Evaluation of the three-in-one team-based care model on hierarchical diagnosis and treatment patterns among patients with diabetes: a retrospective cohort study using Xiamen's regional electronic health records.

BACKGROUND: Xiamen is a pilot city in China for hierarchical diagnosis and treatment reform of non-communicable diseases, especially diabetes. Since 2012, Xiamen has implemented a program called the "three-in-one", a team-based care model for the treatment of diabetes, which involves collaboration between diabetes specialists, general practitioners, and health managers. In addition, the program provides financial incentives to improve care, as greater accessibility to medications through community health care centers (CHCs). The aim of this study was to evaluate the effectiveness of these policies in shifting visits from general hospitals to CHCs for the treatment of type 2 diabetes mellitus (T2DM). METHOD AND MATERIALS: A retrospective observational cohort study was conducted using Xiamen's regional electronic health record (EHR) database, which included 90% of all patients registered since 2012. Logistic regression was used to derive the adjusted odds ratio (OR) for patients shifting from general hospitals to CHCs. Among patients treated at hospitals, Kaplan-Meier(KM) curves were constructed to evaluate the time from each policy introduction until the switch to CHCs. A k-means clustering analysis was conducted to identify patterns of patient care-seeking behavior. RESULTS: In total, 89,558 patients and 2,373,524 visits were included. In contrast to increased outpatient visits to general hospitals in China overall, the percentage of visits to CHCs in Xiamen increased from 29.7% in 2012 to 66.5% in 2016. The most significant and rapid shift occurred in later periods after full policy implementation. Three clusters of patients were identified with different levels of complications and health care-seeking frequency. All had similar responses to the policies. CONCLUSIONS: The "three-in-one" team-based care model showed promising results for building a hierarchical health care system in China. These policy reforms effectively increased CHCs utilization among diabetic patients.

Pattern of HIV testing and multiple sexual partnerships among men who have sex with men in China.

BACKGROUND: Men who have sex with men (MSM) are a hidden but emerging population susceptible to HIV infection against a background of rapidly increasing HIV prevalence in China. Low HIV testing levels and multiple partnerships among MSM are two major contributing factors to HIV transmission. METHODS: We conducted a cross-sectional survey among 447 Chinese MSM in Changsha and Tianjin cities from November to December 2011 using an anonymous questionnaire. We aim to investigate (1) the trend of HIV testing rates among Chinese MSM during 2009 to 2011; and (2) the patterns of multiple sexual relationships with male, female and commercial partners. RESULTS: The self-reported past-12-months HIV testing level among Chinese MSM increased from 16.6% in 2009 to 46.3% in 2010 and 58.6% in 2011 (χ(2) = 173.49, p < 0.001). Compared with men who have tested for HIV, the never-tested MSM were generally younger, never married, students, and more likely to have unprotected anal intercourse with non-commercial male partners. Furthermore, 21.3% (56/263) MSM reported having multiple regular male and female sexual partnerships and 6.2% (16/257) reported having commercial male partners in the past six months. However, individuals who were never-tested for HIV are consistently less likely to engage in multiple sexual relationships. CONCLUSIONS: HIV testing rates have increased substantially among Chinese MSM in the period 2009-2011, although significant barriers to testing remain. Multiple sexual partnerships, and especially bisexual behaviours, are common among Chinese MSM.

HIV prevalence and related risk factors among male sex workers in Shenzhen, China: results from a time-location sampling survey.

BACKGROUND: HIV transmission among men who have sex with men has recently become a major concern in China. Little is known, however, about HIV transmission among male sex workers (MSW). This study aimed to investigate HIV infection prevalence and risk factors among MSW in Shenzhen, China. MATERIALS AND METHODS: Following formative research, a cross-sectional study was conducted using time-location sampling among MSW in Shenzhen, from April to July 2008. Behavioural and serological data on HIV and syphilis were collected. The risk factors for HIV infection were analysed using a logistic regression model. RESULTS: In total, 394 MSW were recruited for the survey. The prevalence of HIV and syphilis among these workers was 5.3% and 14.3%, respectively. Only a quarter of the MSW self-identified as homosexual. More than 70% had sex with both men and women. HIV-related knowledge levels were high regardless of HIV serostatus. Consistent condom use was low (37.1%) and varied by type of sexual partner. Factors including more non-commercial male partners, working in small home-based family clubs, being drunk before sexual intercourse, having a history of HIV tests, syphilis infection and a short period of residence in Shenzhen were associated with an increased risk of HIV infection. CONCLUSIONS: High-risk sexual practices were common among MSW regardless of their high level of HIV awareness. The working venues were associated with HIV infection and a recent test for HIV was a potential predictor of HIV infection. The time-location sampling method was found to be an appropriate way of recruiting MSW for this study, especially those without fixed working places.

Stigmatizing attitudes and behaviors toward PLHA in rural China.

Stigma is a significant barrier to effective control of HIV/AIDS, despite laws to control it. The purpose of this study was to examine factors associated with HIV stigma in a rural Chinese community. A survey was conducted in north-west Anhui province among 963 residents to assess HIV-related knowledge, attitudes, and behaviors. Participants scored a mean of 16.6/26 (63.8%) for knowledge. Sixty-eight percent of respondents held at least one fear of casual transmission, 42% would blame people living with HIV/AIDS (PLHA) for their disease, and 73% thought having HIV is shameful. More than half reported that they had observed at least one stigmatizing behavior toward PLHA in their villages. Multivariable analysis indicated that people with higher education, higher HIV knowledge, higher household wealth and who learned about HIV from professional sources were less likely to hold a stigmatizing attitude, while people who had observed discriminating behaviors toward PLHA in their community and lived in villages with fewer PLHA were more likely to hold a stigmatizing attitude. Despite education campaigns, knowledge remains low and stigmatizing attitudes and behaviors toward PLHA remain a problem.

Evaluation of Electronic Healthcare Databases for Post-Marketing Drug Safety Surveillance and Pharmacoepidemiology in China.

INTRODUCTION: Electronic healthcare databases (EHDs) are used increasingly for post-marketing drug safety surveillance and pharmacoepidemiology in Europe and North America. However, few studies have examined the potential of these data sources in China. METHODS: Three major types of EHDs in China (i.e., a regional community-based database, a national claims database, and an electronic medical records [EMR] database) were selected for evaluation. Forty core variables were derived based on the US Mini-Sentinel (MS) Common Data Model (CDM) as well as the data features in China that would be desirable to support drug safety surveillance. An email survey of these core variables and eight general questions as well as follow-up inquiries on additional variables was conducted. These 40 core variables across the three EHDs and all variables in each EHD along with those in the US MS CDM and Observational Medical Outcomes Partnership (OMOP) CDM were compared for availability and labeled based on specific standards. RESULTS: All of the EHDs' custodians confirmed their willingness to share their databases with academic institutions after appropriate approval was obtained. The regional community-based database contained 1.19 million people in 2015 with 85% of core variables. Resampled annually nationwide, the national claims database included 5.4 million people in 2014 with 55% of core variables, and the EMR database included 3 million inpatients from 60 hospitals in 2015 with 80% of core variables. Compared with MS CDM or OMOP CDM, the proportion of variables across the three EHDs available or able to be transformed/derived from the original sources are 24-83% or 45-73%, respectively. CONCLUSIONS: These EHDs provide potential value to post-marketing drug safety surveillance and pharmacoepidemiology in China. Future research is warranted to assess the quality and completeness of these EHDs or additional data sources in China.

Current situation and challenge of registry in China.

Increasing emphasis has been placed on registries for an organized system used in developing clinical research to improve health care. China has sufficient data that can be applied broadly, but the heterogeneity and irregularity of registries limit their applicability. This article aims to describe the status of registries in China and the related challenges. Patient registries for observational studies were retrieved from the International Clinical Trials Registry to quantitatively evaluate the number of comparatively high-quality registries in China. A literature search was also performed to provide support and updates. A total of 64 patient registries were retrieved from ClinicalTrials.gov using disease, product, and health service as criteria. The sample sizes ranged from 15 to 30,400, with only 12 registries marked as completed. This article describes and compares the detailed information in many aspects. The efficient use of registries has already made considerable progress in China; however, registries still require standardization, high-quality transition, and coordinated development.

Evolution of men who have sex with men community and experienced stigma among men who have sex with men in Chengdu, China.

OBJECTIVES: To understand the stigma and discrimination experienced by men who have sex with men (MSM) in Chengdu, and to evaluate their impact on effective HIV prevention. METHODS: Focus group discussions and individual in-depth interviews were conducted from June to September 2006. RESULTS: Stigma and social pressure for MSM were reported to mainly arise from their families to get married and have children to protect family reputation and lineage. Few participants reported experiencing stigma and discrimination from friends, colleagues, or general society. Nevertheless, fear of being ostracized because of their sexual orientation was frequently expressed, and was a major barrier for participating in HIV/AIDS prevention programs. Fear of stigma and discrimination related to HIV infection from inside the MSM community was also identified as a major reason for MSM reluctance to seek HIV testing and treatment. CONCLUSIONS: Stigma and discrimination related to homosexual activities and HIV/sexually transmitted disease infection have been major barriers for MSM seeking health services. HIV/AIDS programs must be sensitive to issues of stigma both from outside and inside the MSM community.

HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection.

OBJECTIVE: To assess the prevalence of HIV and selected sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Chengdu, China, and the risk factors associated with HIV infection. METHODS: A cross-sectional study using a snowball sampling method was conducted from March to July 2007. Participants were asked to complete a questionnaire about sexual history, high-risk behaviors, STD infection history, HIV knowledge and testing, and an assessment of depression. Blood samples were taken for antibody testing for HIV, herpes simplex virus 2 (HSV-2), and syphilis. RESULTS: A total of 538 MSM were recruited, and 513 (95.4%) consented to complete the questionnaire. HIV, HSV-2, and syphilis prevalence were 9.1%, 24.7%, and 28.1%, respectively. The rate of consistent condom use was low and varied by types of sexual partners. The highest was with casual male partners (38.6%), and the lowest was with wife or girl friend (17.8%). Money boys were 6 times more likely to be infected with HIV compared with clerks/students. Infection with either HSV or syphilis increased the risk of HIV infection more than 4-fold. CONCLUSIONS: The prevalences of HIV and STDs were high among MSM in Chengdu. To prevent HIV/STDs, campaigns promoting condom use are needed not only to boost the frequency of condom use but also to educate MSM about proper condom use.

Acceptance of and barriers to voluntary HIV counselling and testing among adults in Guizhou province, China.

OBJECTIVES: To find and compare the levels of acceptance of and barriers to voluntary counselling and testing (VCT) among adults in two different counties of Guizhou province, China, one in which the China CARES project was operating and the other in which it was not. DESIGN: A longitudinal design with two-stage cluster sampling was employed. METHODS: A total of 1012 participants were recruited in the two counties. All participants were interviewed, then given a coupon for free VCT after the interview. Participants were paid for returning the coupon within 2 months, whether tested or not. The uptake of VCT was measured within 2 months after the interview. RESULTS: The study found that the levels of HIV/AIDS knowledge and acceptability of VCT among the adults in both counties were low. Although 459 participants (43.5%) expressed an intent to use the VCT services, only 193 (16.5%) actually visited the VCT facilities, and only 42 (3.7%) actually took an HIV test within 2 months after the interview. The use of VCT was related to occupation, age, transportation difficulties, health status, ethnicity, and high-risk behaviors. The main barriers to HIV testing included perceiving oneself as low risk, fear of unsolicited disclosure, and fear of stigma and discrimination that would result from taking the test. CONCLUSION: Education about HIV/AIDS and VCT needs to be improved, and levels of stigma and discrimination reduced, in order to enhance the uptake of VCT services, an essential step for the initiation of treatment.