectional Study of HIV/AIDS Patient Records in 2013, Shandong Province, China.

BACKGROUND: The 90-90-90 targets recommended by the Joint United Nations Programme on HIV/AIDS require strengthening human immunodeficiency virus (HIV) care, which includes diagnosis, linkage to and retention in care, assessment for treatment suitability, and optimization of HIV treatment. We sought to quantify patient engagement along the continuum, 10 years after introduction of Chinese HIV care policies. METHODS: We included patients from Shandong, China, who were diagnosed with HIV from 1992 to 2013. Records were obtained from the HIV/AIDS Comprehensive Response Information Management System to populate a 7-step HIV care continuum. Pearson χ(2) test and multivariate logistic regression were used for analysis. RESULTS: Of 6500 estimated HIV-infected persons, 60.1% were diagnosed, of whom 41.9% received highly active antiretroviral therapy (HAART). Only 59.6% of patients on HAART and 15% of all infected persons achieved viral suppression. Children infected by mother-to-child transmission (MTCT) and persons infected by intravenous drug use were less likely to be linked to and retained in care (odds ratio [OR], 0.33 [95% confidence interval {CI}, .14-.80] and OR, 0.58 [95% CI, .40-.90], respectively). Persons tested in custodial institutions were substantially less likely to be on HAART (OR, 0.22 [95% CI, .09-.59]) compared with those tested in medical facilities. Patients on HAART infected by homosexual or heterosexual transmission and those infected by MTCT were less likely to achieve viral suppression (OR, 0.18 [95% CI, .09-.34]; OR, 0.12 [95% CI, .06-.22]; OR, 0.07 [95% CI, .02-.20], respectively). CONCLUSIONS: Our report suggests, at the current rate, Shandong Province has to accelerate HIV care efforts to close disparities in HIV care and achieve the 90-90-90 goals equitably.

Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China.

Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.

HIV/AIDS-related knowledge and behaviors among rural married migrant women in Shandong Province, China: a comparison study.

Migrant women in China are disproportionately affected by HIV/AIDS. This study described HIV/AIDS-related knowledge and behaviors among married migrant women in Shandong province in comparison to non-migrant local women and identified factors associated with HIV testing history and extramarital sex among married migrant women. A probability-based sample of 1,076 migrant and 1,195 local women were included in the analyses. Compared to local women, married migrant women had lower levels of HIV/AIDS knowledge and were more likely to have had premarital sex, extramarital sex, history of sexually transmitted diseases, and drug use. Less than a quarter of migrant women used condoms consistently in extramarital sex. Only 31.0 % of married migrant women had ever tested for HIV, and the rate of premarital HIV testing was very low. Multivariable analysis showed that married migrant women with a history of extramarital sex were more likely to be from Yunnan province, be living in Yantai city, be in their first marriage, have lower family income, have poor relationship with spouses, use drug, have a history of sexually transmitted diseases, and have lower social support. Our findings provide further evidence that married migrant women are at higher risk for HIV infection and that targeted interventions need to be developed for this population.

[How to properly use the fear in AIDS intervention-the history and further of fear appeal development].

The AIDS epidemic in men who have sex wlth men (MSM) in recent years showed a sharp upward trend, looking for behavioral intervention strategies should be imperative. Fear appeals by fear prompted intervention received intervention information, provide a new breakthrough to achieve better effect of propaganda and intervention. After over 70 years development, the Fear Appeal generated from the driver model that proposed the fear decided the effectiveness of behavior intervention, to the extended parallel process model theory which integrated protection motivation theory and parallel process theory, both of which believed the fear is just one of the estimators, suggested fear is the key factor. The fear appeal theory is turning to be even more comprehensive and accurate. As an important theoretical basement, the fear appeal is still developing, and need more work to make it perfection.

Introducing rapid oral-fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges.

BACKGROUND: This study was conducted to ascertain the feasibility of using rapid oral fluid testing as an alternative HIV testing method in China. METHOD: This is a mixed-method study among men who have sex with men (MSM), female sex workers (FSW) and VCT clients, conducted in 4 cities in Shandong Province. A pre-tested questionnaire was administered to 1137 participants through face-to-face interview to assess demographic characteristics, HIV testing histories and willingness to accept rapid oral fluid testing. VCT clients were provided with the saliva test kits for a screening test and errors in operation were recorded. Testing results were compared between oral and blood testing. Short feedback questionnaire was administered to 200 FSW who had undergone oral testing. RESULTS: The rate of willingness to take oral-fluid HIV testing among MSM, FSW and VCT clients was 72.8%, 72.1% and 67.4% respectively. Common errors recorded during test kit operation by the 229 VCT clients included: unpreparedness, wrong swab sampling, wrong dilution, wrong testing and inability to read test results. Advantages of oral testing listed by participants included: less intrusive, painlessness, easy self- testing and privacy. Disadvantages included perceived unreliable results (55.5%) and not nationally recognised (9%). Comparison of saliva and the blood testing results recorded a consistency rate of 0.970 (χ2 = 153.348, P < 0.001), implying an excellent consistency. CONCLUSION: Introduction of oral rapid fluid testing as an alternative HIV testing method in China is highly feasible but with some challenges including low recognition and operation errors.

Syndemics of syphilis, HCV infection, and methamphetamine use along the east coast of China.

BACKGROUND: An upsurge in club drug use has been observed in recent years in some cities of China, especially methamphetamine, which is quickly replacing heroin to become the most widespread drug across the nation. This study investigated the type of drugs used, syphilis and hepatitis C virus (HCV) infection and the correlates for syphilis, HCV and unprotected commercial sex behavior among drug users in two cities along the east coast of China. METHODS: A cross-sectional survey conducted in 2010 provided demographics, sexual and drug use behaviors, HIV knowledge and the utilization of intervention services among drug users. Blood samples were tested for HIV, syphilis, and HCV infection. RESULTS: Of 805 eligible participants, 0.2% were infected with HIV, 3.7% with HCV, and 9.6% with syphilis. Of the participants, 96.6% were methamphetamine users, 11.9% reported ever having used ≥2 types of these drugs, and 11.4% reported ever injecting drugs. In the multivariable logistic regression analysis, participants infected with syphilis were more likely to be female (adjusted odds ratio (AOR)=2.8, 95% confidence interval (CI): 1.2-6.5), have ever had commercial sex in the past 12 months (AOR=2.0, 95% CI: 1.0-3.9), be infected with HCV (AOR=12.1, 95% CI: 4.1-20.3) and less likely to have ever had sex with regular partners in the past 12 months (AOR=0.2, 95% CI: 0.1-0.6). Participants infected with HCV were more likely to have ever injected drugs (AOR=2.7, 95% CI: 1.1-6.5) and be infected with syphilis (AOR=8.0, 95% CI: 3.5-18.0). Participants who had unprotected sex with commercial sex partners in the last sexual encounter were more likely to be female (AOR=2.9, 95% CI:1.7-4.9), have middle school or lower level education (AOR=3.4, 95% CI:2.0-5.5), never have received intervention in the last year (AOR=2.1, 95%CI:1.2-3.6) and be infected with syphilis (AOR=4.2, 95% CI:2.4-7.4). CONCLUSIONS: Methamphetamine is the predominant drug used among the drug users, the prevalence of syphilis and HCV infection are alarmingly high, and unprotected commercial sex was common among this group. The findings highlight the need for effective, multifaceted interventions addressing sexual and drug use-related risky behaviors among this group. Further research is needed to better understand the causal pathway of the syndemics.

[Analysis of antiviral therapy HIV/AIDS children from Shandong province].

OBJECTIVE: To analyze the outcome among HIV-infected children following antiretroviral treatment in Shandong province. METHODS: From the national AIDS antiviral treatment database during April 2009 and December 2013, 50 children who were according to antiviral treatment in Shandong province were classified as the cases. Regular follow-up observation and test were conducted among children under antiretroviral therapy before treatment,0.5(th), 1(th), 2(th), 3(th), 6(th), 9(th), 12(th) months after treatment, and then one time after every 3 months follow-up after one year. The height and weight of the children under antiretroviral therapy and normal children (2010 national student physical health survey results)were compared during different times. And the height and weight of the follow-up period of situation, the CD4(+)T cell count and viral load, regular physical examination results, the incidence of opportunistic infections were compared with baseline data. RESULTS: Among the 50 children under antiviral therapy, male accounted for 54.0% (27/50) , female 46.0% (23/50) , the youngest was 2 years of age, the oldest was 15 years old, and all of them were transmitted by the mother-to-child route and none received mother-to-child prevention. The shortest treatment time lasted five months, the longest 61 months, with a median 25 months. The height of the baseline, 12(th), 24(th), 36(th) months after antiviral treatment were ( 111.9 ± 23.4), (118.1 ± 20.9), (127.1 ± 13.9), (135.4 ± 10.2)cm, and weigh were ( 20.6 ± 8.7), (23.8 ± 6.3), (27.8 ± 7.2), (30.7 ± 5.5) kg, respectively. The height and weight of the treated children were higher than those in the baseline (P < 0.05), but lower than those among the children without HIV infection. The CD4(+)T lymphocytes level of the baseline, 3(th), 6(th), 12(th), 24(th), 36(th) months after antiviral treatment were 224.0, 279.5, 465.0, 581.0, 640.0, 728.0/µl, the CD4(+)T lymphocytes level after antiviral treatment were higher than the baseline (P < 0.05). Hemoglobin and AST were significantly different between children received treatment after 24 months and those in the baseline (P < 0.05), baseline and 24(th) months after treatment the hemoglobin value were (106.6 ± 22.2), (125.2 ± 5.8), and the AST measurements were (42.1 ± 23.1), (23.4 ± 15.6). Baseline and 12(th), 24(th) months after treatment, the median of viral load were 10 000.0, 105.0,0.0 copies/ml , and the ratio of viral load ≤ 400 copies/ml were 50% (4/8) , 65% (22/34) , 88% (14/16) , respectively, the results of viral load had significant difference among 12(th), 24(th) months after antiviral treatment and baseline (P < 0.05). The incidence of opportunistic infections was 62% (31/50) before treatment, and 12% (6/50) after the antiviral therapy. CONCLUSION: Antiviral therapy can effectively improve the immunity and reduce the incidence of opportunistic infections which is helpful to improve the quality of life among HIV-infected children following antiretroviral treatment in Shandong province.

[A retrospective cohort study on survival time of AIDS death cases receiving Antiretroviral Therapy and related factors].

OBJECTIVE: To analyze survival time of AIDS death cases receiving Antiretroviral Therapy and related factors. METHODS: A retrospective cohort study was carried out to collect the data on death cases receiving Antiretroviral Therapy by the National HIV/AIDS Comprehensive Response Information Management System. Kaplan-Meier was used to calculate the median survival time, and compare survival time among different groups of age, sex, marriage status, infectious routes, WHO clinical stage, baseline CD4(+)T cell counts, and interval time from the start of ART to HIV confirmation. Life table and survival curve were applied to describe survival distribution. Cox proportional hazard model was used to determine the factors associated with the survival time. RESULTS: Among 142 AIDS death cases, 125 (88.03%) were related with AIDS and 17(11.97%) were not. The total median survival time was 3.100 months (95%CI: 2.279-3.921). The cumulative survival rate was (52 ± 4)%, (33 ± 4)%, (26 ± 4)% in the first 3 months, 3-6 months, and 6-12 months. The median survival time of married or cohabitation group was 2.670 months (95%CI:1.470-3.870), and single (unmarried, divorced, separation, widowed) group was 5.870 months (95%CI: 2.617-9.123). The median survival time of WHO clinical stage I or II group was 5.870 months (95%CI: 3.989-7.751), and WHO clinical stage III or IV group was 1.700 months (95%CI: 0.885-2.515). The median survival time of baseline CD4(+)T cell counts ≤ 50 /µl group was 1.670 months (95%CI: 0.759-2.581), and 51-199 /µl group was 4.400 months (95%CI: 2.735-6.065), and ≥ 200/µl group was 7.100 months (95%CI: 0.000-14.542). The survival time was significantly different among different baseline marital status groups, different WHO clinical stage groups, and different CD4(+)T cell counts groups. The mortality risk of Single (unmarried, divorced, separation, widowed) group was 0.641 times of the risk in married or cohabitation group. The mortality risk of WHO clinical stage III or IV was 1.856 times of the risk in stage I or II. The mortality risk of baseline CD4(+)T cell counts 51-199 /µl group was 0.582 times of the risk in ≤ 50 /µl group, and ≥ 200 /µl group was 0.551 times of the risk in ≤ 50 /µl group. CONCLUSION: The total median survival time was relatively short. Most AIDS deaths happened in the first 3 months or 3-6 months after they received Antiretroviral Therapy, and the mortality trend slowed down in the following months. Married or cohabitation, low-baseline CD4(+)T cell counts, or WHO clinical stage III or IV were found to be the risk factors associated with AIDS death cases receiving Antiretroviral Therapy.

Dual epidemics of syphilis and methamphetamine use among drug users in Shandong Province of China.

We assessed the types of drugs, the prevalence of HIV, syphilis, and its correlates among Shandong's drug users in China. Two consecutive cross-sectional surveys in 2009 and 2010 provided demographics, types of drugs, sexual and drug-use behaviors, and HIV-related services. Of the 1320 unique, eligible participants, 81.1% were male, two-thirds <35 years of age, 13.0% non-Shandong residents; in the past year, majority (96.4%) reported ever using methamphetamine, 3.4% using heroin, 8.6% using ≥2 types of these drugs and 8.0% injecting drugs, 63.8% having commercial sex. HIV and syphilis prevalence were 0.2% and 8.3%, respectively. In multivariable logistic regression analysis, syphilis was independently associated with female, non-Shandong residents, higher levels of education, and 2010. Synthetic drugs, especially methamphetamine, have become the predominant sources of drug addiction. The emerging epidemic of syphilis potentially driven by methamphetamine use underscored the urgency to implement an effective sex and substance use-related intervention.

An integrated individual, community, and structural intervention to reduce HIV/STI risks among female sex workers in China.

BACKGROUND: We assessed the effectiveness of an integrated individual, community, and structural intervention to reduce risks of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs). METHODS: The integration individual, community, and structural intervention was implemented from 2004 to 2009 in six counties of Shandong Province. Post-intervention cross-sectional surveys were conducted in six intervention counties and 10 control counties. RESULTS: Of 3326 female sex workers were recruited and analyzed in the post-intervention survey with 1157 from intervention sites and 2169 from control sites. No HIV positive was found in both intervention and control counties. The rate of syphilis was 0.17% for intervention sites and 1.89% for control sites (OR=11.1, 95% CI: 2.7, 46.1). After adjusted for age, marital status, education, economic condition, recruitment venues, the rates of condom use in the last sex with clients(AOR=2.7; 95% CI: 1.9, 3.8), with regular sex partners(AOR=1.5; 95% CI: 1.1, 1.9) and consistent condom use in the last month with clients (AOR=3.3; 95% CI: 2.6, 4.1) and regular sex partners (AOR=1.7; 95% CI: 1.3, 2.3) were significantly higher in intervention sites than that in control sites. The proportion of participants correctly answered at least six out of eight HIV-related questions (83.3%) in intervention sites is significant higher than that (21.9%) in control sites (AOR=24.7; 95% CI: 2.5, 42.7), the five indicators related to HIV-related intervention services ever received in the last year including HIV testing(AOR=4.9; 95% CI: 2.8, 6.7), STD examination and/or treatment(AOR=5.1; 95% CI: 4.2, 6.4), free condom(AOR=20.3; 95% CI: 14.3, 28.9), peer education(AOR=4.3; 95% CI: 3.5, 5.4), education materials(AOR=19.8; 95%CI: 13.1, 29.8) were significantly higher in intervention sites than that in control sites, the participants in the intervention sites are more likely to seek medical treatment when they had any disorders (AOR=3.2; 95% CI: 2.5, 4.2). CONCLUSION: This study found that the integrated individual, community, and structural intervention showed positive impact in reducing HIV and STI risks among FSWs.

[Mutation of drug resistant gene in HIV/AIDS patients with antiretroviral therapy in Shandong province in 2011].

OBJECTIVE: To investigate drug resistance status in patients with highly active antiretroviral therapy (HAART) in Shandong province. METHODS: A total of 758 patients were separated from the anticoagulatory whole blood during May and October in 2011. The entire protease gene and part of the reverse transcriptase gene were amplified by RT-PCR and nest-PCR in the samples with viral load larger than 1000 copies/ml, then sequenced the gene fragments. Mutation of drug resistant gene and drug susceptibility was analyzed by the online tool HIV db program developed by Stanford University. RESULTS: The rate of virologic failure in patients was 9.1% (69/758). A total of 53 gene sequences that acquired were used for genotypic resistance analysis. A total of 23 patients were indicated drug resistance with the total of 3.1% (23/742). Drug resistance rates of nucleotide reverse transcriptase inhibitor (NRTI) and non-NRTI(NNRTI) were 2.4% (18/742) and 3.0% (22/742), respectively, and the primary mutation types of drug resistance were M184V and Y181C for NRTI and NNRTI, with no resistance to protease inhibitor (PI). In the 23 patients indicated drug resistance, 78.3% (18/23) were NRTI resistance, 95.7% (22/23) were NNRTI resistance and 73.9% (17/23) dual NRTI and NNRTI resistance. CONCLUSION: The presence of drug resistant gene in HIV strains among AIDS patients with HAART in Shandong province was at low level, but mutation diversity was found in drug resistant gene.

Commercial sex venues, syphilis and methamphetamine use among female sex workers.

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.

Predictors of consistent condom use based on the Information-Motivation-Behavioral Skills (IMB) model among female sex workers in Jinan, China.

BACKGROUND: Female commercial sex workers (FSWs) are at high risk of human immunodeficiency virus (HIV) transmission in China. This study was designed to examine the predictors of condom use with clients during vaginal intercourse among FSWs based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between IMB model constructs. METHODS: A cross-sectional study was conducted in Jinan of Shandong Province, from May to October, 2009. Participants (N = 432) were recruited using Respondent-Driven Sampling (RDS). A self-administered questionnaire was used to collect data. Structural equation modeling was used to assess the IMB model. RESULTS: A total of 427 (98.8%) participants completed their questionnaires. Condom use was significantly predicted by social referents support, experiences with and attitudes toward condoms, self-efficacy, and health behaviors and condom use skills. Significant indirect predictors of condom use mediated through behavioral skills included HIV knowledge, social referents support, and substance use. CONCLUSIONS: These results suggest that the IMB model could be used to predict condom use among Chinese FSWs. Further research is warranted to develop preventive interventions on the basis of the IMB model to promote condom use among FSWs in China.

[Analysis of condom use and its factors on female sex workers in Shandong province].

OBJECTIVE: This study was to investigate the condom use and its factors on sex workers in Shandong province, and to provide effective suggestions for AIDS prevention strategies and interventions. METHODS: From April to July in 2009, 4732 female sex workers were investigated through anonymous questionnaires from 11 cities which were selected based on the AIDS epidemic, geographic location, economic conditions in Shandong province. Serum samples were collected and antibodies were tested by ELISA and TPPA from 4641 people. RESULTS: 4732 female sex workers who were 15 - 58 years old were investigated and the majority belonged to the low age group (≤ 24 years old) which accounted for 61.5% (2912/4732). Among the 4732 female sex workers, the unmarried, the divorced, or the widowed females accounted for 72.8% (3441/4725) and 72.0% (3403/4726) of them were poorly educated.42.3% (1994/4719) of them were found from other provinces. The right answers for knowledge of AIDS accounted for 45.7% (2164/4732). 80.6% (3416/4236) of these females were found to used condoms in the most recent commercial sex activity. The rate of consistently using condoms in sex activity during the last month was 58.4% (2467/4221). In this survey, 7.3% (337/4637) of investigated females had been diagnosed with sexually transmitted diseases, 30.7% (1449/4726) of them had received HIV antibody test, 70.4% (3323/4732) of these people had received the AIDS intervention services, and 3.6% (167/4668) of them had ever used drug. Multivariate logistic regression analysis showed that high education level (junior high school or lower vs senior high school or higher, adjusted OR = 0.77, 95%CI: 0.67 - 0.90), having received the HIV intervention (received vs unreceived, adjusted OR = 1.36, 95%CI: 1.17 - 1.58), antibody detection (done vs not done, adjusted OR = 1.33, 95%CI: 1.15 - 1.55), and good knowledge about AIDS (low score group vs high score group, adjusted OR = 0.37, 95%CI: 0.32 - 0.44) were independent factors that increased safe sex behavior; while using drug (drug vs not drug, adjusted OR = 0.22, 95%CI: 0.15 - 0.31) was a negative factor. CONCLUSION: The prevalence rate of HIV infection among female sex workers was low in Shandong province. However, the low rate of condom use and the high prevalence of self-reported STD-related symptoms suggested that more attentions should be paid to the factors of risk behaviors, and more targeted interventions are critically needed.

[The prevalence and evolution of HIV drug-resistant strains in people who live with HIV/AIDS during HIV antiretroviral therapy in Shandong province].

OBJECTIVE: To understand the prevalence and evolution of HIV drug-resistant strains in people who live with HIV/AIDS (PLWHA) during HIV antiretroviral therapy in Shandong province. METHODS: Viral load testing was performed by using fluorescence real-time quantitative PCR (NucliSens EasyQ system) on 324 patients who were under HIV antiretroviral therapy (ART) over 1 year in Shandong province. HIV resistance testing was conducted on the samples with more than 1000 copies/ml by using genotypic resistance testing method established in our lab. We tested the samples from drug-resistant patients before and after treatment to analyze the evolution of HIV resistant strains. RESULTS: The resistance rate for the patients under HIV ART over 1 year was 6.2% (20/324). The rate of drug-resistant mutation, but not resistant to ART was 0.6% (5/324). Nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs (NNRTIs) accounted for 93.1% (94/101) and protein inhibitors (PIs) accounted only 6.9% (7/101) of all mutations. M184V (48.0%, 12/25) and Y181C (32.0%, 8/25) were the most frequent mutations among 25 samples. Our research showed 20.0% (2/10) patients were resistant to primary ART and 1 patient was detected drug resistance in 6 months after ART treatment. HIV evolved from wild type to drug resistant virus, from low level to high level drug resistance, and from resistance to few to multiple drugs. In addition, interactions between mutations may influence the sensitivity of patients to other drug treatment. CONCLUSION: The prevalence of HIV drug-resistant strains in Shandong province is still at a low level, but its evolution is complex.

HIV infection and mental health of "money boys": a pilot study in Shandong Province, China.

A pilot study was conducted in eight cities of Shandong Province, China to examine the seroprevalence of HIV and syphilis infection, and the mental health of "money boys" who were recruited by respondent-driven sampling and interviewed using a semi-structured questionnaire. The prevalence of the HIV-positive among money boys was 5.1%. Factors associated with the infection were having sex with women in the past 6 months (p < 0.05) and suffering STD-like symptoms (p < 0.01). The prevalence of syphilis was 10.2%. There were 77.2% participants engaged in such an occupation for economic survival. The prevalence of anxiety and depression among money boys was 46.6% and 68.1%, respectively. Heterosexual money boys were more likely to suffer from such mental symptoms. This study revealed the urgent need for interventions for HIV/AIDS control, together with mental counseling, targeting this vulnerable population.

Digital crowdsourced intervention to promote HIV testing among MSM in China: study protocol for a cluster randomized controlled trial.

BACKGROUND: Men who have sex with men (MSM) are an important HIV key population in China. However, HIV testing rates among MSM remain suboptimal. Digital crowdsourced media interventions may be a useful tool to reach this marginalized population. We define digital crowdsourced media as using social media, mobile phone applications, Internet, or other digital approaches to disseminate messages developed from crowdsourcing contests. The proposed cluster randomized controlled trial (RCT) study aims to assess the effectiveness of a digital crowdsourced intervention to increase HIV testing uptake and decrease risky sexual behaviors among Chinese MSM. METHODS: A two-arm, cluster-randomized controlled trial will be implemented in eleven cities (ten clusters) in Shandong Province, China. Targeted study participants will be 250 MSM per arm and 50 participants per cluster. MSM who are 18 years old or above, live in the study city, have not been tested for HIV in the past 3 months, are not living with HIV or have never been tested for HIV, and are willing to provide informed consent will be enrolled. Participants will be recruited through banner advertisements on Blued, the largest gay dating app in China, and in-person at community-based organizations (CBOs). The intervention includes a series of crowdsourced intervention materials (24 images and four short videos about HIV testing and safe sexual behaviors) and HIV self-test services provided by the study team. The intervention was developed through a series of participatory crowdsourcing contests before this study. The self-test kits will be sent to the participants in the intervention group at the 2nd and 3rd follow-ups. Participants will be followed up quarterly during the 12-month period. The primary outcome will be self-reported HIV testing uptake at 12 months. Secondary outcomes will include changes in condomless sex, self-test efficacy, social network engagement, HIV testing social norms, and testing stigma. DISCUSSION: Innovative approaches to HIV testing among marginalized population are urgently needed. Through this cluster randomized controlled trial, we will evaluate the effectiveness of a digital crowdsourced intervention, improving HIV testing uptake among MSM and providing a resource in related public health fields. TRIAL REGISTRATION: ChiCTR1900024350 . Registered on 6 July 2019.

Prevalence and Trends of HIV, Syphilis, and HCV in Migrant and Resident Men Who Have Sex with Men in Shandong, China: Results from a Serial Cross-Sectional Study.

BACKGROUND: Migrant men who have sex with men (MSM) have a higher predisposition for HIV transmission. We aimed to determine and compare the prevalence and trends of HIV, Syphilis, and HCV between migrant and resident MSM in Shandong, China. METHODS: A serial cross-sectional study was conducted in eight cities in Shandong, China from 2010 to 2014. The surveys collected information on demographics, HIV-related knowledge, and HIV-related behaviors including the serologic status of HIV, syphilis, and HCV. Bivariate and multivariable logistic regressions were used to determine differences between migrant and resident MSM. RESULTS: The overall prevalence of HIV among the 15,705 MSM (14120 were resident, 1580 were migrant and 5 were missing) was 2.6%, with an increase of 1.0% in 2010 to 4.4% in 2014. Prevalence of HIV was higher among migrant MSMs (5.5%) compared to resident MSMs (2.3%). Compared to residents, migrants also had higher prevalence of syphilis (7.5% vs 4.9%) and HCV (1.1% vs 0.6%). We found that there was an increase in the proportion of migrant MSM engaging in anal sex [adjusted OR (AOR) = 1.41 in migrants vs 1.12 in residents], condom use during last anal sex (AOR = 1.14 in residents, P for trend = 0.32), consistent condom use (AOR = 1.04 residents, P for trend = 0.11) and drug use (AOR = 1.51 in migrants and 1.29 among residents). Except in the year 2011, receiving some health services in last year was significant for people who were HIV-positive compared to negative. (P for trend <0.05). CONCLUSIONS: Prevalence of HIV increased in resident as well as migrant MSMs. The migrant MSMs had higher STIs compared to resident MSMs and therefore, should be targeted for effective interventions aimed at reducing their risk behaviors. Deeper understanding of the role of migration in health issues is required for combating the persistently high and gradually increasing HIV burden in MSM in China.