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Li X, Tang K. The Effects of Online Health Information-Seeking Behavior on Sexually Transmitted Disease in China: Infodemiology Study of the Internet Search Queries. J Med Internet Res 2023; 25:e43046. [PMID: 37171864 DOI: 10.2196/43046] [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: 09/28/2022] [Revised: 03/11/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Sexually transmitted diseases (STDs) are a serious issue worldwide. With the popularity of the internet, online health information-seeking behavior (OHISB) has been widely adopted to improve health and prevent disease. OBJECTIVE This study aimed to investigate the short-term and long-term effects of different types of OHISBs on STDs, including syphilis, gonorrhea, and AIDS due to HIV, based on the Baidu index. METHODS Multisource big data were collected, including case numbers of STDs, search queries based on the Baidu index, provincial total population, male-female ratio, the proportion of the population older than 65 years, gross regional domestic product (GRDP), and health institution number data in 2011-2018 in mainland China. We categorized OHISBs into 4 types: concept, symptoms, treatment, and prevention. Before and after controlling for socioeconomic and medical conditions, we applied multiple linear regression to analyze associations between the Baidu search index (BSI) and Baidu search rate (BSR) and STD case numbers. In addition, we compared the effects of 4 types of OHISBs and performed time lag cross-correlation analyses to investigate the long-term effect of OHISB. RESULTS The distributions of both STD case numbers and OHISBs presented variability. For case number, syphilis, and gonorrhea, cases were mainly distributed in southeastern and northwestern areas of China, while HIV/AIDS cases were mostly distributed in southwestern areas. For the search query, the eastern region had the highest BSI and BSR, while the western region had the lowest ones. For 4 types of OHISB for 3 diseases, the BSI was positively related to the case number, while the BSR was significantly negatively related to the case number (P<.05). Different categories of OHISB have different effects on STD case numbers. Searches for prevention tended to have a larger impact, while searches for treatment tended to have a smaller impact. Besides, due to the time lag effect, those impacts would increase over time. CONCLUSIONS Our study validated the significant associations between 4 types of OHISBs and STD case numbers, and the impact of OHISBs on STDs became stronger over time. It may provide insights into how to use internet big data to better achieve disease surveillance and prevention goals.
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Affiliation(s)
- Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Yu Z, Zhang TT, Wang X, Chang Q, Huang H, Zhang H, Song D, Yu M, Yang J, Liu Y, Li C, Cui Z, Ma J. Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China. BMJ Open 2022; 12:e055046. [PMID: 36171031 PMCID: PMC9528664 DOI: 10.1136/bmjopen-2021-055046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The HIV epidemic in key populations such as men who have sex with men (MSM) is a public health issue of worldwide concern. China has seen an increase in newly diagnosed HIV infections through male-male sexual contact in the past decade. In a long-term cohort, how the complex behaviour pattern of MSM changed and the association with the HIV risk are unclear at present. METHODS This study was conducted from October 2011 to December 2019 in Tianjin. MSM were recruited by snowball sampling through online and offline ways. Demographic and sexual behavioural data were collected for analysis. Three indicators (condom use in last anal sex, frequency of condom use during anal sex and the number of sexual partners) were used to define the behaviour change. Participants with zero, one, and two or three risk indicators were categorised into behaviour types of 'protective', 'moderate', and 'fragile', respectively. Change in behaviour type between baseline and each visit was considered. Time-varying Cox models were performed to evaluate HIV infection risk. RESULTS Of 2029 MSM included in the study, 127 were new HIV diagnoses. The overall incidence rate was 3.36 per 100 person-years. The percentage of 'protective' and 'moderate' behaviour types had a conspicuous growth trend as the follow-up. Furthermore, the HIV incidence rate in each visit among different behaviour transition types showed a general downward trend as the number of total follow-up times increased. Individuals who remained in 'fragile' (adjusted HR (aHR): 25.86, 95% CI: 6.92 to 96.57) or changed from 'protective' to 'moderate' (aHR: 4.79, 95% CI: 1.18 to 19.47), 'protective' to 'fragile' (aHR: 23.03, 95% CI: 6.02 to 88.13), and 'moderate' to 'fragile' (aHR: 25.48, 95% CI: 6.79 to 95.40) between baseline and the last follow-up had a higher HIV risk. Gained risk indicators were associated with the increase of HIV risk (gained one indicator, aHR: 2.67, 95% CI: 1.68 to 4.24; gained two or three indicators, aHR: 4.99, 95% CI: 3.00 to 8.31) while losing just one risk indicator could halve the risk (aHR: 0.43, 95% CI: 0.21 to 0.90). CONCLUSIONS Among MSM in Tianjin, it is necessary to get timely behaviour change for those with high-incidence behaviour patterns while sustaining for those with low-incidence patterns. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR2000039500).
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Affiliation(s)
- Zeyang Yu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Tian-Tian Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Xiaomeng Wang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Qinxue Chang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Huijie Huang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Honglu Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Desheng Song
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, No. 43, Shuimu Tiancheng Tuanjie Ring Road, Hongqiao District, Tianjin, China
| | - Yuanyuan Liu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Changping Li
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Jun Ma
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
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Sun X, Feng C, Feng L, Xiao T, Zhao X, Liu H, Wang Z, Chen C, Zhou S, Zhou D. An exploratory transmission mode of HIV/AIDS among older people based on data from multiple sources in China. Sci Rep 2022; 12:16077. [PMID: 36168023 PMCID: PMC9515084 DOI: 10.1038/s41598-022-20146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
The HIV/AIDS cases and proportion in older people are continuously and rapidly increasing in China, especially in males. However, the transmission mechanism is not well understood. This study aims to explore the transmission mechanism of HIV/AIDS and potential ways to prevent or control HIV/AIDS transmission in a city in southwestern China. Data from multiple sources, including HIV/AIDS case reports in 2010–2020, a survey of HIV/AIDS cases in 2020, and sentinel surveillance data of female sex workers (FSWs) in 2016–2020 were analyzed. We explored the transmission mechanism of HIV/AIDS cases aged 50 years and older. In this city, the number of newly reported HIV/AIDS cases aged 50 years and older increased from 2010 to 2019, and decreased in 2020. The number of male and female cases aged 50 years and older both increased rapidly in 2017–2019, though the number of male cases was larger than that of female. The survey data showed that 84.7% of older male cases reported commercial sexual behavior, among whom 87.7% reported never using condom and 37.6% reported more than 10 times of commercial sexual behaviors in 1 year. In terms of price of sexual behavior, 68.3% of older male cases sought low-tier FSWs among whom the HIV/AIDS positive rate was 5.4% from the sentinel surveillance data. These results suggested HIV transmission between older men and low-tier FSWs through commercial sexual behavior. Among female cases aged 50 years and older, most reported non-marital and non-commercial heterosexual (60.5%) or regular sexual partner (31.4%) transmission, suggesting that they were infected by their spouse/regular sexual partner. Data of matched couples showed that most male cases had both marital sexual behavior and commercial sexual behavior, or acquired HIV through commercial sexual behavior, while most female cases had only marital sexual behavior. Based on these findings, we proposed a transmission mode of that local older male people and FSWs are transmitting bilaterally through commercial sexual behavior, and local older male people are spreading to local older female people through spouse or regular sexual partner route. By studying data from multiple sources, we explored the HIV transmission mode among older people. In the meantime, we found that marital status had a different impact on male and female old people in their sex behaviors.
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Affiliation(s)
- Xiwei Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Caibi Feng
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Liao Feng
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Ticheng Xiao
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Xinran Zhao
- Cornell University College of Veterinary Medicine, Ithaca, USA
| | - Hong Liu
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Zhiqiu Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chen Chen
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Shoulin Zhou
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Dinglun Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Jiao K, Li H, Zhang D, Jiang Z, Lin Y, Liu X, Xu H, Yan X, Tang H, Ma W. Drug users' awareness of and willingness to use HIV non-occupational post-exposure prophylaxis (nPEP) services in China: a mixed methods study. BMC Infect Dis 2022; 22:151. [PMID: 35164694 PMCID: PMC8842954 DOI: 10.1186/s12879-022-07106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Drug users are regarded as a high-risk population for HIV infection. Non-occupational post-exposure prophylaxis (nPEP) is internationally regarded as an effective biomedical prevention against HIV but still a small-scale pilot project in China at present. The aim of this study was to understand drug users’ awareness of and willingness to use nPEP service in China. Methods This mixed methods study consisting of a qualitative study and a cross-sectional survey was conducted in two cities of China from 2018 to 2019. The in-depth interviews were audio-taped, transcribed verbatim and analyzed using thematic framework analysis. Univariate and multivariate logistic regressions were used to examine factors associated with drug users’ awareness of and willingness to use nPEP. Results There were 401 and 19 participants included in quantitative and qualitative study respectively. Among participants in quantitative study, 30.2% had heard of nPEP and 56.7% reported willingness to use nPEP in future HIV exposure. In multivariate analyses, nPEP awareness was associated with age, sex, education level, AIDS knowledge score and HIV risk perception. nPEP willingness was associated with AIDS knowledge score, HIV risk perception, alcohol use, monthly income and awareness of nPEP. The qualitative results showed the barriers to nPEP willingness included the fatigue after taking drugs, high cost and side effects of nPEP medication, long nPEP course, and fear of privacy disclosure. Conclusion Drug users had low nPEP awareness and only about half participants reported willingness to use nPEP. It is essential to promote nPEP education campaigns among drug users, especially for elders, women and those with lower education level. Simultaneously, price regulation, side effect management, psychological support and privacy protection need to be managed well when nPEP is routinized. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07106-x.
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Affiliation(s)
- Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Haochu Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Dapeng Zhang
- Blue City, Suite 028, Building 2, North of Pinguo Neighborhood, 32 Baiziwan Road, Beijing, 100020, People's Republic of China
| | - Zhenxia Jiang
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, 175 Shandong Road, Qingdao, Shandong, 266033, People's Republic of China
| | - Yuxi Lin
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Xueyuan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Hengmin Xu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Xuemei Yan
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Haoqing Tang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.
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Wang Y, Chen X, Ye M, Pang W, Zhang C, Xiong SD, Zheng YT. Consistency of spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected drug users in China. BMC Infect Dis 2021; 21:1001. [PMID: 34563139 PMCID: PMC8465760 DOI: 10.1186/s12879-021-06711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the transmission routes of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) are similar, previous studies based on separate research on HIV-1 and HCV assumed a similar transmission pattern. However, few studies have focused on the possible correlation of the spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected patients. METHODS A total of 310 HIV-1/HCV coinfected drug users were recruited in Yingjiang and Kaiyuan prefectures, Yunnan Province, China. HIV-1 env, p17, pol and HCV C/E2, NS5B fragments were amplified and sequenced from serum samples. The genetic characteristics and spatial dynamics of HIV-1 and HCV were explored by phylogenetic, bootscanning, and phylogeographic analyses. RESULTS Among HIV-1/HCV coinfected drug users, eight HCV subtypes (1a, 1b, 3a, 3b, 6a, 6n, 6v, and 6u) and two HIV-1 subtypes (subtype B and subtype C), three HIV-1 circulating recombinant forms (CRF01_AE, CRF07_BC and CRF08_BC), and four unique recombinant forms (URF_BC, URF_01B, URF_01C and URF_01BC) were identified. HCV subtype 3b was the most predominant subtype in both Yingjiang and Kaiyuan prefectures. The dominant circulating HIV-1 subtypes for drug users among the two areas were CRF08_BC and URF_BC. Maximum clade credibility trees revealed that both HIV-1 and HCV were transmitted from Yingjiang to Kaiyuan. CONCLUSIONS The spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected drug users seem to have high consistency, providing theoretical evidence for the prevention of HIV-1 and HCV simultaneously.
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Affiliation(s)
- Yu Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China
| | - Xin Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,Department of Pathogenic Biology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Mei Ye
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Wei Pang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Si-Dong Xiong
- KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China. .,Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China.
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China. .,KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China.
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Zhang B, Yan X, Li Y, Zhu H, Liu Z, Lu Z, Jia Z. Epidemic of HIV infection among persons who inject drugs in mainland China: a series, cross-sectional study. Harm Reduct J 2021; 18:63. [PMID: 34118933 PMCID: PMC8199561 DOI: 10.1186/s12954-021-00511-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Studies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China. However, there has never been a study to assess the national HIV epidemic among persons who inject drugs (PWIDs) based on a nationwide database.
Methods PWIDs among new entrants in detoxification centers with HIV test results were extracted from the 2008–2016 National Dynamic Management and Control Database for Persons Who Use Drugs (NDMCD). Logistic regressions were used to analyze factors associated with HIV infection, and joinpoint regression were used to examine trends in the HIV prevalence. Results A total of 103,619 PWIDs among new entrants tested for HIV in detoxification centers between 2008 and 2016 were included in the analysis. The HIV prevalence was 5.0% (n = 5167) among PWIDs. A U-shaped curve of the HIV prevalence decreased from 4.9% in 2008 to 3.3% in 2010 (Annual Percent Change [APC] − 20.6, 95% CI − 32.5 to − 6.7, p < 0.05) and subsequently increased from 3.3% in 2010 to 8.6% in 2016 (APC 17.9, 95% CI 14.5–21.4, p < 0.05) was observed. The HIV prevalence in west regions in China all presented decreased trends, while central and eastern regions presented increased trends. Conclusions Although the HIV prevalence has been declining in general population, the HIV prevalence among PWIDs has shown an increasing trend since 2010. Current policies on HIV control in PWIDs should be reassessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00511-6.
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Affiliation(s)
- Bo Zhang
- School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Xiangyu Yan
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yongjie Li
- School of Public Health, Peking University, Beijing, 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Zhimin Liu
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Zuhong Lu
- State Key Laboratory for Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 211189, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing, 100191, China. .,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, 100191, China. .,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, 100191, China.
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HIV/AIDS Among Female Sex Workers in China: Epidemiology and Recent Prevention Strategies. Curr HIV/AIDS Rep 2020; 17:151-160. [PMID: 32030600 DOI: 10.1007/s11904-019-00477-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the epidemiology of HIV among female sex workers (FSWs) in China over the past decade, to summarize current gaps in knowledge regarding risk factors, and to identify new directions for HIV prevention strategies. RECENT FINDINGS We summarized national and regional levels of HIV prevalence among FSWs based on reported rates in the literature from 2008 to 2018. Studies identified cases of HIV infection among FSWs in all but one province during this time period, and demonstrated a sporadic pattern in most provinces, with a low overall national HIV prevalence below 1%. However, in Yunnan and Guanxi Zhuang Autonomous Regions, the median-reported prevalence rates were close to or slightly above 1%. National prevention programs have widely promoted male condoms as a primary and practical measure for HIV prevention, but studies evaluating condom use practices among FSWs demonstrated wide variability. A rise in illicit use of synthetic drugs and changing sexual practices in the setting of sex work (e.g., anal sex) may represent newer risk factors for HIV transmission among FSWs; however, more data are needed to better characterize these trends. Limited studies have examined the feasibility and efficacy of innovative prevention tools (e.g., female condoms) or strategies (e.g., pre-exposure prophylaxis, PrEP) to prevent HIV among FSWs. We call for a more comprehensive understanding of current trends in HIV risk among FSWs, as well as more research focuses on innovative strategies to reduce the spread of HIV in this vulnerable population.
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Liu X, Chen MG, Chen Y, Shi L, Chen Y, Zhang Z, Xu X, Huan X, Fu G, McFarland W. Changing trends in the types of drug used and infectious disease prevalence among drug users in jiangsu province, china. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103034. [PMID: 33232884 DOI: 10.1016/j.drugpo.2020.103034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, a boom of synthetic drugs, especially methamphetamine has been documented in China, however, the situation in Jiangsu was unclear. The objective of this study was to evaluate the changing trends in types of drug used, examine the prevalence trends of HIV, syphilis and HCV over time and compare the demographic, drug and sexual behaviors among different types of people who use drugs (PWD) in Jiangsu Province, China. METHODS Consecutive cross-sectional studies were conducted from 2011 to 2015 in nine compulsory detoxification centers, which were HIV sentinel surveillance sites, in Jiangsu Province, China. A structured questionnaire was administered in a face-to-face interview with each participant to collect demographic, behavioral and laboratory information. Participants were classified into three types: opioids PWD (using heroin, opium, morphine and dolantin); stimulant PWD (using cocaine, methamphetamine, methylene dioxymetham-phetamine and Magu); poly-drug PWD (using opioids and stimulant drugs simultaneously). RESULTS Among a total of 16,164 PWD recruited from 2011 to 2015, the proportion of opioids PWD declined from 40.1% in 2011 to 11.8% in 2015, while the proportion of stimulant PWD increased from 53.6% to 84.3%. Overall HIV, syphilis, and HCV prevalence for the period was 0.3%, 9.6% and 31.6%, respectively. As types of drugs used shifted from opioids to stimulants, HIV prevalence increased (P = 0.031) while HCV decreased (P<0.001). HIV, syphilis and HCV prevalence trends varied across the three subgroups. Injection and needle-sharing behaviors differed between opioids and stimulant PWD, whereas unsafe sexual behaviors were similar. Poly-drug PWD might have higher risks for these infections due to combinations of unsafe sexual and injection behaviors. CONCLUSION Although the trend of drugs used have changed over time, HIV, syphilis and HCV infection risk behaviors among PWD still exist. Therefore, traditional intervention strategies should seek to address the challenge of increasing stimulant PWD. Access to convenient testing services, as well as pre- and post-exposure prophylaxis for HIV risk reduction should be improved among PWD. Antiviral treatment for HCV should be added to medical insurance coverage as soon as possible in Jiangsu Province.
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Affiliation(s)
- Xiaoyan Liu
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Master Guohong Chen
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China.
| | - Yuheng Chen
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Lingen Shi
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Yunting Chen
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Zhi Zhang
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Xiaoqin Xu
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Xiping Huan
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Gengfeng Fu
- Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, California, USA
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Do national funding organizations properly address the diseases with the highest burden?: Observations from China and the UK. Scientometrics 2020. [DOI: 10.1007/s11192-020-03572-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Li Z, Li Y. A comparative study on the prediction of the BP artificial neural network model and the ARIMA model in the incidence of AIDS. BMC Med Inform Decis Mak 2020; 20:143. [PMID: 32616052 PMCID: PMC7330958 DOI: 10.1186/s12911-020-01157-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background As a kind of widely distributed disease in China, acquired immune deficiency syndrome (AIDS) has been quickly growing each year, become a serious problem and caused serious damage to the life and health of people and the social events of China and the world because of its high fatality rate. It has been much concerned by all aspects of society. Therefore, developing early warning technology and finding the trend of early development are of quite significance to prevent and control human immunodeficiency virus (HIV)/AIDS. This study aimed to explore a suitable model for the morbidity of AIDS in China and establish a professional and feasible disease prediction model for the prevention and control works of AIDS. Methods At present, the traditional linear model is still utilized by most scholars to predict the incidence of HIV/AIDS. In addition, some scholars may attempt to use the nonlinear prediction model. Both prediction models showed good fitting and prediction effects. In China, the incidence of AIDS presents linear and nonlinear characteristics. In this research, the nonlinear back propagation artificial neural network (BP-ANN) model and the typical auto-regressive integrated moving average (ARIMA) linear model were applied to predict the incidence of HIV/AIDS and compare their fitting effects. Results Both models were capable of predicting the expected cases of AIDS. It was seen that ARIMA and BP-ANN models could be used to forecast the monthly incidence of HIV/AIDS, but the fitting and forecasting effects of the nonlinear BP neural network model were better than those of the traditional linear ARIMA model. Conclusions In summary, it was further concluded that the BP-ANN model was a suitable way to monitor and predict the change trend and morbidity of AIDS in China.
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Affiliation(s)
- Zeming Li
- School of Public Health of Peking University, NO.38 Xueyuan Road, Beijing, 100191, China
| | - Yanning Li
- School of Public Health Guangxi Medical University, NO.22 Shuangyong Road, Nanning, 530021, China.
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11
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Ge L, Li D, Li P, Qu S, Chen F, Lyu F. HIV and HCV Infection Status Among Drug Users - China, 2010-2018. China CDC Wkly 2020; 2:109-112. [PMID: 34594835 PMCID: PMC8428419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/13/2020] [Indexed: 11/22/2022] Open
Abstract
What is already known about this topic? It is known that drug users (DUs) was brought into human immunodeficiency virus (HIV) sentinel surveillance as HIV related high-risk group since 1990s with a higher HIV antibody positive rate in the early stage. What is added by this report? This study not only showed that HIV antibody positive rate had decreased steadily since 2010 and maintained stable in past 4 years, but also showed that the proportion of the new narcotic and the mixed drug users increased since 2010 and HIV antibody positive rate of mixed abuse users increased year by year. What are the implications for public health practice? Some existing policies and strategies publicity, education and interventions require adjustments since new narcotic drug users contributed to DUs HIV infections. The challenge of HIV infection and transmission among drug users abusing both traditional and new narcotic drugs also require more attention.
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Affiliation(s)
- Lin Ge
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmin Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peilong Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuquan Qu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lyu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China,Fan Lyu,
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12
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Xiao C, Jike C, Liu D, Jia P, Xu X, Xiao L, Yu G, Nan L, Sun X, Ge J, Wang J, Wang K, Liao Q, Wang Q, Wenwen Z, Yang S. The changing modes of human immunodeficiency virus transmission and spatial variations among women in a minority prefecture in southwest China: An exploratory study. Medicine (Baltimore) 2020; 99:e18776. [PMID: 32028390 PMCID: PMC7015565 DOI: 10.1097/md.0000000000018776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.
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Affiliation(s)
- Chenghan Xiao
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Chunnong Jike
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Xiaohe Xu
- School of Public Administration, Sichuan University, Chengdu
- Department of Sociology, The University of Texas at San Antonio, TX
| | - Lin Xiao
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Gang Yu
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Lei Nan
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Xiaxia Sun
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jingjing Ge
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Ju Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Ke Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Qiang Liao
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Qixing Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Zhai Wenwen
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Shujuan Yang
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
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13
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Abstract
PURPOSE OF REVIEW This study aims to review the history of the human immunodeficiency virus (HIV) infection epidemic in China. RECENT FINDINGS The HIV infection epidemic in China has evolved significantly over the past 35 years, from initially exclusively within people who inject drugs (PWID), to outbreaks due to plasma collection contamination in the mid-1990s, to now almost exclusive transmission via sexual contact. The number of newly-diagnosed cases and the number HIV-related deaths have increased each year since 2004, coinciding with a massive scale-up of both HIV testing and antiretroviral therapy initiation. The proportion of cases diagnosed later in their disease progression has remained constant. The initial outbreaks of HIV across China were identified quickly and the overall trends have been monitored. While the HIV epidemic among PWID has been well managed, the growing HIV epidemic via sexual contact has grown more complex and even more difficult to control.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
- University of California, California, Los Angeles, USA.
| | - Junfang Chen
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
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Chinese herbal medicine for patients living with HIV in Guangxi province, China: an analysis of two registries. Sci Rep 2019; 9:17444. [PMID: 31767895 PMCID: PMC6877622 DOI: 10.1038/s41598-019-53725-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/31/2019] [Indexed: 11/29/2022] Open
Abstract
Anti-Retroviral Therapy (ART) is the recommended first line therapy for patients with HIV. Since 2004, Chinese government has provided free Chinese herbal medicine (CHM) for Chinese HIV/AIDS patients. Data of living patients with HIV from the NFTCMP database and Center for Disease Control (CDC) database during 2003–2016 in Guangxi province was obtained and compared. Patients were divided into 3 groups according to their recorded treatment regimens. A total of 2954 patients with their treatment recorded in the two databases were included for analysis, their median age was 46 years (IQR = 36–59), and 64.63% were male. CHM regimens users had baseline CD4 cell counts (380.11 ± 240.59 cell/μL), approximately 100 cell/μL significantly higher than patients receiving CHM combined with ART regimens or only ART regimens. There was no significant difference in mortality among groups. All three regimens improved patients’ CD4 cell counts. Compared to the sharp improvement in ART group during the first 6 months, CD4 cell counts of patients in CHM group and CHM combined with ART group showed a smooth and steady rise. CD4 cell counts of the combined group remained much lower than ART group in the first 3 years, but overtook ART group in the fourth year.
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Ye X, Liu J, Yi Z. Trends in the Epidemiology of Sexually Transmitted Disease, Acquired Immune Deficiency Syndrome (AIDS), Gonorrhea, and Syphilis, in the 31 Provinces of Mainland China. Med Sci Monit 2019; 25:5657-5665. [PMID: 31361737 PMCID: PMC6685330 DOI: 10.12659/msm.915732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to investigate trends in the epidemiology of the leading sexually transmitted diseases (STDs), acquired immune deficiency syndrome (AIDS), gonorrhea, and syphilis, in the 31 provinces of mainland China. MATERIAL AND METHODS This retrospective study analyzed the incidence data of STDs from official reports in China between 2004 and 2016. The grey model first order one variable, or GM (1,1), time series forecasting model for epidemiological studies predicted the incidence of STDs based on the annual incidence reports from 31 Chinese mainland provinces. Hierarchical cluster analysis was used to group the prevalence of STDs within each province. RESULTS The prediction accuracy of the GM (1,1) model was high, based on data during the 13 years between 2004 and 2016. The model predicted that the incidence rates of AIDS and syphilis would continue to increase over the next two years. Cluster analysis showed that 31 provinces could be classified into four clusters according to similarities in the incidence of STDs. Group A (Sinkiang Province) had the highest reported prevalence of syphilis. Group B included provinces with a higher incidence of gonorrhea, mainly in the southeast coast of China. Group C consisted of southwest provinces with a higher incidence of AIDS. CONCLUSIONS The GM (1,1) model was predictive for the incidence of STDs in 31 provinces in China. The predicted incidence rates of AIDS and syphilis showed an upward trend. Regional distribution of the major STDs highlights the need for targeted prevention and control programs.
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Affiliation(s)
- Xuechen Ye
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, P.R. China
| | - Jie Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning, P.R. China
| | - Zhe Yi
- Department of Prothodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, P.R. China
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16
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Luo S, Lin C, Feng N, Wu Z, Li L. Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:73-77. [PMID: 31233972 DOI: 10.1016/j.drugpo.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/06/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Drug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors. METHODS The cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers. RESULTS The Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009). CONCLUSION The findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.
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Affiliation(s)
- Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
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Prevalence of HIV, HCV and HBV infection and sociodemographic characteristics of people who inject drugs in China: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:87-93. [PMID: 31125802 DOI: 10.1016/j.drugpo.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/30/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Globally, China is the largest country by population and contributes substantially to the burden of people who inject drugs (PWID). The aims of this study were to estimate the prevalence of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV) among PWID at the national and subnational level in China and examine characteristics of PWID. METHODS We undertook a systematic review of studies published from 2008 to 2017 on HIV, HCV, and HBV seroprevalence among PWID, and characteristics of PWID in Mainland China, Hong Kong, Macao and Taiwan. Meta-analyses were conducted to generate pooled prevalence estimates by province, region, and nationally. RESULTS Eighty-five papers were included. The pooled HIV, HCV antibody and HBV prevalence among PWID in China was 10.5% (95% confidence interval [95%CI]: 8.6%-12.5%), 71.6% (65.7%-77.6%) and 19.6% (13.7%-25.5%), respectively. In Mainland China, HIV prevalence was highest in the Southwest (14.4%, 10.5%-18.4%) and lowest in the North (1.3%, 0.4%-3.4%). Xinjiang Province had the highest HIV prevalence (42.6%, 35.5%-49.8%). HCV antibody prevalence was highest in the Southwest (77.7%, 69.9%-85.4%), followed by South (76.2%, 65.9%-86.4%). Sichuan had the highest HCV antibody prevalence (91.7%, 86.6%-95.3%), followed by Guangxi (86.1%, 81.8%-90.4%). HBsAg prevalence among PWID was highest in South (25.3%, 14.6%-36.0%), followed by Central (20.8%, 17.4%-24.1%). HBsAg prevalence ranged from 2.4% (0.6-5.9%) in Guizhou to 40.0% (33.7%-46.6%) in Shannxi Province. In China, women and young people accounted for 21.3% and 23.1% of PWID, respectively. It was estimated that 96.1% of PWID injected opioids mainly, and recent injecting risk and sexual risk was reported by 28.5% and 36.7%. CONCLUSION There is a large burden of HIV, HCV and HBV prevalence among PWID in China, with considerable geographic variation. The disease burden of viral hepatitis is particularly high, implying that effective management should be integrated into harm reduction interventions among PWID in China.
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18
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Han J, Wu Z, McGoogan JM, Mao Y, Tang H, Li J, Zhao Y, Jin C, Detels R, Brookmeyer R, Lima VD, Montaner JSG. Overrepresentation of Injection Drug Use Route of Infection Among Human Immunodeficiency Virus Long-term Nonprogressors: A Nationwide, Retrospective Cohort Study in China, 1989-2016. Open Forum Infect Dis 2019; 6:ofz182. [PMID: 31139671 PMCID: PMC6527089 DOI: 10.1093/ofid/ofz182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/06/2019] [Indexed: 01/13/2023] Open
Abstract
Background Why some persons living with human immunodeficiency virus (HIV) (PLWH) progress quickly and others remain "healthy" for a decade or more without treatment remains a fundamental question of HIV pathology. We aimed to assess the epidemiological characteristics of HIV long-term nonprogressors (LTNPs) based on a cohort of PLWH in China observed between 1989 and 2016. Methods We conducted a nationwide, retrospective cohort study among Chinese PLWH with HIV diagnosed before 1 January 2008. Records were extracted from China's national HIV/AIDS database on 30 June 2016. LTNPs were defined as those with AIDS-free, antiretroviral therapy-naive survival, with CD4 cell counts consistently ≥500/μL for ≥8 years after diagnosis. Prevalence was calculated, characteristics were described, and determinants were assessed by means of logistic regression. Potential sources of bias were also investigated. Results Our cohort included 89 201 participants, of whom 1749 (2.0%) were categorized as LTNPs. The injection drug use (IDU) route of infection was reported by 70.7% of LTNPs, compared with only 37.1% of non-LTNPs. The odds of LTNP status were greater among those infected via IDU (adjusted odds ratio [95% confidence interval], 2.28 [1.94-2.68]) and with HIV diagnosed in settings with large populations of persons who inject drugs (1.75 [1.51-2.02] for detention centers, 1.61 [1.39-1.87] for Yunnan, 1.94 [1.62-2.31] for Guangdong, and 2.90 [2.09-4.02] for Xinjiang). Conclusions Overrepresentation of the IDU route of infection among LTNPs is a surprising finding worthy of further study, and this newly defined cohort may be particularly well suited to exploration of the molecular biological mechanisms underlying HIV long-term nonprogression.
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Affiliation(s)
- Jing Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Houlin Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Cong Jin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California-Los Angeles
| | - Viviane D Lima
- British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
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Li L, Wu Z, Liang LJ, Lin C, Luo S, Cao X, Hsieh J, Rou K. An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China. Drug Alcohol Depend 2019; 194:143-150. [PMID: 30445272 PMCID: PMC6413495 DOI: 10.1016/j.drugalcdep.2018.09.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention. METHODS This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period. RESULTS Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90). CONCLUSIONS The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Julie Hsieh
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
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Changing epidemiological patterns of HIV and AIDS in China in the post-SARS era identified by the nationwide surveillance system. BMC Infect Dis 2018; 18:700. [PMID: 30587142 PMCID: PMC6307199 DOI: 10.1186/s12879-018-3551-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/23/2018] [Indexed: 11/12/2022] Open
Abstract
Background China has made substantial progress in tackling its HIV and AIDS epidemic. But the changing patterns of HIV and AIDS incidence based on the longitudinal observation data were rarely studied. Methods The reporting incidence (RI) and mortality data on HIV and AIDS in China covering 31 provinces from 2004 to 2014 were collected from the Chinese Public Health Science Data Center. To decompose the time-series data, Empirical Mode Decomposition (EMD) was applied to properly describe the trends of HIV and AIDS incidence. A mathematical model was used to estimate the relative change of incidence among provinces and age groups. Results A total of 483,010 newly HIV infections and 214,205 AIDS cases were reported between 2004 and 2014 nationwide. HIV infection increased from 13,258 in 2004 (RI 1.02 per 100,000 person years) to 74,048 in 2014 (RI 5.46 per 100,000). The number of AIDS cases increased from 3054 in 2004 (RI 0.23 per 100,000) to 45,145 in 2014 (RI 3.33 per 100,000). The overall relative changes for HIV infection and AIDS incidence were 1.11 (95% confidence interval [CI] 1.10–1.13) and 1.28 (95% CI 1.23–1.33), respectively. The relative increase for HIV and AIDS RI was higher in northwest provinces while lower in Henan, Xinjiang, Guangxi and Yunnan. The overall relative changes for HIV infection were 1.12 (95% CI 1.11–1.14) in males and 1.10 (95% CI 1.06–1.13) in females. For AIDS RI, the relative increases were 1.31 (95% CI 1.26–1.36) in males and 1.22 (95% CI 1.17–1.28) in females. The lowest relative increase was detected among young adults, while the largest relative increase (odds ratio [OR] > 1.30) was detected in people aged 55 years or above. Conclusions HIV and AIDS showed an increasing trend in China from 2004 to 2014, respectively, but the epidemic tended to be under control among provinces and young people that used to have a high HIV and AIDS incidence. Northwest China and older people could be new “hop-spots” for HIV and AIDS risk.
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Jiang Z, Xiu C, Yang J, Zhang X, Liu M, Chen X, Liu D. HIV test uptake and related factors amongst heterosexual drug users in Shandong province, China. PLoS One 2018; 13:e0204489. [PMID: 30335766 PMCID: PMC6193625 DOI: 10.1371/journal.pone.0204489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In China, the mode of HIV transmission and the types and routes of drug use have changed in the past decade. HIV testing amongst drug users needs further improvement. METHODS Interviewer-administered questionnaires were used for data collection amongst 600 heterosexual drug users from the community and a municipal detention centre, where criminal suspects are supervised. Descriptive statistics, univariate analysis and multilevel logistic regression analysis were used to identify the factors associated with HIV testing amongst heterosexual drug users. All participants were screened HIV and sexually transmitted infections. RESULTS Amongst 600 participants, 554 (92.3%) were methamphetamine users, and 155 (25.8%) underwent HIV testing in the past year. Multivariate analysis results revealed that drug users who were single (adjusted odds ratio(AOR) = 1.923, 95% confidence interval(CI) = 1.189-3.109), had less knowledge of HIV (AOR = 1.706, 95% CI = 1.074-2.711), used only one kind of drug (AOR = 2.649, 95% CI = 1.155-6.077), used drug via a non-injection route (AOR = 2.121, 95% CI = 1.103-4.078), did not receive free condoms (AOR = 2.307, 95% CI = 1.129-4.715) and who did not receive free publicity material from health workers in the past year (AOR = 2.828, 95% CI = 1.757-4.552) were less likely to undergo HIV testing. A total of 594 participants underwent HIV and syphilis screening in this survey. Amongst these participants, 2 (0.3%) were HIV antibody positive, and 88 (14.8%) showed positive results in both non-treponemal test (rapid plasma regain test) and treponemal test (Treponema pallidum particle agglutination test) for the first time. CONCLUSIONS The rate of HIV test uptake amongst heterosexual drug users in China remains low. Thus, more specific interventions are urgently needed to improve the utilisation of HIV testing amongst heterosexual drug users, particularly amongst non-injection drug users in China.
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Affiliation(s)
- Zhenxia Jiang
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Cuizhen Xiu
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Jun Yang
- Department of STI and Leprosy Prevention and Control, Jining Hospital for Skin Disease Control and Prevention, Jining, Shandong, China
| | - Xijiang Zhang
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Minghua Liu
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Xinlong Chen
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, China
| | - Dianchang Liu
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, China
- * E-mail:
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Shen L, Assanangkornchai S, Liu W, Cai L, Li F, Tang S, Shen J, McNeil EB, Chongsuvivatwong V. Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China. PLoS One 2018; 13:e0200105. [PMID: 29969481 PMCID: PMC6029801 DOI: 10.1371/journal.pone.0200105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS To examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients' social network characteristics. DESIGN Cross-sectional study. SETTING Four MMT clinics in Kunming, Yunnan province, China. PARTICIPANTS 324 consecutive MMT clients. MEASUREMENTS A structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites. ANALYSIS The association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations. FINDINGS MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use. CONCLUSION Social networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.
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Affiliation(s)
- Ling Shen
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- School of Public Health, Kunming Medical University, Kunming, China
| | | | - Wei Liu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, Kunming, China
| | - Fei Li
- School of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Songyuan Tang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jiucheng Shen
- Yunnan Institute for Drug Abuse, Xi Shan District, Kunming, China
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Guanghua L, Yi C, Shuai T, Zhiyong S, Zhenzhu T, Yuhua R, Yousuf MA, Wensheng F. HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China: Results of 3 cross-sectional surveys from 2013 to 2015. Medicine (Baltimore) 2018; 97:e0404. [PMID: 29668597 PMCID: PMC5916656 DOI: 10.1097/md.0000000000010404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess human immunodeficiency virus (HIV), syphilis, and behavioral risk factors among men who have sex with men (MSM) in southwestern China, where HIV started as a drug-driven epidemic, and shifted to mainly heterosexual transmission.These cross-sectional studies were conducted yearly in 2013, 2014, and 2015 in Guangxi, China. A total of 1,996, 1,965, and 1,697 participants were recruited in 2013, 2014, and 2015, respectively. The data included demographic and sexual behavioral variables. Other variables included individuals who used illegal drugs, and who received HIV counseling, testing, and free condoms, and peer education. Participants were tested for HIV, syphilis, and hepatitis C virus (HCV) with whole blood specimens. Questionnaires and laboratory testing data were double entered, and validated with EpiData software. The data were then transferred into SPSS software (SPSS Inc, Chicago, IL) and Chi-square test performed.The prevalence of HIV was 6.6% in 2013, 8.4% in 2014, and 11.2% in 2015. The prevalence of syphilis was 9.3% in 2013, 9.8% in 2014, and 6.1% in 2015. And HCV prevalence was 0.5% in 2013 and remained stable at 0.4% in 2014, and 2015. HIV infection, and associated factors among MSM in these 3 annual cross-sectional survey showed that HIV-infected MSM were significantly, more likely, to perform unprotected anal intercourse with any commercial male partners in the past 6 months (adjusted odds ratio [AOR] = 1.81, 95% CI: 1.50-2.20), had sex with any female partners in the past 6 months (AOR = 1.31, 95% CI: 1.01-1.71), used drugs in the past (AOR = 2.73, 95% CI: 1.30-5.71), and are syphilis infected (AOR = 3.53, 95% CI: 2.77-4.49).There is an urgent need for intervention strategies like condom distribution, HIV counseling, free testing, and education regarding safe sex, HIV, and other sex-related diseases in Guangxi to curb, and prevent HIV among MSM.
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Affiliation(s)
- Lan Guanghua
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Chen Yi
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Tang Shuai
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Shen Zhiyong
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Tang Zhenzhu
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Ruan Yuhua
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Beijing
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | | | - Fan Wensheng
- Department of Health Services Administration, Florida International University, Miami, FL
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Lee SS, Newman R. Methadone maintenance-lessons from two systems in China. Harm Reduct J 2017; 14:66. [PMID: 28946906 PMCID: PMC5613321 DOI: 10.1186/s12954-017-0193-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022] Open
Abstract
In Hong Kong, methadone maintenance treatment (MMT) was launched in the 1970s, almost 30 years before the counterpart programme’s inauguration in Mainland China. Both were established in response to perceived public crises—addiction-related crime and HIV outbreak, respectively—and both are now regular services under two systems in the same country. Effectiveness of MMT in achieving the stated goals was evident in each case and provides useful lessons on strategies for dealing with the varied concerns related to illicit drug use. Today, with changing patterns of drug addiction, increasing competition for resources, and changing attitudes towards addiction and its treatment, the two MMT systems are confronted with similar challenges to achieve sustainability.
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Affiliation(s)
- Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Robert Newman
- Beth Israel Medical Center (President Emeritus), New York, USA
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Sun Y, Guo W, Li G, He S, Lu H. Increased synthetic drug abuse and trends in HIV and syphilis prevalence among female drug users from 2010-2014 from Beijing, China. Int J STD AIDS 2017; 29:30-37. [PMID: 28697679 DOI: 10.1177/0956462417715174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to monitor the trend of addiction drug use and its relationship with sexually transmitted infections (STIs) among female drug users (FDUs). Serial cross-sectional surveys were conducted during 2010-2014 among FDUs in Beijing to collect information on addiction drug usage, sexual behaviors, and STI prevalence. Characteristics were analyzed and compared between traditional and synthetic drug users among FDUs by logistic regression method. A total of 3859 FDUs were surveyed during 2010-2014, with the median age being 32.7 years old. The proportion of synthetic drug users among FDUs increased from 43.7% in 2010 to 70.7% in 2014. Compared with traditional drug users, synthetic drug users were younger (P < 0.001), lacked education (P < 0.001), were unmarried (P < 0.001), and were non-local residents (P < 0.001). No significant difference was found with condom usage during sexual activity between traditional and synthetic drug FDUs. However, the engagement of commercial sexual activities (P < 0.001) and syphilis prevalence (P < 0.001) among synthetic drug users were significantly higher than traditional drug users. Synthetic drug abuse appears to be correlated with commercial sex behavior and higher syphilis prevalence among FDUs. Tailored strategies on health education to curb the prevalence of synthetic drug abuse are urgently needed in Beijing.
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Affiliation(s)
- Yanming Sun
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Wei Guo
- 2 Division of Epidemiology, 196543 National Center for AIDS/STD Control and Prevention , Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guiying Li
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Shufang He
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Hongyan Lu
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
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27
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Wu Q, Kamphuis C, Duo L, Luo J, Chen Y, Richardus JH. Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities. Harm Reduct J 2017; 14:10. [PMID: 28193236 PMCID: PMC5307648 DOI: 10.1186/s12954-017-0137-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/02/2017] [Indexed: 02/04/2023] Open
Abstract
Background Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a reduced risk of HIV infection among drug users. Methods We wished to quantify the extent to which city-level characteristics (such as NSP and MMT service coverage) and individual-level determinants (e.g., self-reported exposure to NSP and MMT services, knowledge, motivation, and skills) were associated with the risk of HIV infection among drug users. In 2006, we conducted an integrated serological and behavioral survey among drug users in five cities of Yunnan Province, China (N = 685), constructing a multilevel logistic regression model with drug users clustered within these cities. Results Drug users who reported having received NSP or MMT services were about 50% less likely to be infected with HIV than those who reported not having received them (OR 0.45, 95% CI, 0.26–0.83 for NSP and 0.48, 95% CI, 0.31–0.73 for MMT). Despite a between-city variation of HIV infection risk (ICC 0.24, 95% CI 0.08–0.54), none of the city-level factors could explain this difference. Individual-level determinants such as perceived risk of infection and use of condoms were not associated with HIV infection. Conclusions Although people who had used NSP or MMT services were less likely to be HIV infected, this study found no relationship between city-level coverage of HIV prevention programs and variations in HIV infection between cities. This may have been due to the low number of cities in the analysis. Future research should include the analysis of data from a larger number of cities, which are collected widely in China through integrated behavioral and serological surveys. Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0137-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing Wu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,School of Public Health, Kunming Medical University, Yunnan, People's Republic of China.
| | - Carlijn Kamphuis
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Lin Duo
- Department of Research and Development, Yunnan Provincial Red Cross Hospital, Kunming, People's Republic of China
| | - Jiahong Luo
- School of Public Health, Kunming Medical University, Yunnan, People's Republic of China
| | - Ying Chen
- School of Public Health, Kunming Medical University, Yunnan, People's Republic of China
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Wang C, Shi CX, Zhang B, Chen H, Wang H, Zhang N, Rou K, Cao X, Luo W, Wu Z. HIV seroconversion and risk factors among drug users receiving methadone maintenance treatment in China: A qualitative study. Drug Alcohol Depend 2016; 167:169-74. [PMID: 27567967 PMCID: PMC6625317 DOI: 10.1016/j.drugalcdep.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to explore the experiences of drug users in China who were recently diagnosed with HIV infection while engaged in methadone maintenance treatment (MMT) and to better understand their perceptions of MMT, HIV risk, and HIV prevention. METHODS We recruited clients of MMT clinics in Chongqing and Kunming who had a baseline HIV-negative test result upon entry to MMT and had been diagnosed with HIV within the past 12 months. We conducted semi-structured qualitative interviews and thematic data analysis to identify situations and factors that increased HIV risk. RESULTS Among the 27 participants who were interviewed, 15 believed their infection was due to injection drug use, 7 attributed their infection to sexual contact, and 5 were unsure as to how they became infected. High risk behaviors were common; 18 participants continued to use drugs during treatment, and 10 engaged in unprotected sex. Common themes were the difficulty of drug abstinence despite receiving MMT, social pressure to continue using drugs, and low knowledge of effective HIV prevention measures. CONCLUSION While MMT is effective in reducing drug usage and needle sharing, many clients remain at risk of HIV infection due to continued injection drug use and unprotected sex. Clients may benefit from additional counseling on HIV prevention methods as well as structural interventions to increase the availability of clean injection equipment.
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Affiliation(s)
- Changhe Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Cynthia X Shi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China,Department of Epidemiology of Microbial Diseases and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, New Haven, CT 06511, USA
| | - Bo Zhang
- Yunnan Institute for Drug Abuse, 471 Xifu Road, Kunming 650228, China
| | - Hong Chen
- Chongqing Center for Disease Control and Prevention, 8 Changjiang 2nd Road, Chongqing 400016, China
| | - Hua Wang
- Yunnan Institute for Drug Abuse, 471 Xifu Road, Kunming 650228, China
| | - Nanci Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China.
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Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008-2013. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1631878. [PMID: 27761466 PMCID: PMC5059519 DOI: 10.1155/2016/1631878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown. Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies. Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (P < 0.001); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (P < 0.001). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)]. Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis.
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Chen X, Zhu L, Zhou YH, Liu FL, Li H, Yao ZH, Duo L, Pang W, Ye M, Zheng YT. Factors associated with needle sharing among people who inject drugs in Yunnan, China: a combined network and regression analysis. Infect Dis Poverty 2016; 5:73. [PMID: 27502491 PMCID: PMC4977866 DOI: 10.1186/s40249-016-0169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 07/07/2016] [Indexed: 11/29/2022] Open
Abstract
Background Network analyses have been widely utilized to evaluate large datasets, but have not yet been used to explore factors associated with risk behaviours. In combination with traditional regression analysis, network analyses may provide useful information and highlight key factors for reducing needle sharing behaviours among people who inject drugs (PWID). Methods Sociodemographic data, and information on injection behaviour and sexual practices were collected from a cross-sectional survey that was conducted with PWID in five prefectures of Yunnan province, China. A combination of logistic regression and correlation network analyses were used to explore key factors for reducing needle-sharing behaviours among PWID. Results In a total of 1 049 PWID, 37.5 % had a history of needle or syringe sharing. The logistic analysis showed that Zhaotong, Qujing, Dehong, or Lincang residents, diazepam use, longer injection duration, needle reuse, and infection with HIV, viral hepatitis, tuberculosis and/or malaria were independently associated with needle sharing. The correlation network analyses showed that, compared to PWID who had never shared needles, PWID who did share needles would achieve harm reduction goals faster and more permanently. HIV serostatus and marital status were found to be closely associated with other risk factors. By combining regression analyses with network analyses, it was shown that PWID who are HIV seropositive will be an ideal target group for harm reduction programs. Conclusion Needle-sharing behaviours are common among PWID in Yunnan, and harm reduction programs may help PWID who are HIV seropositive reduce risk behaviours and prevent blood borne diseases. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0169-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, 650204, China
| | - Lin Zhu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, 650204, China
| | - Yan-Heng Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.,College of Life Sciences, Yan'an University, Yan'an, Shaanxi, 716000, China
| | - Feng-Liang Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Hong Li
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, 650022, China
| | - Zhi-Hong Yao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Lin Duo
- The Second People's Hospital of Yunnan Province, Kunming, Yunnan, 650021, China
| | - Wei Pang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Mei Ye
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, 650204, China
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.
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Barriers to community-based drug dependence treatment: implications for police roles, collaborations and performance indicators. J Int AIDS Soc 2016; 19:20879. [PMID: 27435714 PMCID: PMC4951535 DOI: 10.7448/ias.19.4.20879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community-based treatment centres as mediators. The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community-based treatment.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hser YI, Liang D, Lan YC, Vicknasingam BK, Chakrabarti A. Drug Abuse, HIV, and HCV in Asian Countries. J Neuroimmune Pharmacol 2016; 11:383-93. [PMID: 27000123 DOI: 10.1007/s11481-016-9665-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/10/2016] [Indexed: 02/07/2023]
Abstract
Drug abuse and co-occurring infections are associated with significant morbidity and mortality. Asian countries are particularly vulnerable to the deleterious consequences of these risks/problems, as they have some of the highest rates of these diseases. This review describes drug abuse, HIV, and hepatitis C (HCV) in Asian countries. The most commonly used illicit drugs include opioids, amphetamine-type stimulants (ATS), cannabis, and ketamine. Among people who inject drugs, HIV rates range from 6.3 % in China to 19 % in Malaysia, and HCV ranges from 41 % in India and Taiwan to 74 % in Vietnam. In the face of the HIV epidemics, drug policies in these countries are slowly changing from the traditional punitive approach (e.g., incarcerating drug users or requiring registration as a drug user) to embrace public health approaches, including, for example, community-based treatment options as well as harm reduction approaches to reduce needle sharing and thus HIV transmission. HIV and HCV molecular epidemiology indicates limited geographic diffusion. While the HIV prevalence is declining in all five countries, use of new drugs (e.g., ATS, ketamine) continues to increase, as well as high-risk sexual behaviors associated with drug use-increasing the risk of sexual transmission of HIV, particularly among men who have sex with men. Screening, early intervention, and continued scaling up of therapeutic options (drug treatment and recovery support, ART, long-term HIV and HCV care for drug users) are critical for effective control or continued reduction of drug abuse and co-infections.
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Affiliation(s)
- Yih-Ing Hser
- University of California, Los Angeles, Los Angeles, CA, USA. .,China Medical University, Taichung City, Taiwan.
| | - Di Liang
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Amit Chakrabarti
- Regional Occupational Health Centre (ROHC), Eastern, National Institute of Occupational Health, Ahmedabad, Gujarat, India
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Estimating HIV incidence among key affected populations in China from serial cross-sectional surveys in 2010-2014. J Int AIDS Soc 2016; 19:20609. [PMID: 26989062 PMCID: PMC4796775 DOI: 10.7448/ias.19.1.20609] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/13/2015] [Accepted: 02/05/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China. Methods Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality. Results The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable. Conclusions Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.
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Wang R, Ding Y, Bai H, Duan S, Ye R, Yang Y, Wang J, Tang R, Gao M, He N. Illicit Heroin and Methamphetamine Use among Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Province, China. PLoS One 2015. [PMID: 26196394 PMCID: PMC4510060 DOI: 10.1371/journal.pone.0133431] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Methadone maintenance treatment (MMT) was introduced to China in 2004 to reduce the harm of injecting drug users (IDUs). However, little is known about continued drug use, especially methamphetamine (MAMP), among MMT patients. Methods A survey was conducted among patients attending five major MMT clinics in Dehong Prefecture in 2014 to investigate the heroin and MAMP use and their associated risk factors. Participants were administered with face-to-face interviews, and urine tests for morphine and MAMP. Results A total of 2,121 were eligible and participated in the study. Among them, 220 (10.4%) were only positive for morphine, 12.9% were only positive for MAMP, and 196 (9.2%) were positive for both morphine and MAMP. Compared with neither use of heroin nor MAMP during MMT, heroin use (not using MAMP) was associated with ethnicity, shorter duration of MMT, lower dose of methadone, and having had no more than two sex partners in the past year; MAMP use (not using heroin) was associated with ethnicity, longer duration of MMT, higher dose of methadone and being aged <30 years (vs. ≥50 years); use of both heroin and MAMP was associated with being Dai minority (vs. Han), a marital status of divorced or widowed, having used drugs for ≥10 years and shorter duration of MMT. Conclusion These findings indicate the complexity in the treatment of heroin users and underscore the importance in prescribing appropriate methadone dosages in order to reduce both heroin and MAMP use.
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Affiliation(s)
- Rongrong Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Disease Control and Prevention, National Health and Family Planning Commission, Beijing, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Hongling Bai
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Jibao Wang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Renhai Tang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- * E-mail:
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