A community-based comprehensive intervention to reduce syphilis infection among low-fee female sex workers in China: a matched-pair, community-based randomized study.

BACKGROUND: Low-fee female sex workers (FSWs) are at high risk of acquiring and spreading human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) in China. There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections. Thus, this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair, community-based randomized intervention trial carried out in 12 cities in three provinces in China. METHODS: Four cities from Guangxi Zhuang Autonomous Region, four from Yunnan Province, and four from Hunan Province were paired and participants received either the intervention package (including condom promotion, HIV and syphilis testing, reimbursement for syphilis treatment costs, and free anti-retroviral therapy or the current standard of care. Venue-based, convenience sampling was used to recruit FSWs. A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months. Generalized linear mixed models (GLMM) were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs. RESULTS: A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up. GLMM results showed that syphilis infection was reduced by 49% in the intervention group compared to the current standard of care group (P = 0.0378, OR = 0.51, 95% CI: 0.27-0.96). FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old (P <  0.0001, OR = 2.38, 95% CI: 1.55-3.65). The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education (P <  0.05, OR = 0.43, 95% CI: 0.63-0.93). CONCLUSIONS: This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs. Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs. TRIAL REGISTRATION: CHiCTR-TRC-12002655.

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China: a Cross-sectional Study.

OBJECTIVE: To examine HIV self-testing uptake and its determinates among men who have sex with men (MSM) in Beijing, China. METHODS: A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio (AOR) and 95% confidence interval (CI). RESULTS: Among the 5,996 MSM included in the study, 2,383 (39.7%) reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income (AOR = 1.49; CI = 1.10-2.02; P = 0.010), large number of male sex partners (⋝ 2: AOR = 1.24; CI = 1.09-1.43; P = 0.002), sexual activity with commercial male sex partners (⋝ 2: AOR = 1.94; CI = 1.34 -2.82; P = 0.001), long-term drug use (AOR = 1.42; CI = 1.23-1.62; P < 0.001), and long-term HIV voluntary counseling and testing (VCT) attendance (AOR = 3.62; CI = 3.11-4.22; P < 0.001) were all associated with increased odds of HIV self-testing uptake. CONCLUSION: The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.

HIV care-seeking behaviour after HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study.

BACKGROUND: Men who have sex with men (MSM) has become the group with the fastest growing HIV epidemic in China. Since many Chinese MSM are conducting HIV self-testing, we aimed to determine the rate of HIV care seeking after self-testing, examine characteristics of "seekers" compared to "non-seekers," and explore factors associated with HIV care-seeking behaviour. METHODS: A cross-sectional study design was used and an online survey was conducted in Beijing, China in 2016, among users of a popular Chinese gay networking smart phone application. Chi-square test was used to compare characteristics of those who sought HIV care ("seekers") and those who did not ("non-seekers"). Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking. RESULTS: Among 21,785 screened, 2383 participants (10.9%) were included in the study. A total of 380 participants (15.9%) reported seeking HIV care after HIV self-testing while 2003 (84.1%) did not. Lack of knowledge of the "window period" (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [95% CI] = 0.47-0.97, P = 0.04) was associated with reduced odds of seeking HIV care, while lower monthly income (AOR = 1.29, 95% CI = 1.03-1.62, P = 0.03) and obtaining HIV self-testing kits from health facilities (AOR = 2.40, 95% CI = 1.81-3.17, P < 0.001), and non-governmental organizations (AOR = 2.44, 95% CI = 1.79-3.34, P < 0.001) was associated with increased odds of seeking HIV care. Among those who sought HIV care, a large majority (92.4%) had non-reactive HIV self-testing results. Only 29 out of 265 with reactive, uncertain, or unknown results sought HIV care. CONCLUSIONS: We found a very low rate of HIV care seeking among our sample of urban Chinese MSM. The observation that most with reactive, uncertain, or unknown results did not seek HIV care is a cause for concern. These people should be paid more attention and helped to enter the care cascade. Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed. However, further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.

[Study on the incidence and risk factors of HCV infection among heroin addicts who were on methadone maintenance treatment in Dehong prefecture,Yunnan province].

OBJECTIVE: To determine the incidence and risk factors of HCV infection among heroin addicts who were receiving methadone maintenance treatment(MMT)in Dehong prefecture, Yunnan province. METHODS: All heroin addicts who were HCV negative at the initiation of MMT in June 2005 through March 2012, in Dehong prefecture, were included in this cohort analysis. HCV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model. RESULTS: A total of 2390 MMT clinic attendants were qualified for this cohort study by March 2012. 731(30.6%) of them had never received any follow-up HCV testing so were recognized as loss to follow-up. The other 1659 (69.4%) participants had received at least one follow-up HCV testing and were observed for a total of 3509.12 person-years(py). During this period 99 new HCV infections or HCV sero-converters were identified. The overall HCV incidence was 2.82/100 py and was 3.62/100 py for 2006, 5.36/100 py for 2007, 6.71/100 py for 2008, 2.56/100 py for 2009, 1.90/100 py for 2010, and 0.44/100 py for 2011, respectively. Results from multiple regression analysis, using Cox proportional hazard model, indicated that after controlling for confounding variables, those who were unemployed, being injecting drug users(IDUs)or HIV positive at entry into the MMT program were more likely to be newly infected with HCV or HCV sero-converted during the follow-up period than those who were peasants, non-IDUs or HIV negative at entry into the MMT program(HR = 2.02, 95% CI:1.18-3.48; HR = 9.05, 95% CI:5.49-14.93; HR = 2.12, 95% CI: 1.37-3.56), respectively. CONCLUSION: The incidence of HCV infection among MMT clinic attendants was decreasing since 2009 in Dehong prefecture. Those who were unemployed, injecting drug users and HIV positive were at higher risk of HCV infection.

[Current situation related to antiretroviral therapy and related influential factors on HIV infected injection drug users in the methadone maintenance treatment clinics].

OBJECTIVE: To find out the current coverage of antiretroviral therapy (ART) among HIV positive subjects and to identify the major influential factors associated with the participation in ART among them. METHODS: 291 HIV positive subjects from 6 methadone maintenance treatment (MMT) clinics in Guangxi and Yunnan province were surveyed by questionnaires. RESULTS: 217 males (74.6%) and 74 females (25.4%) were under investigation, with the average age of 38.4 +/- 5.9. Most of them received less than senior high school education, married and unemployed. Results from the single factor logistic regression analysis showed that: working status, living alone, self-reported history of drinking alcohol in the last month, negative attitude towards MMT among family members,poor self-reported compliance to MMT in the last month,lack of incentives in the MMT clinics, reluctance on disclosure of their own HIV status, good self-perception on their health status, lack of communication on ART related topics among family members in the last 6 months, lack of correct attitude and knowledge on ART etc. appeared as the main factors that influencing the participation in ART program among the patients. Data from the multivariate logistic regression analysis showed that factors as: living alone, unwilling to tell others about the status of HIV infection, poor self-perception on HIV infection, lack of discussion of ART related topics within family members in the last 6 months and poor awareness towards ART among the family members etc., were associated with the low participation rate of ART. Conclusion Strengthening the publicity and education programs on HIV positive patients and their family members at the MMT clinics seemed to be effective in extending the ART coverage. Attention should also be paid to increase the family support to the patients.

[Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

OBJECTIVE: To study the factors that associated with the mortality of overdose on methadone maintenance treatment(MMT)among HIV-positive patients. METHODS: A 1 : 1 matched case-control design was used to identify the relationship between factors related to demography, drug use, characteristics of treatment and the mortality of overdose. 110 HIV-positive patients who died of drug overdose from March 2004 to September 2012 were defined as cases. Controls were another 110 patients who were still alive and paired with the cases, according to the same gender, similar date of MMT initiation and from the same clinics. RESULTS: Multivariate conditional logistic regression analyses indicated that risk factors as sharing needles before enrolled in the MMT program(OR = 5.19, 95% CI:1.39-19.33), HIV infection because of injecting drug-use (OR = 3.08, 95% CI: 1.16-8.21), and off from the treatment before the end point of the program(OR = 2.54, 95% CI: 1.23-5.23)were associated with mortality caused by overdose. Higher adherence(OR = 0.31, 95%CI: 0.10-0.95)appeared to be associated with lower mortality when compared with the control group. CONCLUSION: In order to reduce the mortality rate, comprehensive intervention could be introduced to improve the compliance of retention on MMT among patients. Intervention efforts should be focused on those patients who shared needle/syringes.

[Evaluation on the long-term effectiveness among the first set eight methadone maintenance treatment clinics in China].

OBJECTIVE: To evaluate the long-term effectiveness of the first set 8 methadone maintenance treatment (MMT) clinics in China. METHODS: Repeated cross-sectional surveys were conducted on the first month after the enrollment and 5 years later, among drug users who received MMT, using a standard questionnaire. Data on demographic characteristics, HIV-related high-risk behaviors, criminal records associated with drug use and related family/social functions were collected and analyzed. RESULTS: There were 252 and 195 participants being interviewed at the baseline and the 5-year surveys, respectively. Of them, 66 participants were involved in both surveys. There was no significant differences on factors as ethnicity, level of education, working status, marital status and living status (P > 0.05) between the baseline and the 5-year surveys. Compared with data from the baseline survey, participants' behavior on drug abuse (100.0% vs. 24.1%, P < 0.001), needle sharing behavior (19.4% vs. 0.0%, P < 0.001), and exchanging sex for drugs (34.5% vs. 0.0%, P < 0.001) had significant decreases at the 5-year survey. Rates on condom use (10.6% vs. 25.0%, P = 0.004), and having jobs (27.8% vs. 47.7%, P < 0.001) had been improved significantly, while self-reported criminal cases related to drug use (15.1% vs. 1.5%, P < 0.001) and the contacts with drug users (88.9% vs. 31.3%, P < 0.001) had been significantly reduced after joining the MMT program. CONCLUSION: MMT could play an active role in reducing the HIV-related high-risk behaviors, criminal cases associated with drug abuse as well as enhancing the family and social functions of the MMT patients. Providing high quality service to the MMT clinic and trying to keep the drug users stick to the program remain difficult. It was also important to improve the training programs for staff working at the MMT clinics.

[Characteristics and associated factors of long-term retention for methadone maintenance treatment patients].

OBJECTIVE: To describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients. METHODS: This study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients. RESULTS: Of the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05). CONCLUSION: Illicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients' continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.

[Study on the prevalence of HIV and AIDS-related risky sexual behaviors among male university students who have sex with men in Beijing, China].

OBJECTIVE: To assess the prevalence of HIV and risky sexual behaviors among university students who have sex with men (MSM) in Beijing. METHODS: MSM students in the universities were mainly recruited via internet. Questionnaires were self-administered to collect social demographic information and AIDS-related risky sexual behaviors. After completing the questionnaire, blood sample was collected to determine HIV infection through serological testing. χ(2) test and logistic regression were employed for univariate and multivariate analysis, respectively. RESULTS: A total of 157 students were recruited with mean age of 22.7 ± 2.8 years old, 12.1% of them were minorities and 77.7% were self-identified as homosexual. 98.1% had engaged in anal intercourse (AI) in their lifetime and 73.9% reported that AI was common sexual behavior they often practised. In the past 6 months, 58.6% had ever had unprotected anal intercourse (UAI), 58.0% never used condoms during oral intercourse, and 59.2% had multiple sex partners (≥ 2). Nearly half of them believed that they were at low or no risk of contracting HIV and the prevalence of HIV infection was 2.5%. Data from logistic regression analysis showed that ever having had sex with a casual partner in a lifetime (OR = 13.10), understanding that serving an insertive role had less risk than being receptive during the AI (OR = 3.37), and ever having been to a gay bar (OR = 2.49) was independently related to having multiple sex partners in the past 6 months. CONCLUSION: Despite the extensive programs on education, behaviors regarding UAI and ever having had multiple sex partners were still commonly seen among university MSM students. Interventions were needed to prevent HIV transmission in this population.

[Adherence and related determinants on methadone maintenance treatment among heroin addicts in Dehong prefecture, Yunnan province].

OBJECTIVE: To determine the adherence to and its determinants of methadone maintenance treatment (MMT) among heroin addicts in Dehong prefecture in Yunnan province from 2005 to 2009. METHODS: A dynamic cohort analysis was conducted with the time of treatment initiation as the time of cohort entry, to calculate the proportion of adhering to the treatment at different time points after initiation of the treatment, and to study the determinants of adherence. RESULTS: A total of 3758 had been treated. Among them, 95.8% were males, 75.8% aged between 20 - 39 years, 90.4% were peasants or unemployed, 57.0% were ethnic minorities, 35.0% were single and 55.5% were married with spouses, 43.9% were illiterate or educated at most primary school. The age of first using drugs averaged at 23.93 years. About 96.3% of the study subjects had used heroin and 21.7% were HIV-infected. The minimum time under MMT was less than 1 month and the maximum 61 months. The median methadone dose at first delivery was 25 ml, with the minimum 1 ml and the maximum 330 ml. By the end of the study or observation period, a total of 1798 patients had withdrawn from treatment and 1960 were still under treatment. The proportions of adherence to or still being under the treatment after 1, 3, 6, 9, 12, 24, 36, 48 and 60 months treatment were 0.919, 0.847, 0.756, 0.690, 0.637, 0.519, 0.417, 0.360 and 0.321, respectively. Multiple regression analysis using Cox proportional hazard model indicated that withdraw from the methadone maintenance treatment was significantly associated with location of the treatment clinics, year of treatment initiation, marital status, HIV infection status, methadone dose of first delivery and the result of last urine test for heroin use. CONCLUSION: MMT attendants in Dehong prefecture had a relatively high withdraw rate and low adherence rate. More efforts are needed to provide tailored counseling and education to MMT attendants, to provide family and community support, appropriate methadone dose at first delivery, and to better coordinate with local police department.

[Study on incidence of HIV infection among heroin addicts receiving methadone maintenance treatment in Dehong prefecture, Yunnan province].

OBJECTIVE: To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment (MMT) in Dehong prefecture, Yunnan province. METHODS: All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011, in Dehong prefecture were included in the cohort analysis. HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model. RESULTS: A total of 3154 MMT clinic attendants were qualified for this cohort study. By June 2011, 1023 (32.4%) of them had never received any follow-up HIV testing so were thus referred as loss to follow-up. The other 2131 (67.6%) members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years. During the period, 22 new HIV infections or seroconverters were identified, making the overall HIV incidence as 0.48/100 person-years. The HIV incidence was higher among those who were unemployed, never married, self-reported being injecting drug users (IDUs) and HCV positive at entry into the MMT program. None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period. Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables, non-IDUs at the entry point for the MMT program, were less likely to be HIV newly-infected or seroconverted than IDUs (HR = 0.29, 95%CI: 0.11 - 0.76). CONCLUSION: MMT program in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use. Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment, were at higher risk of HIV seroconvertion. More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.

[Risk factors which were associated with heroin use during the methadone maintenance treatment among 1301 patients in 9 cities of China.].

OBJECTIVE: To determine the proportion of heroin use among patients who were involved in community-based methadone maintenance treatment (MMT) program and to identify the risk factors associated with heroin use. METHODS: This study was conducted in 9 MMT clinics within 3 provinces. Thirteen hundred and one patients who met the study criteria were selected from each of the five groups with different dosages of methadone users. An administrative questionnaire was applied to explore the demographics, drug abuse-related behaviors and MMT services received by the clients, etc. The prevalence of depression and anxiety among the clients were also collected by SAS and SDS. Urine samples were collected as a biological marker to indicate if heroin had been used. RESULTS: Of the 1301 patients, 76.2% were males. The mean age was (34.6 +/- 6.5) years while 71.7% had an education level of primary school or below. The average daily dosage of methadone was (48.1 +/- 29.4) mg and self-satisfied evaluation score on treatment was 8.6. On average, 27.7% urine samples showed positive opiate evidence. Marital status, employment status, treatment retention, self-satisfied evaluation score on dosage and dropout history were found to be significantly associated with heroin use, while gender, education level and dosage had no significant association with heroin use. It seemed that risk factors that associated with heroin use were different from areas to areas. CONCLUSION: High quality MMT clinic services, high self-satisfied score, longer treatment retention and low dropout rate seemed to have the effects of reducing the risk of ongoing heroin abuse under the methadone maintenance treatment program.

[A study of HIV/AIDS-related stigma and discrimination among former plasma donors in rural areas].

OBJECTIVE: To understand the types of, reasons for and sources of stigma and discrimination in a rural community where the majority of people living with HIV/AIDS (PLHA) are former plasma donors (FPDs). METHODS: Eighty local residents, including 20 HIV-positive villagers, 20 family members, 20 villagers from non-HIV-positive households and 20 health workers, were selected as study subjects by using purposive sampling method in rural areas of Anhui Province. Face-to-face interviews and focus group discussions were held to collect information on HIV/AIDS-related stigma and discrimination and its contributing factors. RESULTS: Of the 80 study subjects, 1 didn't finish the survey. Of the 79 subjects who finished the survey, the main forms of stigma and discrimination were expanded stigma [81.0% (64/79)], abandonment and avoidance, stigma and discrimination in healthcare setting [47.4% (28/59)], loss of social support [33.3% (13/39)]. The level of stigma was less in village where were more HIV-positive villagers living and vice versa. The reasons for stigma and discrimination included: ignorance or misunderstanding of HIV/AIDS [57.5% (23/40)], fear of HIV/AIDS [32.5% (13/40)] and morality judgment toward PLHA. The majority of HIV positive participants were unwilling to disclose their positive status to others in order to protect their family members and children. CONCLUSION: Ignorance and misunderstanding of HIV/AIDS were main contributing factors to HIV/AIDS-related stigma and discrimination and it is very important to implement appropriate intervention programs to reduce stigma and discrimination.

[Survey on AIDS/STD risk behaviors and prevalence among men who have sex with men in Langfang, Hebei].

OBJECTIVE: To understand the demographic and HIV risk behaviors, HIV and syphilis infection among men who have sex with men (MSM) in Langfang, Hebei. METHODS: 106 completed questionnaires were collected from 118 participants, who were recruited from MSM pubs and internet from October to November, 2007. Data on homosexual and heterosexual relationships as well as sexual behaviors were collected by face-to-face interview. Blood specimen were collected to determine HIV/syphilis serostatus. RESULTS: Age, marital status and occupation were statistically different (P < 0.05) among MSM subgroups enrolled through different recruitment methods. Almost 90.0% of the MSMs identified their sexual orientation, 82.1% MSMs had sexual contacts with men, 50.4% MSMs maintained sexual relationship with women. The exposures of sexual contacts were anal intercourse (87.7%), blow job (58.5%), rimming (32.1%), fist sucking (15.1%), group sex (8.5%) etc. As for the awareness of risk for HIV infection, only 31.1% of the participants were beware of their risk of HIV infection they had been facing while 23.6% of them had ever received HIV testings. The prevalence rates of HIV and syphilis antibody positive among the 84 MSMs in this program were 4.8% and 22.6% respectively. CONCLUSION: MSMs were lack of HIV/STI awareness on their risks and having a high prevalence of HIV and syphilis. Specific HIV/STI intervention should be carried out in this population urgently.

[Evaluation of first 8 pilot methadone maintenance treatment clinics in China].

OBJECTIVE: To evaluate the effectiveness of the first eight pilot methadone maintenance treatment (MMT) clinics in China. METHODS: A questionnaire survey of the clients at the 8 pilot MMT clinics was performed at entry, 6 month and 12 month follow-up. Drug using behaviors, drug related crime behaviors, and relationships in families were compared among at entry, 6 and 12 months follow-up. RESULTS: There were 585, 609 and 468 clients involved at baseline, 6 month and 12 month follow-up surveys, respectively. At entry, 6 month and 12 month follow-up, the proportion of clients whose injection of drugs reduced from 69.1% to 8.9% and 8.8%, and the frequency of injection in the past month had reduced from 90 times per month to 2 times per month. Employment rate increased from 22.9% to 43.2% and 40.6%, and self-reported criminal behaviors reduced from 20.7% to 3.6% and 3.8%. At 12 month follow-up, 65.8% of clients reported a healthy family relationship, increased from 46.8% at entry, 95.9% of clients reported that they were satisfied with the MMT service. CONCLUSION: Pilot MMT program reduced drug use, drug injecting behaviors, drug related criminal behaviors, and improved relationship with family members. Therefore, MMT clinic should be considered as a platform for providing comprehensive services to drug users.