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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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Thavorn K, Kugathasan H, Tan DHS, Moqueet N, Baral SD, Skidmore B, MacFadden D, Simkin A, Mishra S. Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis. Syst Rev 2018; 7:47. [PMID: 29544530 PMCID: PMC5855998 DOI: 10.1186/s13643-018-0710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit access in many jurisdictions. In the absence of guidelines for the synthesis of economic evaluations, we developed a protocol for a systematic review of economic evaluation studies for PrEP by drawing on best practices in systematic reviews and the conduct and reporting of economic evaluations. We aim to estimate the incremental cost per health outcome of PrEP compared with placebo, no PrEP, or other HIV prevention strategies; assess the methodological variability in, and quality of, economic evaluations of PrEP; estimate the incremental cost per health outcome of different PrEP implementation strategies; and quantify the potential sources of heterogeneity in outcomes. METHODS We will systematically search electronic databases (MEDLINE, Embase) and the gray literature. We will include economic evaluation studies that assess both costs and health outcomes of PrEP in HIV-uninfected individuals, without restricting language or year of publication. Two reviewers will independently screen studies using predefined inclusion criteria, extract data, and assess methodological quality using the Philips checklist, Second Panel on the Cost-effectiveness of Health and Medicines, and the International Society for Pharmacoeconomics and Outcomes Research recommendations. Outcomes of interest include incremental costs and outcomes in natural units or utilities, cost-effectiveness ratios, and net monetary benefit. We will perform descriptive and quantitative syntheses using sensitivity analyses of outcomes by population subgroups, HIV epidemic settings, study designs, baseline intervention contexts, key parameter inputs and assumptions, type of outcomes, economic perspectives, and willingness to pay values. DISCUSSION Findings will guide future economic evaluation of PrEP strategies in terms of methodological and knowledge gaps, and will inform decisions on the efficient integration of PrEP into public health programs across epidemiologic and health system contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038440 .
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, ICES Ottawa, Ottawa, Ontario, Canada
| | - Howsikan Kugathasan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Nasheed Moqueet
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Stefan D Baral
- Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, USA
| | - Becky Skidmore
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Derek MacFadden
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, 02115, USA
| | - Anna Simkin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada. .,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy and Management, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Medical Sciences, University of Toronto, Toronto, Canada.
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Allende R, Acuña MP. Is pre-exposure prophylaxis effective for preventing HIV infection in men who have sex with men? Medwave 2017; 17:e7117. [PMID: 29286354 DOI: 10.5867/medwave.2017.09.7117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Increasing rates of HIV infection remain of concern, especially for high-risk groups such as men who have sex with men. Oral pre-exposure prophylaxis has emerged as an alternative to prevention. However, doubts persist in patients and physicians about its effectiveness. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including twelve studies overall, of which six were randomized trials. We concluded the use of oral pre-exposure prophylaxis reduces the probability of HIV infection in men who have sex with men, has few or no adverse effects, and is a measure with a good balance between benefits, risks and costs.
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Affiliation(s)
- Rubén Allende
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - María Paz Acuña
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Infectología, Hospital Dr. Sótero del Río, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Centro de Innovación UC Anacleto Angelini, Av. Vicuña Mackenna 4860, Macul, Santiago
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Carlson NS. Current Resources for Evidence-Based Practice, January/February 2017. J Obstet Gynecol Neonatal Nurs 2016; 46:91-99. [PMID: 27840207 DOI: 10.1016/j.jogn.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zhang X, Tang W, Li Y, Mahapatra T, Feng Y, Li M, Chen F, Li P, Xing J, Qian S, Ge L, Bu K, Mahapatra S, Tang S, Wang L, Wang N. The HIV/AIDS epidemic among young people in China between 2005 and 2012: results of a spatial temporal analysis. HIV Med 2016; 18:141-150. [PMID: 27552922 DOI: 10.1111/hiv.12408] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite a recent increase in the HIV/AIDS epidemic among young people in China, youth-specific HIV data are limited. METHODS In total, 56 621 individuals with HIV/AIDS, aged 15-24 years, registered in the Case Reporting System of China between 2005 and 2012 and having complete spatial information were included in the present analysis. Spatial autocorrelation (general and local) and space-time scanning were performed using the ArcGIS 10.2 and SaTScan 9.3 software, respectively. RESULTS During 2005-2012, the number of reported HIV/AIDS cases and the proportion of HIV cases increased while the proportion of AIDS cases decreased. Sexual contact became the predominant route of transmission in later years. Spatial analysis showed marked geographical variations in HIV infection among young people throughout China during 2005-2012. The number of new hotspots increased over time. They were mainly localized to southeastern coastal areas, southwestern frontier provinces or autonomous regions (of Guangxi, Yunnan and Sichuan) and Beijing municipality. Later these hotspots disappeared and new hotspots were found in the northeast of the country. Significant clusters of HIV-positive cases were identified in three different time periods, which indicated high HIV transmission among young Chinese people in the recent past. The risk of HIV infection was highest in the first cluster (2009-2012; this cluster was the largest in size) covering the provinces of Guizhou and Yunnan, the Chongqing municipality, Guangxi, and the province of Sichuan. The second cluster (2010-2012) was mostly located in Shanghai, South Jiangsu, Zhejiang and South Anhui, while the third cluster (2010-2012) was located in Beijing and Tianjin. CONCLUSIONS Target-specific comprehensive behavioural interventions are urgently needed to contain the HIV epidemic among young people.
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Affiliation(s)
- X Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Shijingshan Center for Disease Control and Prevention, Beijing, China
| | - W Tang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
| | - Y Li
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - T Mahapatra
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Y Feng
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - M Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - F Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - P Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - J Xing
- Beijing Human Resources and Social Security Bureau, Beijing, China
| | - S Qian
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - L Ge
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - K Bu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - S Mahapatra
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - S Tang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
| | - L Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - N Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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