Correlation between HIV infection, club drug use and anal canal human papillomavirus infection in men who have sex with men in Taizhou / 中华流行病学杂志

Objective: To explore the correlation between club drug use and anal canal human papillomavirus (HPV) infection in HIV-negative and HIV-positive men who have sex with men (MSM) in Taizhou. Methods: A cross-sectional survey was conducted in Taizhou. HIV-negative MSM were recruited by convenient sampling in voluntary counseling and testing clinics of Taizhou prefectural CDC from August 2016 to October 2017, and HIV-positive MSM were recruited through the routine follow-up and management by Taizhou prefectural CDC from August 2016 to June 2019. A face-to-face questionnaire interview was conducted to collect the information about the socio-demographic characteristics, sexual orientation, sexual behavior, club drug use and other information of the participants. Anal canal swabs were collected for HPV genotyping. The correlation between club drug use and the prevalence of HPV infection were evaluated with χ2 test and logistic regression analysis. Results: A total of 69 HIV-negative and 345 HIV-infected MSM were included. The prevalence of any type of anal canal HPV infection in HIV-negative MSM (27.5%, 19/69) was lower than that in HIV-positive MSM (66.4%, 229/345) (χ2=36.114,P<0.001). The prevalence of self-reported club drug use in HIV-negative MSM was higher (17.4%, 12/69) than that in HIV-positive MSM (7.0%, 24/345) (χ2=7.886, P=0.005). For HIV-negative MSM, the prevalence of club drug use was higher in MSM who had homosexual group sex (P=0.036); the prevalence of HPV infection was 50.0% (6/12) in club drug users and 22.8% (13/57) in non-club drug users (χ2=3.674, P=0.055). For HIV-positive MSM, the prevalence of HPV infection was 70.8% (17/24) in club drug users and 66.0% (212/321) in non-club drug users (χ2=0.230, P=0.632). Multivariable logistic regression model showed that HPV infection in MSM was positively correlated with HIV infection (OR=5.42, 95%CI: 2.92-10.06), and the association between HPV infection and club drug use (OR=1.66, 95%CI: 0.75-3.71) was not significant. Conclusions: HIV infection was positively correlated with anal canal HPV infection in MSM in Taizhou. Club drug use was positively correlated with high-risk sexual behaviors, while its association with HPV infection needs further study.

Prevalence of obesity among primary and middle students in Taizhou City / 上海预防医学

Objective To understand the prevalence of obesity among primary and middle school students in Taizhou, and provide scientific evidence for prevention and control. Methods A primary school, a middle school and a high school were randomly selected from each of 9 counties(cities or districts)in Taizhou using stratified sampling. We collected data on height, weight and age to calculate body mass index(BMI)and evaluated it according to the Appendix A of Technical Specification for Student Health Examination(GB/T 26343-2010)"Screening Standards for Overweight and Obesity in Children and Adolescents". Descriptive statistics of obesity was conducted. Results The prevalence of obesity among primary, middle, and high school students in Taizhou was 8.08%. It was higher among boys(10.80%)than girls(5.08%)(P < 0.05). The trend of obesity significantly decreased among students in different schools was as follows:primary school > middle school > high schoolt(χboy2 = 259.309, P < 0.001; χgirl2 = 244.679, P < 0.001), regardless of sex. Conclusion Obesity among primary, middle, and high school students in Taizhou remains high, with an increasing trend in recent years. The targeted population for prevention and control is 7-12-year-old primary school students, especially boys.

Epidemiological investigation on a cluster epidemic of COVID-19 in Taizhou， Zhejiang Province / 上海预防医学

Objective:To analyze the epidemiological characteristics of a family and workplace clustering of COVID-19， identify the source of infection and the transmission chain， and provide evidence for prevention and control of COVID-19 pandemic. Method:Field epidemiological method was used to conduct the investigation of confirmed cases and close contacts in this cluster. Data were analyzed with descriptive method. Real-time fluorescent quantitative PCR （RT-PCR） was used to detect the novel coronavirus nucleic acid in the collected respiratory tract samples. Results:A total of 18 epidemiological related cases were collected including 16 confirmed cases and 2 cases of asymptomatic infections. The involved places included 1 beauty clinic workplace and 3 families. Seven cases were males and 11 cases were females， with the minimum， maximum and median age of 3， 65 and 32 years old， respectively. Among them， the employees attack rate was 9.80% （10/102）， the family attack rate was 7.70% （5/78）， and the customer attack rate was 0.58% （1/173）. Positive nucleic acid test result in the respiratory tract sample of asymptomatic infection lasted for more than 2 months. Conclusions:The cause of this clustered COVID-19 epidemic is that the workplace environment is relatively closed with clustering crowds， and the source of imported infection is not discovered in time， which lead to a point-source outbreak and spread through family close contacts and clustering.

Comparison of risk for HIV, syphilis and HCV infection between club drug users and traditional drug users in TaizhouCity / 上海预防医学

Objective To compare the risk for HIV, syphilis and HCV infection between club drug users and traditional drug users in Taizhou City of Zhejiang Province, in order to provide evidence for further behavioral intervention. Methods Drug users in Taizhou were surveyed with the questionnaires for national HIV sentinel surveillance during 2016-2019.Blood samples were collected for detection of HIV, syphilis and HCV antibodies. Results A total of 1 612 drug users were surveyed, in which club drug users accounted for 78.7% and traditional drug users 21.3%.Significant differences were observed in gender, age, educational level, ethnic background, and household registration between these two groups (P < 0.05).Among club drug users, injecting drug users accounted for 7.1%, lower than traditional drug users (P < 0.001).Among the injecting drug users, those who shared needles with others accounted for 8.9%, similar to the traditional drug users (P>0.05).In the past year, the proportion of having sex after drug abuse among club drug users was 77.9%, higher than traditional drug users (P=0.002).The proportion of condom use during sex were nearly 30.0% for both club drug users and traditional drug users.Of the club drug users, 0.2% were infected with HIV, which was not significantly different from that in traditional drug users (P>0.05).The prevalence of syphilis among club drug users was 12.6%, higher than traditional drug users (P < 0.05);whereas the HCV prevalence (10.4%) was lower among club drug users (P < 0.001). Conclusion The threats of blood-borne transmission and sexual transmission of diseases are common among club drug users, suggesting the need of targeted intervention measures.

Characteristics and influencing factors of heterosexual behavior among young men who have sex with men in Taizhou City from 2015 to 2018 / 中华疾病控制杂志

Objective To investigate characteristics and influencing factors of heterosexual behavior among young men who have sex with men (YMSM) in Taizhou, and to provide evidence for conducting intervention on acquired immune deficiency syndrome (AIDS). Methods The demographic characteristics, behavioral characteristics and AIDS related knowledge of YMSM in Taizhou were investigated by the method of questionnaire survey from January to July in 2015, February to September in 2016, January to August in 2017, and January to August in 2018. Human immunodeficiency virus (HIV), syphilis and hepatitis C virus (HCV) were tested in everyone. Results A total of 432 YMSM were recruited, including 56 YMSM who had heterosexual behavior. 14.3% of YMSM who had heterosexual behavior never used condoms when having heterosexual behavior. 26.8% did not use condoms when having the last heterosexual behavior. The detection rates of HIV and syphilis were both 5.4%. No HCV positive person was found. The awareness rate of AIDS related knowledge was 91.1%. In multivariate logistic regression, marital status and local residence time were influencing factors of heterosexual behavior among YMSM. Conclusions YMSM in Taizhou are at risk of spreading HIV and syphilis. Although the awareness rate of AIDS related knowledge is better, there are still high-risk behavior such as commercial sex behavior and knowledge-practice separation such as not using condoms. It is necessary to promote intervention activities for safe sexual behavior, especially among YMSM who are married and live in the local areas for less than 2 years.

Characteristics of patients on methadone maintenance treatment in Taizhou City / 预防医学

Objective To investigate the characteristics of methadone maintenance treatment(MMT)clients, and to explore their retention rate and associated factors in Taizhou, Zhejiang Province. Methods Heroin or opiate addicts who started MMT between 2006 and 2014 in study area were included. Data including demographics, history of drug use and treatment information was extracted from the National MMT Data Management System and descriptive analysis were conducted. Multiple logistic regression models were used to explore factors associated with retention rate. Results In total, 2 262 MMT clients were included for analysis. Most of them were male(87.53%), single, divorced or widowed(55.75%), and had an education of junior middle school or below(88.68%). Almost all of them (98.32%)were heroin addicts, and the age at first drug use ranged from 9 years to 54 years, with average age of(25.06±6.34)years. A total of 1 123(49.65%)clients had a history of inject drug use and 81(3.58%)clients had ever shared needles with others. The average duration on MMT was 5.02±2.01 years, and the average methadone dosage during treatment was (34.49 ±22.69)mL. The MMT retention rate was 29.2% (661/2 262). In multivariable analysis, districts such as Huangyan District, Yuhuan County and Linhai City, aged≥40 years and average methadone dosage>20 mL during treatment were independently and positively associated with retention rate. Conclusion Most of MMT clients in Taizhou are male, unmarried, and had low education level. The retention rate is low in Taizhou but older patents and those receive high methadone dosage have a relatively higher retention rate.

Drug resistance analysis on smear-positive pulmonary tuberculosis in Taizhou City from 2015 to 2017 / 上海预防医学

[Objective]To ascertain the drug resistance for pulmonary tuberculosis in Taizhou City, and to provide basis for tuberculosis prevention and control strategy. [Methods] The sputum samples were collected form 267 smear positive pulmonary tuberculosis patients who registered in a drug susceptibility testing (DST) monitoring site in Taizhou City form 2015 to 2017. Then with culture, identification of Mycobacterium and DST for 9 anti-tuberculosis drugs [isoniazid (INH) , rifampicin (RFP) , ethambutanol (EMB) , streptomycin (SM) , kanamycin (KAM) , ofloxacin (OFX) , crinkledmycin (CPM) , promethylamine (PTO) and para amino salicylate (PAS) ] by using proportion method performed on all sputum specimens. [Results]Of the 267 smear positive cases, 220 were cultured with 190 culture positive (17 were identified as nontuberculous mycobacterial infections) , 28 culture negative, and 2contaminated. Among 160 cases with the result of DST to 9 drugs, the overall drug resistance rate was22.5％. The overall drug resistance rates were 21.4％ and 33.3％ in the newly diagnosed patients and retreated patients respectively. There was no significant difference between the two groups (P>0.05). The multidrug resistance rate was 3.1％, and had a significant difference between the new and retreated patients (0.7％ vs. 26.7％, P<0.01). Drug resistances rates of the 9 drugs ranged from high to low as:INH (8.1％) , PTO (8.1％) , SM (6.9％) , RFP (6.3％) , OFX (2.5％) , PAS (2.5％) , EMB (2.5％) , CPM (2.5％) and KAM (2.5％). There was no gender difference found in drug resistance rates (P> 0.05). Neither was there age difference (P> 0.05). [Conclusion] The epidemic of drugresistant of tuberculosis in Taizhou City are still high, especially that of acquired multi-drug resistance of tuberculosis. We must continue to improve the "three-in-one"management model, improve the quality of clinical diagnosis and treatment, and strengthen community medication management.

Sentinel surveillance on HIV status and related factors among men who have sex with men above 50 years in Taizhou Prefecture from 2010 to 2017 / 上海预防医学

[Objective] To investigate the HIV infection status and behavioral characteristics of men who have sex with men (MSM) over the age of 50 in Taizhou during 2010-2017 HIV sentinel surveillance, analyze the related factors of HIV infection, and provide basis for developing targeted intervention strategies. [Methods] HIV sentinel surveillance data from 2010 to 2017 in Taizhou was used to analyze the demographic characteristics, HIV awareness, and sexual behaviors of MSM over the age of 50. Also, HIV infection status and related factors were analyzed by multivariate regression analysis. [Results]A total of 334 MSM aged over 50 were surveyed by HIV sentinel surveillance in 2010-2017, and the HIV positive rate was 14.1％. The average age of the 334 MSM was (59.6 ± 7.2) years, and those with junior high school education and below accounted for 76.0％, with awareness of AIDS knowledge being 85.6％. And78.7％ of them had anal sex with men in the past 6 months. Among them, 30.4％ used condoms each time. And 4.8％ of them had commercial sex with men and 37.1％ had sex with women in the past 6months. Multivariate analysis showed that syphilis-positiveness was a risk factor for HIV infection and awareness of HIV-related knowledge proved to be a protective factor for HIV infection. [Conclusion] The MSM over 50 years old in Taizhou has a high rate of HIV-positiveness and high-risk behaviors exist. It is imperative to strengthen dynamic HIV surveillance for this population and behavioral intervention to reduce HIV related risky behavior.

Estimation and projection on HIV/AIDS through application of Estimation and Projection Package and Spectrum models, in Taizhou prefecture, Zhejiang province / 中华流行病学杂志

Objective To apply Estimation and Projection Package (EPP) and Spectrum models for the estimation and projection on HIV/AIDS epidemics in areas with relatively low HIV/AIDS prevalence in China,and to explore the influences of antiretroviral therapy (ART) on the outputs of the models.Methods Taizhou prefecture in Zhejiang province was selected as the study site.Social and demographic data as well as all the information on HIV/AIDS epidemics in Taizhou prefecture were collected,managed,input to EPP and Spectrum models to estimate and project the HIV/AIDS epidemic in Taizhou prefecture.Impact of ART on the HIV/AIDS epidemic was also assessed.Results According to the estimates from both EPP and Spectrum model,the HIV/AIDS epidemic in Taizhou prefecture was at a relatively low level.HIV prevalence rates among men having sex with men (MSM) and injection drug users (IDU) were relatively high and rapidly increasing.It was estimated that 1773 (1384-2449) people were living with HIV in 2010 in Taizhou prefecture,with an overall HIV prevalence of 0.03％ (0.02％-0.04％).ART had reduced and would continue to reduce new HIV infections and AIDS deaths,but had no significant impact on the overall HIV prevalence and the numbers of people living with HIV and adults who were in need of ART.Conclusion EPP and Spectrum models seemed to be suitable and useful tools for estimation and projection on HIV/AIDS in Taizhou prefecture,and the results could provide reference for the further studies in other areas with a relatively low epidemic level of HIV/AIDS.ART appeared effective for HIV/AIDS prevention and control.

Risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province / 中华流行病学杂志

Objective To understand the risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province. Methods Newly reported HIV infections from May 2008 through March 2010 in Taizhou prefecture were invited to participate in a cross-sectional survey which requested numbers and contact information of individuals with whom they had had high risk contacts as well as risk behavioral acts with them. Persons having had risky contacts with HIV-infected cases were thereof approached to participate in this survey and to receive HIV testing.Those who tested positive for HIV were subject to further round of the surveys. Results A total of 267 HIV cases were newly reported during this study period. Among them, 191 participated in the survey and served as 'index cases', including 158 cases identified from routine HIV surveillance programs and 33 cases identified from the present survey. Heterosexual transmission was the primary transmission route (74.9%, or 143/191 ), followed by homosexual transmission ( 19.4%, or 37/191 )and injection drug use (5.8%, or 11/191 ). These 191 HIV cases reported a total of 1152 individuals with whom they had had risky contacts. They were able to provide contact information of 461 risk contacts. Of them, 129 received HIV testing and 61 (47.3%) tested positive for HIV. HIV prevalence was the highest among spouses or long-term sex partners of HIV cases (45.6%, or 47/103) and malesex partners of HIV-infected men having sex with men (MSM) (60.0%, or 12/20). Condom use wasvery low among them, with only 33.9% consistently using condoms for sex. Conclusion Newlyreported HIV infections in Taizhou prefecture reported a large and complicated risk behavioral networks and low condom use, suggesting a potential risk of HIV among these connected people,especially among MSM. Much efforts are needed to intervene these high risk subgroups and high risk behavioral networks.

Human immunodeficiency virus/sexually transmitted infection,risk behavior and sexual networks among men who have sex with men in Taizhou city,Zhejiang province / 中华流行病学杂志

Objective To study the prevalence of human immunodeficiency virus(Hiv),sexually transmitted infection(Sti),risk behavior and the sexual neworks among men who have sex with men (MSM)in Taizhou city，Zhejiang province.Methods cross-sectional Astudy was applied with venue-based sampling in 2 MSM gathering sites in Taizhou.'Informed Consent'principle was applied and MSM were studied through a structured questionnaire．Blood samples were collected from thee who accepted free and confidential HIV/STI counseling and then tested for HIV,syphilis,HCV and HsV-2 antibodies with ELISA.HIV positive sera were certified with western blot．Results 106 MSM were investigated and 97 qualified questionnaires were collected.25.0％(23/92)of these MSM have ever had l female sex partner while 47.8％(44/92)had 2 or more.14.3％(13/91)of them reported having had 1 male partner who had engaged in anal sex and 80.2％(73/91)had 2 or more.22.1％(19／86)of therh had partieipated in group sex but 62.5％(55／88)of them did not always use condom when having analintercourse.15.1％(14／93) of them had l orfll sex partner while 75.3％(70／93)having 2 or more.38.9％(37／95)of them had sex with female sex worker,and 35.5％(33／93)had sex with male-to-male sex worker.15.3％(13/85)0f them had once been male-to-male sex worker themselves.3.9％(3/77)of them were found HIV positive in blood tests,with 24.7％(18/73)positive of syphilis,15.1％(11/73)positive ofHSV-2 but HCV appeared to be negative.46 csses reported their egocentric recognition networks,with mean degree of 5.91(ranging0-10),and mesa density of 0.548(ranging 0．000-1.000).43 sexual networks were identified,with mean degree of 2.70(ranging 0-10),and mean density of 0.246(ranging 0.000-1.000).Conclusion Risk behaviors,such as multiple sex partners，IOW proportion of condom use and commercial sex engagement both with heterosexuals and homosexuals,were extensively existed among MSM in Taizhou,and the prevalence of HIV/STI was relatively high.Their sexual networks seemed complicated but there might be in place of some sukstantiaUy isolated MSM groups with high risk of Hlv/sTl infection.More study should be applied to identify the relationship between scxual networks and HIV/STI transmigsion.