HIV testing and seroprevalence among couples of people diagnosed with HIV in China: A meta-analysis.

BACKGROUND: Partner notification and testing could expand HIV testing and link infections to care. We performed a meta-analysis on HIV testing rate and prevalence among couples of people diagnosed with HIV in China. METHODS: Six electronic databases (PubMed, Cochrane Library, Embase, Web of Science, the China National Knowledge Internet, and WanFang) and abstracts of five HIV/sexually transmitted infections conferences were searched up to February 1, 2020. Meta-analysis was conducted using a random-effects model to assess HIV testing rate and prevalence among couples of Chinese people diagnosed with HIV. RESULTS: Of 3,657 records retrieved, 42 studies were identified. Among them, three studies were conducted among pregnant women and 10 among men who have sex with men. The pooled uptake rate of couples HIV testing among Chinese people diagnosed with HIV was 65% (95% confidence interval, 57% -73%; 23 studies). The pooled HIV prevalence among couples who had an HIV test was 28% [24%-32%] (38 studies). Subgroup analyses showed that the pooled couples HIV testing uptake rates among pregnant women and men who have sex with men were 76% [66%-86%] (3 studies) and 49% [30%-68%] (8 studies), and the pooled HIV prevalence in two populations was 53% [27%-78%] (3 studies) and 14% [10%-17%] (10 studies), respectively. CONCLUSIONS: Nearly two-thirds of couples of people diagnosed with HIV have had an HIV test, of whom 28% were positive. Couples of MSM with a positive HIV diagnosis had a lower testing rate, which indicates more effective strategies need to be carried out to improve couples HIV testing among Chinese MSM.

An evaluation of impact of social support and care-giving on medication adherence of people living with HIV/AIDS: A nonrandomized community intervention study.

To evaluate the effect of the social support on adherence of highly active antiretroviral therapy (HAART) of people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA). Participants of PLWHA at Beijing, China were intervened by 1-year social support program intervention. Difference of social support scale and medication adherence scale before and after the intervention were evaluated. Our results showed that there were statistically significant difference for total score and subjective score, medication adherence between before and after intervention (t = -3.62, -2.81, 5.75, P < .05), and there were statistically significant correlation between the difference of total social support score and that of social support utilization score, and the difference of medication adherence score (r = 0.14, 0.12, all P < .05). Multifactor linear regression showed that the medication adherence score was influenced by the insurance status, the residential status, and the difference in the social support utilization score (ß = -0.14, 0.17, 0.16, all P < .05). Social support and care-giving can exert some influence and facilitate PLWHAs adherence of HAART.

Barriers to the availability and accessibility of controlled medicines for chronic pain in Africa.

Africans endure a high burden of pain and suffering from HIV/AIDS and cancer, yet receive a meager amount of the world's pain medication. This tragedy occurs needlessly, given that inexpensive, effective and easily administered interventions are available. WHO has a 'three-step analgesic ladder' framework for managing cancer pain. This widely adopted clinical practice guideline is an integral part of palliative care programs and has also been applied to non-cancer pain. However, untreated pain is a major public health problem due to the discordance between scientific evidence and public policy. Historically, the International Narcotics Board has taken an unbalanced prohibitionist approach to international drug control that has emphasized suppressing controlled substances over making them available for medical and scientific purposes. The procurement process for controlled pain medications in most African countries is a morass of restrictions that make it exceedingly difficult for patients to obtain these drugs. Often, these restrictions arise in part from a misunderstanding of addiction and dependence on opiates. The result has been widespread 'opiophobia' among African policy makers and physicians. A host of factors have misaligned the analgesic pharmaceutical supply chain. Taken together, access to medically necessary controlled substance in sub-Saharan Africa is suboptimal.

A comparison of DALYs for periodontal disease in China between 1990 and 2013: insights from the 2013 global burden of disease study.

BACKGROUND: China has undergone a rapid demographic and epidemiological transition with fast ecomonic development since the 1980s. Oral health is becoming a major public health problem as the prevalence of non-communicable diseases has greatly increased. Periodontal disease (PD) and caries are among the most prevalent oral diseases. PD accounts for the majority of tooth loss and increases with age. China's third national epidemiological investigation on oral diseases (2005) revealed that periodontitis affected >50% of the adult population. The Global Burden of Disease Study 2013 (GBD2013) have been used to estimate DALYs for 301 acute and chronic diseases and injuries in 188 countries for 1990-2013. The estimation of burden of PD between 1990 and 2013 will provide a unique perspective for planning interventions and developing public health policies for PD even chronic diseases in China. METHODS: We used the GBD 2013 results for Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) to calculate Disability Adjusted Life Years (DALYs) for PD in China. PD standardized DALYs rate (SDR) per 100,000 persons, the percentage of PD standardized DALYs rate (% PD SDR) in all diseases DALYs, and variance ratio of these two indexes between the years of 1990 and 2013 were compared by province, gender and age groups. RESULTS: Nationwide, compared to 1990, the SDR in 2013 increased slightly from 24.7 to 25.7, while the variance ratio of SDR for provinces in the middle, west and south of China showed a greater variation(4.8-6.2%). The % PD SDR in all disease DALYs increased from 0.06 to 0.11% for all groups. The four highest variance ratios % PD SDR in all diseases DALYs between 1990 and 2013 occurred in the west of China (97, 98.6, 108.4 and 112.8%). The PD SDR changed slightly in the women (20.3 to 21.7), meanwhile the variance ratio of PD SDR and % PD SDR in all diseases DALYs for the women (6.7 and 94.5%) was also higher than for men (2.1 and 60.6%). The highest variance ratio % PD SDR in all oral diseases DALYs occurred between 1990 and 2013 in ages 20 to 24 (50.7%) and 25 to 29 years (50.5%). CONCLUSION: The PD standardized DALYs rate and % PD SDR in all diseases DALYs in China in 2013 has increased from 1990. Especially, the variance ratio of % PD SDR in all disease DALYs among Young population and women, in the west provinces of China have been becoming the highest in all age groups and national wide. Future intervention measurements should include young women of child-bearing age because women's health impacts infant health. Periodontal disease has risk factors in common with a number of other non-communicable diseases (NCD) and conditions, and focusing on the common behavioral and environmental risk factors would be instrumental in the effective prevention of periodontal disease.

Drug Resistance and Virological Failure among HIV-Infected Patients after a Decade of Antiretroviral Treatment Expansion in Eight Provinces of China.

BACKGROUND: China's National Free Antiretroviral Treatment Program (NFATP) has substantially increased the survival rate since 2002. However, the emergence of HIV drug resistance (HIVDR) limits the durability and effectiveness of antiretroviral treatment (ART) in at risk patients. METHOD: A cross-sectional survey was conducted among patients having received a median of 13.9 months of ART in eight provinces in China. Demographic and clinical information was collected, and venous blood was sampled for CD4 cell counts, measurement of the HIV viral load (VL), and HIV drug resistance (HIVDR) genotyping. Possible risk factors for HIVDR were analyzed by the logistic regression model. RESULTS: The study included 765 patients. Among them, 65 patients (8.5%) had virological failure (VLF) defined as ≥1,000 copies/ml. Among the individuals with VLF, 64 were successful genotyped, and of these, 33 had one or more HIVDR mutations. The prevalence of HIVDR mutations among patients receiving first-line ART was 4.3% (33/765). All of the patients with HIVDR mutations were resistant to non-nucleoside transcriptase inhibitors, 81.8% were resistant to nucleoside reverse transcriptase inhibitors, and only 3% had mutations that caused resistance to protease inhibitors. Having lower ratios of drug intake in the past month and dwelling in two southwestern provinces were factors independently associated with the emergence of HIVDR. CONCLUSION: Most patients receiving first-line ART treatment achieved sound virological and immunological outcomes. However, poor adherence is still a key problem, which has led to the high rate of HIVDR. It was notable that the proportion of drug resistance widely varied among the provinces. More studies are needed to focus on adherence.

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China.

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40-49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%-2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%-0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.

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.

Long-term outcomes of antiretroviral therapy in an adult HIV program: a 10-year retrospective cohort study in Kano, Nigeria.

BACKGROUND: Treatment outcomes from HIV/AIDS programs in resource-limited settings mostly describe short-term follow-up. We report 10-year treatment outcomes in an HIV clinic in Kano, Nigeria. METHODS: Using paper medical charts, the authors conducted a retrospective cohort study of patients that initiated ART from June 1, 2004 to December 31, 2007, and were followed up until June 30, 2014. The authors abstracted data from patient case files and did a time-to-event analysis on ART failure and loss to follow-up, and determined immunologic trends. RESULTS: The authors studied 345 patient records (29,860 person months of follow-up); 82 records (23.7%) indicated that patients failed their first-line ART regimen at the rate of 2.75 failures per 1000 person-months. The estimates of durability on first-line ART regimen were 99.1% at 1 year and 59.0% at 10 years. Of the studied patients, 83.0% were still in care at the end of the 10-year period. Only being on abacavir (hazard ratio: 8.0) was a positive predictor of ART failure. CD4 increment at 4 years (hazard ratio: 0.9) and 5 years (hazard ratio: 0.9) were negative predictors. CONCLUSION: A high rate of long-term ART durability and modest long-term retention in care were achieved among our cohort. Improved availability of low-cost virologic and immunologic monitoring tools and provision of resistance testing technology will go a long way in improving early detection of treatment failure in the developing world.

Global health education in general preventive medicine residencies.

Opportunities for global health training during residency are steadily increasing. For example, surveys show that more than half of residency programs now offer international electives. Residency programs are increasingly recognizing that global health training improves communication skills, fosters awareness of health disparities, and inspires careers in primary care and public health. Although research has focused on global health education in other specialties, there is a paucity of research on global health training in public health and general preventive medicine (GPM). We sought to describe the extent of global health training across GPM residencies, capture the perspectives of program directors regarding competencies residents need for careers in global health, and identify program directors' perceived barriers to providing global health training. The survey was sent electronically to 42 U.S. GPM residency program directors from September to October 2013. Twenty-three completed surveys were returned. Information from residencies that did not complete the study survey was collected through a predefined search protocol. Data analysis was performed from February through July 2014. Among program directors completing the survey, the most common types of reported global health education were courses (n=17), followed by international rotations (n=10). Ten program directors indicated that resident(s) were involved in global health training, research, or service initiatives. Commonly perceived barriers included funding (87%), scheduling (56.5%), and partnership and sustainability (34.8%). Through global health coursework, research, and practicum rotations, GPM residents could acquire skills, knowledge, and attitudes contributing to careers in global health.

Enrolment trends in a comprehensive HIV programme in rural north-central Nigeria: improved care indices, but declining quality of clinical data over time.

BACKGROUND: Vanderbilt University affiliate Friends in Global Health was funded in 2008 to support comprehensive HIV/AIDS services in north-central Nigeria. We summarise programme characteristics and trends in enrolment and quality of data collection in this rural, resource-limited environment. METHODS: We used routinely collected programme data in supported sites from June 1 2009 to September 30, 2013.Baseline characteristics were defined as those collected closest to a 90-day window period before and after enrolment. Summary characteristics were compared by site and enrolment year. RESULTS: We enrolled 3,960 HIV-infected patients into care (68% women), median age of 32 years [interquartile range (IQR): 27-40]. Most clients were married (79%) and unemployed (60%). At enrolment, median CD4+ cell count was 230 cells/µL (IQR: 114-390) and haemoglobin was 10.7 g/dL (IQR: 9.3-11.9). Advanced clinical disease [World Health Organization (WHO) clinical stage III/IV] at enrolment was documented in 29% of clients. Cumulative enrolment increased from 377 patients in 2009 to 3,960 patients by 2013.With each successive year, more clients were enrolled at earlier stages of disease; in 2009, 37% of patients were identified as WHO clinical stage I, while in 2013, 55% of patients were so classified. While documentation of clinical staging remained stable, the completeness of CD4+ cell count and haemoglobin data declined with time. CONCLUSION: Expanded testing in a comprehensive HIV programme in rural Nigeria brought persons to care at earlier stages of illness. Yet, as clinical services expanded, data collection quality declined. The paradox of successful scaling up HIV services but deteriorating quality of data underscores the importance of data management training and quality improvement efforts.

Male involvement for the prevention of mother-to-child HIV transmission: A brief review of initiatives in East, West, and Central Africa.

Current trends in HIV/AIDS research in sub-Saharan Africa (SSA) highlight socially and culturally sensitive interventions that mobilize community members and resources for universal access to HIV prevention, treatment, and care services. These factors are particularly important when addressing the complex social and cultural nature of implementing services for prevention of mother-to-child transmission of HIV (PMTCT). Across the globe approximately 34 % fewer children were infected with HIV through the perinatal or breastfeeding route in 2011 (est. 330,000) than in 2001 (est. 500,000), but ongoing mother-to-child HIV transmission is concentrated in sub-Saharan Africa, where fully 90 % of 2011 cases are estimated to have occurred. Recent literature suggests that PMTCT in Africa is optimized when interventions engage and empower community members, including male partners, to support program implementation and confront the social, cultural and economic barriers that facilitate continued vertical transmission of HIV. In resource-limited settings the feasibility and sustainability of PMTCT programs require innovative approaches to strengthening male engagement by leveraging lessons learned from successful initiatives in SSA. This review presents an overview of studies assessing barriers and facilitators of male participation in PMTCT and new interventions designed to increase male engagement in East, West, and Central Africa from 2000-2013, and examines the inclusion of men in PMTCT programs through the lens of community and facility activities that promote the engagement and involvement of both men and women in transformative PMTCT initiatives.

Racial disparities in the development of dysphagia after stroke: further evidence from the Medicare database.

OBJECTIVE: To describe the relationship between minority race/ethnicity and dysphagia after stroke in a national sample. Unlike the multiple studies that have examined racial disparities in stroke incidence, risk factors, outcomes, and quality of care, the influence of race or ethnicity on dysphagia after stroke has been understudied. We hypothesized that the odds of dysphagia would be higher for Asians compared with Caucasians in the United States given the results of a previous study in the U.S. DESIGN: Observational study. SETTING: Conducted using the U.S. National Medicare Medical Provider Analysis and Review Data. PARTICIPANTS: Medicare beneficiaries admitted in 2007 with a stroke diagnosis. INTERVENTION: We selected 382,959 cases with cerebrovascular disease codes with self-identified race/ethnicity of Caucasian, African American, Asian, Hispanic, Native American, or other/unknown. Cases had a diagnosis of cerebrovascular disease, defined as International Classification of Disease, Ninth Revision codes 430 to 438.9. Self-reported race/ethnicity was recorded in the following categories: Caucasian, African American, Asian, Hispanic, Native American, and other/unknown. MAIN OUTCOME MEASURE: Dysphagia after stroke as coded in the data. RESULTS: The adjusted odds ratio (OR) for poststroke dysphagia was higher for Asians and other minority groups compared with Caucasians (Asian: OR, 1.73; 95% confidence interval [CI], 1.60-1.88; Hispanic: OR, 1.50; 95% CI, 1.39-1.63; African American: OR, 1.42; 95% CI, 1.37-1.47; unknown/other: OR, 1.27; 95% CI, 1.16-1.38; Native American; OR, 1.44; 95% CI, 1.22-1.69). CONCLUSIONS: Our findings confirm previous research suggesting an association between Asian race and dysphagia after stroke while adding evidence for increased odds in other racial/ethnic minority groups.