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Gao Y, Zheng W, Sun Y, Yang L, Guo Z, Li Y, Lin YF, Lu Z, Yuan T, Zhan Y, Qian HZ, Su B, Zhu Z, Duan J, Wang G, Cui X, Ouyang L, Sheng G, Zhou Y, Long A, Yao Y, Fitzpatrick T, Yu M, Wu G, Zou H. Voluntary Medical Male Circumcision and Incident HIV Infection Among Men Who Have Sex With Men in China (The CoM Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47160. [PMID: 37247211 PMCID: PMC10262017 DOI: 10.2196/47160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses based on observational studies have shown voluntary medical male circumcision (VMMC) may reduce HIV risk among men who have sex with men (MSM). There is a lack of randomized controlled trial (RCT) data assessing the efficacy of VMMC. OBJECTIVE The primary objective of this study was to assess the efficacy of VMMC for preventing HIV acquisition among MSM who primarily engage in insertive anal sex. METHODS A multicenter RCT will be conducted among MSM in 8 cities in China. Eligible participants are men aged 18-49 years who self-report ≥2 male sex partners in the past 6 months, predominantly practice insertive anal sex, and are willing to undergo circumcision. Interested men who satisfy inclusion criteria will be tested for HIV 1 month before enrollment and at enrollment, and only those who are HIV negative will be enrolled. At baseline, all enrolled participants will be asked to report sociodemographic characteristics and sexual behaviors; provide a blood sample for HIV, syphilis, and herpes simplex virus type 2 testing; and provide a penile swab for human papillomavirus testing. Participants will be randomly assigned to the intervention or control group. Those in the intervention group will receive VMMC and undergo a web-based weekly follow-up assessment of postsurgery healing for 6 consecutive weeks. All participants will be tested for HIV at 3-, 6-, 9-, and 12-month follow-ups. All participants will also be asked to report sexual behaviors and undergo repeat herpes simplex virus type 2 and human papillomavirus testing at 6- and 12-month follow-ups. The primary end point is HIV seroconversion. Secondary end points are the safety and satisfaction with VMMC and the changes in sexual behaviors after VMMC. The grouped censored data will be analyzed by intention-to-treat approach. RESULTS Recruitment for the RCT began in August 2020 and continued through July 2022. Data collection is expected to be completed by July 2023, and full data analysis is going to be completed by September 2023. CONCLUSIONS This study will be the first RCT to assess the efficacy of VMMC in preventing HIV infection among MSM. Results from this trial will provide preliminary evidence for the potential efficacy of VMMC to reduce incident HIV infection among MSM. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000039436; https://www.chictr.org.cn/showproj.html?proj=63369. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47160.
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Affiliation(s)
- Yanxiao Gao
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhihui Guo
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yi-Fan Lin
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Tanwei Yuan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Han-Zhu Qian
- GlaxoSmithKline plc, Rockville, MD, United States
| | - Bin Su
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Zhu
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Junyi Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Xin Cui
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Lin Ouyang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Genshen Sheng
- Shenzhen Rainbow 258 Centre for Men, Shenzhen, China
| | - Yepeng Zhou
- Foshan Pengyou Care and Rescue Center for AIDS Prevention, Foshan, China
| | - Ao Long
- Luzhou Red Ribbon Heart Association, Luzhou, China
| | - Yuming Yao
- Zhitong LGBT Service Center, Guangzhou, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Maohe Yu
- Tianjin Municipal Center for Disease Control and Prevention, Tianjin, China
| | - Guohui Wu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Huachun Zou
- School of Public Health, Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Song L, Yu X, Su B, Geng WK, Lan G, Zhang X. HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study. JMIR Form Res 2023; 7:e37344. [PMID: 36630166 PMCID: PMC9893886 DOI: 10.2196/37344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. OBJECTIVE This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. METHODS This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. RESULTS The prevalence of HIV and syphilis was 9.3% (59/632) and 11.4% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95% CI 2.34-119.18, P=.005) were independently associated with HIV infection. CONCLUSIONS There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex.
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Affiliation(s)
- Liping Song
- School of Public Health, Guilin Medical University, Guilin, China
| | - Xiangyuan Yu
- School of Public Health, Guilin Medical University, Guilin, China
| | - Bing Su
- Department of Clinical Psychology, Qingdao Mental Health Center, Qingdao, China
| | - Wen Kui Geng
- Guangxi Zhuang Autonomous Region Health and Family Planning Commission, Nanning, China
| | - Guanghua Lan
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
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The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis. AIDS Behav 2022; 27:2226-2242. [PMID: 36543946 PMCID: PMC9771782 DOI: 10.1007/s10461-022-03954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.
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Lachowsky NJ, Saxton PJW, Dickson NP, Hughes AJ, Jones RG, Clark TC, Ho E, Summerlee AJS, Dewey CE. Ethnicity classification systems for public health surveys: experiences from HIV behavioural surveillance among men who have sex with men. BMC Public Health 2020; 20:1433. [PMID: 32958004 PMCID: PMC7507687 DOI: 10.1186/s12889-020-09517-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Race and ethnicity classification systems have considerable implications for public health, including the potential to reveal or mask inequities. Given increasing “super-diversity” and multiple racial/ethnic identities in many global settings, especially among younger generations, different ethnicity classification systems can underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic minorities. We investigated three ethnicity classification methods and their relationship to sample size, socio-demographics and sexual health indicators. Methods We examined data from New Zealand’s HIV behavioural surveillance programme for men who have sex with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed; recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included Asian, European, indigenous Māori, and Pacific. For each classification method, statistically significant associations with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic regression. Results Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health outcomes: Māori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using Total Response but not Prioritisation or Single/Combination. Conclusions Different classification approaches alter sample sizes and identification of health inequities. Future research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings have broad implications for surveillance and research that is used to inform public health responses.
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Affiliation(s)
- Nathan J Lachowsky
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, V8Q 2Y2, Canada.
| | - Peter J W Saxton
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1023, New Zealand
| | - Nigel P Dickson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
| | | | - Rhys G Jones
- Te Kupenga Hauora Māori (TKHM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1072, New Zealand
| | - Terryann C Clark
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand
| | - Elsie Ho
- Social and Community Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1072, New Zealand
| | | | - Cate E Dewey
- Department of Population Medicine, University of Guelph, Guelph, ON, N1G 2W1, Canada
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Epidemics of HIV Infection among Heavy Drug Users of Depressants Only, Stimulants Only, and Both Depressants and Stimulants in Mainland China: A Series, Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155483. [PMID: 32751337 PMCID: PMC7431999 DOI: 10.3390/ijerph17155483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
Background: Heavy drug users was a global consensus high-risk population of HIV infection. However, the specific impact of drug on HIV infection has not yet been established. Depressants and stimulants were most widely used drugs in mainland China, and mix use of the two drugs was also serious. We assessed the HIV infection rate and trends in heavy drug users by analyzing data from the National Dynamic Management and Control Database for Drug Users (NDMCDDU). Methods: All heavy drug users with HIV test results in NDMCDDU from 2008 to 2016 were grouped into depressants only group (DOG), stimulants only group (SOG), and both depressants and stimulants group (DSG). We used joinpoint regression to examine trends of HIV infection rates. Multivariable logistic regression was used to examine factors related to HIV infection. Results: A total of 466,033 heavy drug users with 9522 cases of HIV infection were included in this analysis. HIV infection rate was estimated at 2.97% (95% CI 2.91–3.04%) of 265,774 users in DOG, 0.45% (95% CI 0.42–0.49%) of 140,895 users in SOG, and 1.65% (95% CI 1.55–1.76%) of 59,364 users in DSG. In DOG, a U-shaped curve of HIV infection rate decreased from 3.85% in 2008 to 2.19% in 2010 (annual percent change (APC) −12.9, 95% CI −19.3–−6.0, p < 0.05), then increased to 4.64% in 2016 (APC 8.3, 95% CI 6.1–10.4, p < 0.05) was observed. However, SOG and DSG showed consistent increases from 0.15% in 2008 to 0.54% in 2016 (APC 8.2, 95% CI 4.8–11.8, p < 0.05) and from 0.78% in 2008 to 2.72% in 2016 (APC 13.5, 95% CI 10.7–16.4, p < 0.05), respectively. HIV infection rate of DOG in the southwest region presented a U-shaped trend. All groups showed significant increases in HIV infection in east and central regions. Conclusions: The U-shaped curve for HIV infection rate among DOG users and consistent increases among SOG and DSG users implies drug abuse is still a critical focus of HIV infection in China. It is urgently needed to reassess the effectiveness of current strategies on HIV prevention and control among drug users.
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Zhang C, Webb GF, Lou J, Shepherd BE, Qian HZ, Liu Y, Vermund SH. Predicting the long-term impact of voluntary medical male circumcision on HIV incidence among men who have sex with men in Beijing, China. AIDS Care 2019; 32:343-353. [PMID: 31619058 DOI: 10.1080/09540121.2019.1679704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using a deterministic compartmental modeling procedure to fit prevalence from 2005-2015, we projected new HIV cases during 2016-2026 under different coverage rates ranging from 0.0001 (at baseline) to 0.15 (an optimistic assumption) with simulations on varying transmission rates, model calibration to match historical data, and sensitivity analyses for different assumptions. Compared with the baseline (λ = 0.0001), we found the new HIV cases would reduce with the increase of coverage rates of the voluntary medical male circumcision (VMMC) among men who have sex wtih men (MSM). The higher the coverage rate, the lower the new HIV incidence would be. As one of the first studies to model the potential impact of VMMC among MSM in China, our model suggested a modest to the significant public health impact of VMMC. Even at just 15% VMMC annual uptake rate, the reduction in new infections is substantial. Therefore, there is a strong need to determine the efficacy of VMMC among MSM, to improve the evidence base for its potential use among MSM in low circumcision settings. Only then can policymakers decide whether to incorporate VMMC into a package of HIV prevention interventions targeting MSM.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Glenn F Webb
- Departments of Mathematics, Vanderbilt University, Nashville, TN, USA
| | - Jie Lou
- Department of Mathematics, Shanghai University, Shanghai, People's Republic of China
| | - Brian E Shepherd
- Departments of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA
| | - Yu Liu
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Sten H Vermund
- School of Public Health, Yale University, New Haven, CT, USA
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Zhang C, Penson DF, Qian HZ, Webb GF, Lou J, Shepherd BE, Liu Y, Vermund SH. Modeling economic and epidemiological impact of voluntary medical male circumcision among men who have sex with men in Beijing, China. Int J STD AIDS 2019; 30:630-638. [PMID: 30890118 PMCID: PMC6666307 DOI: 10.1177/0956462419831859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Voluntary medical male circumcision (VMMC) among men who have sex with men (MSM) may protect against HIV acquisition. We conducted a series of analyses to assess if expanded VMMC might reduce HIV incidence among MSM effectively and economically. We used a deterministic compartmental model to project new HIV cases (2016-2026) under annual VMMC coverage rates (λ) ranging from 0.0001 to 0.15. The 'number needed to avert' (NNA) is defined as the cumulative number of VMMCs conducted up to that year divided by the cumulative number of HIV cases averted in that specific year. Compared with the baseline circumcision coverage rate, we projected that new HIV cases would be reduced with increasing coverage. By 2026 (last year simulated), the model generated the lowest ratio (11.10) when the annual circumcision rate was the most optimistic (λ = 0.15). The breakeven point was observed at the year of 2019 with the annual VMMC coverage rate of 0.001. The total cost saved by averting HIV cases would range from 2.5 to 811 million US dollars by the end of 2026 with different hypothetical coverage rates. Our model suggests that acceleration in VMMC implementation among MSM could help stem the HIV/AIDS epidemic.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | - David F. Penson
- Departments of Urologic Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Han-zhu Qian
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Glenn F. Webb
- Department of Mathematics, Vanderbilt University School of Arts and Sciences, Nashville, Tennessee, USA
| | - Jie Lou
- Department of Mathematics, Shanghai University, Shanghai, China
| | - Brian E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Liu
- Department of Public Health Science, University of Rochester Medical Center, Rochester, New York, USA
| | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, Connecticut, USA
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