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Yan X, Xu Y, Tucker JD, Miller WC, Tang W. Facilitators and Barriers of HIV Partner Notification Services Among Men Who Have Sex With Men in China: A Qualitative Analysis Using a Socioecological Framework. Sex Transm Dis 2022; 49:541-545. [PMID: 35533019 PMCID: PMC9283254 DOI: 10.1097/olq.0000000000001644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV partner notification services (HIV PS) have been poorly implemented in most low- and middle-income countries, including China. Understanding the social context of partner services for key populations is important for scaling up HIV testing services. This study aims to examine facilitators and barriers of HIV PS using qualitative analysis. METHODS This article qualitatively analyzed the texts obtained from a crowdsourcing open call and adopted the socioecological framework to understand the social context of Chinese men who have sex with men (MSM) living with HIV that influenced their uptake of HIV partner services. Crowdsourcing means collecting ideas from and sharing solutions with the public. The open call was held to solicit ideas to enhance HIV partner services for Chinese MSM. Two coders conducted a content analysis of the texts from the submissions using inductive and deductive coding methods to identify facilitators and barriers of HIV PS. RESULTS Textual data from 53 submissions were analyzed. The most mentioned barrier, stigma associated with HIV PS, was deeply embedded at several levels, highlighting the urgent need for stigma reduction. Among the facilitators, many people mentioned anonymous online notification could protect the privacy and avoid social harm for index partners. Differentiated partner services may improve HIV PS uptake by providing tailored intervention according to the individual circumstances. Some people suggested implicit notification, which meant testing the attitude of the partner before direct disclosure. This was feasible and acceptable in many settings. CONCLUSIONS The unique social context of MSM living with HIV provides opportunities for embedding HIV partner services. More clinical trials that test the acceptability and effectiveness of the HIV PS interventions are needed.
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Affiliation(s)
- Xumeng Yan
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
| | - Yongshi Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
| | - Joseph D. Tucker
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William C. Miller
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Shang J, Tan R, Yang J, Yan B, Zhong X, Zhang Y, Alnajebi B, Ma Q, Huang A. Impact of dosing strategies on plasma concentrations of tenofovir: Implications in HIV pre-exposure prophylaxis in China. J Infect Public Health 2021; 14:1169-1173. [PMID: 34391173 DOI: 10.1016/j.jiph.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate has been recommended for pre-exposure prophylaxis (PrEP) to prevent HIV infection. Several studies have shown short but potent intermittent PrEP could provide comparable protection to daily PrEP in men, suggesting such dosing strategy might be useful in Chinese as well. The objective of this study was to evaluate the impact of different dosing strategies on plasma concentrations of tenofovir. METHODS An open label study in 40 Chinese healthy volunteers, randomized to receive the WHO-recommended dose of tenofovir (300mg) at four different dosing intervals: twice weekly for 4 weeks; once daily for 4 weeks with one missing dose in weeks 2-4; once daily for 4 weeks with two missing doses in weeks 2-4; and once every other day for 12 days. Plasma samples were collected at pre-dose, weekly trough and 24h post last dose and assayed using HPLC-UV. RESULTS The tenofovir trough concentrations were below the lower limit of quantification with the twice weekly regimen. The trough concentrations (24h dosing interval) at the steady state were 51.7±12.1ng/ml and 53.5±13.8ng/ml (mean±SD) in the once daily groups. Missing doses, once or twice weekly, had no significant impact on trough concentrations. Prolongation of dosing interval to 48h resulted with concentrations at 24h and 48h (trough) of ∼40 and 20ng/ml, respectively. CONCLUSIONS Intermittent tenofovir regimens resulted with remarkably low plasma concentrations in Chinese participants. Missing doses did not affect trough concentrations significantly.
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Affiliation(s)
- Jingchuan Shang
- Department of Pharmaceutical Analysis and Pharmacology, Chongqing Medical University, Chongqing 400016, China
| | - Rui Tan
- Department of Pharmaceutical Analysis and Pharmacology, Chongqing Medical University, Chongqing 400016, China
| | - Junqing Yang
- Department of Pharmaceutical Analysis and Pharmacology, Chongqing Medical University, Chongqing 400016, China
| | - Bo Yan
- Department of Pharmaceutical Analysis and Pharmacology, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yan Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Bayan Alnajebi
- Department of Pharmacy Practice, University at Buffalo, Buffalo, New York 14214, United States
| | - Qing Ma
- Department of Pharmacy Practice, University at Buffalo, Buffalo, New York 14214, United States.
| | - Ailong Huang
- Key Laboratory of Molecular Biology and Infectious Diseases, Chongqing Medical University, Chongqing 400016, China.
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Modelling the Epidemiological Impact and Cost-Effectiveness of PrEP for HIV Transmission in MSM in China. AIDS Behav 2019; 23:523-533. [PMID: 29971734 DOI: 10.1007/s10461-018-2205-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Risk of HIV infection is high in Chinese MSM, with an annual HIV incidence ranging from 3.41 to 13.7/100 person-years. Tenofovir-based PrEP is effective in preventing HIV transmission in MSM. This study evaluates the epidemiological impact and cost-effectiveness of implementing PrEP in Chinese MSM over the next two decades. A compartmental model for HIV was used to forecast the impact of PrEP on number of infections, deaths, and disability-adjusted life years (DALY) averted. We also provide an estimate of the incremental cost-effectiveness ratio (ICER) and the cost per DALY averted of the intervention. Without PrEP, there will be 1.1-3.0 million new infections and 0.7-2.3 million HIV-related deaths in the next two decades. Moderate PrEP coverage (50%) would prevent 0.17-0.32 million new HIV infections. At Truvada's current price in China, daily oral PrEP costs $46,813-52,008 per DALY averted and is not cost-effective; on-demand Truvada reduces ICER to $25,057-27,838 per DALY averted, marginally cost-effective; daily generic tenofovir-based regimens further reduce ICER to $3675-8963, wholly cost-effective. The cost of daily oral Truvada PrEP regimen would need to be reduced by half to achieve cost-effectiveness and realize the public health good of preventing hundreds of thousands of HIV infections among MSM in China.
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Ning Z, Fu J, Zhuang M, Park JA, Ibragimov U, He N, Wong FY. HIV and syphilis epidemic among MSM and non-MSM aged 50 and above in Shanghai, China: A yearly cross-sectional study, 2008-2014. Glob Public Health 2018; 13:1625-1633. [PMID: 29419357 DOI: 10.1080/17441692.2018.1427271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The magnitude of the HIV and syphilis epidemic among Chinese men ages 50 and older is unclear. In this study, we aimed to characterise and compare the prevalence of HIV and syphilis infections; linkage to care among those infected with HIV; and the geographic distribution of the two epidemics among elderly men who have sex with men (MSM) and non-MSM in Shanghai, China. This cross-sectional study involved 12,910 men ages 50 and above who participated in the HIV voluntary and counselling testing programme each year from 2008 to 2014. HIV prevalence among MSM in our sample ranged between 4.9% and 15.4%, while syphilis frequency among non-MSM decreased from 26.0% to 18.7%. Further, in 2014, MSM participants had a higher HIV prevalence than non-MSM (4.9% vs 1.8%), whereas syphilis was higher in older non-MSM compared to MSM (18.7% vs 12.4%). Among those infected with HIV, 121/211 (53.75%) of participants were linked to HIV treatment, where the linkage rate was comparable to that in Kunming [Zhao, S., Zhao, G., Zhang, W., liao, B., Chu C., Wang J., & Li, L. (2015). Compare the difference of efficiency between voluntary counseling testing and provider-initiated testing counseling for identifying HIV/AIDS in Kunming. Chinese Journal of AIDS & STD, 21(7), 623-625]. The high burden of HIV and syphilis among men ages 50 and older in Shanghai, China highlights the need to target older Chinese men, both MSM and non-MSM, with prevention efforts.
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Affiliation(s)
- Zhen Ning
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China.,b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Jie Fu
- b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Minghua Zhuang
- b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Jason A Park
- c Department of Medicine , Boston University School of Medicine , Boston , MA , USA
| | - Umedjon Ibragimov
- d Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Na He
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China
| | - Frank Y Wong
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China.,e Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine , University of Hawai'i at Mānoa , Honolulu , HI , USA
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Lorway R, Khan S, Chevrier C, Huynh A, Zhang J, Ma X, Blanchard J, Yu N. Sex work in geographic perspective: a multi-disciplinary approach to mapping and understanding female sex work venues in Southwest China. Glob Public Health 2016; 12:545-564. [PMID: 26790097 DOI: 10.1080/17441692.2015.1123748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper examines the findings from an extensive geographic mapping study of female sex work venues located in the south western Chinese city of Zigong, in Sichuan province. Drawing upon the findings from quantitative research, secondary historical sources and field notes, composed during participant observation, we provide a nuanced portrait of how the operation of sex work can be conceptualised in spatial terms, where 'space' is regarded as something socially constructed and historically contingent. The sex work geographies we analyse hold important implications for prevention work conducted in the region. When the sexual practices between sex workers and their clients are viewed against a wider geographic and historical backdrop, focus shifts from the properties and intentionalities of individuals towards the kinds of spaces where sex work operates, the organisation of which are underpinned by economic forces that have given rise to the rapid proliferation of small urban spaces in contemporary China.
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Affiliation(s)
- Robert Lorway
- a Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Shamshad Khan
- b Department of Communication , University of Texas at San Antonio , San Antonio , TX , USA
| | - Claudyne Chevrier
- a Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Anthony Huynh
- a Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Juying Zhang
- c Department of Health and Social Behaviour , West China School of Public Health, Sichuan University , Chengdu , People's Republic of China
| | - Xiao Ma
- c Department of Health and Social Behaviour , West China School of Public Health, Sichuan University , Chengdu , People's Republic of China
| | - James Blanchard
- a Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Nancy Yu
- a Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
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Ho EL, Spudich SS. Neurosyphilis and the impact of HIV infection. Sex Health 2015; 12:148-54. [DOI: 10.1071/sh14195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/18/2015] [Indexed: 11/23/2022]
Abstract
Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.
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Li Y, Xu J, Reilly KH, Zhang J, Wei H, Jiang Y, Geng W, Tang W, Shang H. Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis. PLoS One 2013; 8:e69137. [PMID: 23874891 PMCID: PMC3712943 DOI: 10.1371/journal.pone.0069137] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study is to systematically review the published studies and summarize the estimates of HIV and syphilis prevalences among high school and college student MSM in China in order to provide information for conducting targeted interventions. Methods Pubmed, Chinese National Knowledge Infrastructure, Wanfang and Google Scholar databases were searched in January 2013 to identify relevant articles. Data of eligible citations were extracted by two reviewers. All analyses were performed using Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Results Twenty-four eligible studies (6 in English and 18 in Chinese), published between 2006 and 2012, with a total of 3083 student MSM participants, were included. The meta-analyses showed that the prevalences of HIV and syphilis among studied student MSM were 4.4% (95% CI: 3.0%, 6.4%) and 5.7% (95% CI: 4.8%, 6.7%), respectively. HIV prevalence increased over the study period (3.0% in 2003–2006; 4.5% in 2007–2008, and 6.8% in 2009–2010, trend test chi-square = 11.3, p = 0.001). Conclusions Student MSM have become high-risk populations for HIV infection in China. The high prevalence of syphilis and the increasing HIV prevalence trend indicate the potential for a more severe HIV epidemic. Comprehensive intervention strategies that address condom promotion, syphilis detection and treatment, and health education need to be tailored to this vulnerable population to prevent HIV and syphilis infections.
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Affiliation(s)
- Yongze Li
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kathleen H. Reilly
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianming Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyi Wei
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weiming Tang
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hong Shang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
- * E-mail:
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Wang AL, Peng RR, Tucker JD, Cohen MS, Chen XS. Partner notification uptake for sexually transmitted infections in China: a systematic literature review. Sex Transm Infect 2012; 88:386-93. [PMID: 22427489 DOI: 10.1136/sextrans-2011-050275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE China's sexually transmitted infection (STI) epidemic requires comprehensive control programmes. Partner services are traditional pillars of STI control but have not been widely implemented in China. This study was a systematic literature review to examine STI partner notification (PN) uptake in China. METHODS Four English and four Chinese language databases were searched up to March 2011 to identify articles on PN of STIs including HIV in China. PN uptake was defined as the number of partners named, notified, evaluated or diagnosed per index patient. RESULTS A total of 11 studies met inclusion criteria. For STI (excluding HIV) PN, a median 31.6% (IQR 27.4%-65.8%) of named partners were notified, 88.8% (IQR 88.4%-90.8%) of notified partners were evaluated and 37.9% (IQR 33.1%-43.6%) of evaluated partners were diagnosed. For HIV PN, a median 15.7% (IQR 13.2%-36.5%) of named partners were notified, 86.7% (IQR 72.9%-90.4%) of notified partners were evaluated and 27.6% (IQR 24.1%-27.7%) of evaluated partners were diagnosed. A mean of 80.6% (SD=12.6%) of patients attempted PN, and 72.4% (IQR 63.8%-81.1%) chose self-referral when offered more than one method of PN. Perceived patient barriers included social stigma, fear of relationship breakdown, uncertainty of how to notify and lack of partner contact information. Perceived infrastructure barriers included limited time and trained staff, mistrust of health workers and lack of PN guidelines. CONCLUSION PN programmes are feasible in China. Further research on STI PN, particularly among men who have sex with men and other high-risk groups, is an important public health priority. PN policies and guidelines are urgently needed in China.
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Affiliation(s)
- Alberta L Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology and National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China
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Tucker JD, Cohen MS. China's syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Curr Opin Infect Dis 2011; 24:50-5. [PMID: 21150594 PMCID: PMC3103765 DOI: 10.1097/qco.0b013e32834204bf] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW China has experienced an increase in the incidence and prevalence of syphilis that is especially remarkable since this infection was virtually eradicated in the country 50 years ago. The purpose of this analysis is to provide an overview of recent literature on syphilis proximate determinants and potential public health responses. RECENT FINDINGS Per capita syphilis burden is greatest in coastal urban China. There are a number of biological, demographic, geographic, and behavioral/social proximate determinants of syphilis spread that distinguish the Chinese syphilis epidemic. These determinants portend the need for intensified syphilis control efforts, including: comprehensive testing and treatment; integration with HIV, sexually transmitted infection, and antenatal services; scale-up of novel rapid syphilis test technology, and multisectorial support. SUMMARY The Chinese central government recently announced a 10-year syphilis plan to provide clear expectations for evaluating the success of local syphilis control programs and integration with HIV testing programs. Further research is needed to understand the social and behavioral determinants driving the spread of syphilis.
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Affiliation(s)
- Joseph D Tucker
- Division of Infectious Disease, UNC Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
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Lim SH, Chan R. HIV infection among men who have sex with men in East and South-East Asia - time for action. Sex Health 2011; 8:5-8. [DOI: 10.1071/sh10124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/25/2010] [Indexed: 11/23/2022]
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