[Progress in research of knowledge, attitude and practice of pre-exposure prophylaxis in men who have sex with men and its influencing factors]

Men who have sex with men (MSM) is a group of people at high risk for HIV infection in China, Pre-exposure prophylaxis (PrEP) is a bioprophylaxis strategy in the prevention of HIV infection in MSM, which can reduce the risk for HIV infection in this population effectively. However, in the paractice, the use level of PrEP in MSM is low in China, and there are MSM who know PrEP but receive no PrEP. This paper summarizes the current status of the awareness, willingness to use, actual use of PrEP in MSM and influencing factors both at home and abroad to provide a reference for the promotion of PrEP use in MSM in China.

Investigation on knowledge level about rational use of antimicrobial drugs among pharmacists in medical institutions in Shanxi province, China

OBJECTIVE

To investigate the pharmacist's knowledge about rational use of antimicrobials in Shanxi of China, so as to find out the problems and provide support for the management of antimicrobials.

METHODS

A questionnaire survey was conducted, which included the basic information of the respondents, the basic knowledge about antimicrobial management and the related knowledge about antimicrobial drugs. SPSS 25.0 was used for statistical analysis.

RESULTS

A total of 462 pharmacists were investigated. The average score of the knowledge related to rational use of antimicrobials was 10.49 ± 4.05. It showed that the hospital type, grade, pharmacist's education, professional title and years of experience had effect on the pharmacist's knowledge level about antimicrobial drugs (P < 0.05). Multivariable logistic regression analysis showed that hospital grade and pharmacist's education were the main influencing factors (P < 0.05).

CONCLUSION

Pharmacists have insufficient knowledge about the rational use of antibacterial drugs. It is essential to strengthen the training in management regulations and application of antibacterial drugs.

[Survival analysis since diagnosis of HIV-positive injecting drug users aged 15 years and above in China]

Objective: To understand death's mortality and risk factors among HIV-positive injecting drug users (IDU) aged 15 or above in China and provide further reference to future prevention and treatment policies. Method: Retrospective cohort study was conducted to calculate the mortality rate of HIV-positive IDU based on HIV/AIDS Comprehensive Response Information Management System. Cox proportion hazards regression model was performed to assess the risk factors for deaths. The Excel 2019 and SPSS 22.0 software was used for data cleaning and statistical analysis. Results: Between 2001 and 2020, 119 209 HIV-positive IDU were reported with 59 094 deaths. The all-cause mortality rate was 6.96 per 100 person-years (py), and the AIDS-related mortality rate was 1.91 per 100 py, with a decreasing trend over the years. Multivariate Cox regression indicated for all-cause death risks of HIV-positive IDU, compared with those baseline T⁺ lymphocyte cells (CD4) counts above 500 cells/μl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/μl was 2.85 (2.78-2.93), 2.47 (2.40-2.54), 1.58 (1.53-1.62) and 1.24 (1.21-1.28) respectively. The HR (95%CI) of antiretroviral treatment (ART) naïve was 7.13 (6.99-7.27) compared with those under ART. The HR (95%CI) of methadone maintenance treatment (MMT) naïve was 1.07 (1.04-1.10) compared to those receiving MMT. As for AIDS-related death risks, compared with baseline T+ lymphocyte cell CD4 counts >500 cells/μl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/μl was 3.26 (3.08-3.46), 5.54 (5.24-5.85), 2.35 (2.21-2.50) and 1.41 (1.32-1.50). HR (95%CI) of ART naïve was 5.96(5.74-6.18) compared to those under ART. Conclusions: Further efforts should be made timely on diagnosis, treatment, and harm reduction programs such as MMT for improvement compliance to reduce mortality risks of HIV-positive IDU.

[Epidemiological characteristics of newly reported HIV-infected adolescents aged 15-17 years outside school in China, 2011-2019]

Objective: To understand the epidemiological characteristics of HIV-infected adolescents outside school in China and provide reference to targeted prevention and control of HIV infection in this population. Methods: All the HIV-infected adolescents aged 15-17 years outside school reported during 2011-2019 were included this study. The information about their demographics, transmission routes and migration were collected from HIV/AIDS Comprehensive Response Information Management System. The χ² test was done for comparison among groups. The Joinpoint 4.9.0 software was applied to the annual percent change (APC) for time trends analysis using the Joinpoint regression model. The Excel 2019 and SPSS 22.0 software were used for data cleaning and statistical analysis. Results: A total of 4 919 HIV-infected adolescents aged 15-17 years outside school were reported accumulatively in China between 2011 and 2019, accounting for 63.4% (4 919/7 757) of total reported HIV-infected cases in this age group. Analysis on trend revealed that the new HIV infection diagnosis rate has become stable since 2016 (APC=2.5%, P=0.173) after the increase between 2011 and 2015 (APC=36.4%, P<0.001). The migration across provinces was discovered in 13.9% (684/4 919) of the HIV-infected adolescents outside school. Males, workers, and those diagnosed in detention centers or transmitted by injecting drugs or homosexual contacts accounted for a larger proportion in migrated cases compared with non-migrated cases. The adolescents outside school mainly got HIV infected by sexual contacts route, in which 66.5% (280/421) of the males were infected by homosexual contacts, while 97.8% (182/186) of the females were infected by heterosexual contacts in 2019. Conclusions: HIV-infected adolescents aged 15-17 years outside school were mainly infected by sexual contacts. However, adolescents outside school have low awareness of sexual health and high mobility, to whom close attention should be paid to improve their awareness of sexual health and to provide them with appropriate HIV infection prevention and treatment service.

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis

BACKGROUND

There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.

OBJECTIVES

To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.

DATA SOURCES

We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.

METHODS

Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.

RESULTS

Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%-70.6%), with a rate of 61.0% (95% CI: 50.8%-71.2%) in China and 67.8% (95% CI: 57.1%-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%-48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%-67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.

CONCLUSIONS

The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

[Analysis of Spatial Clustering of HIV infected in men who have sex with men in Chongqing of 2004-2015]

Objective: To analyze the spatial clustering characteristics of HIV/AIDS among men who have sex with men (MSM) in Chongqing from January 2004 to December 2015 and understand the HIV/AIDS related behaviors among MSM by interview. Methods: Data related to MSM who were infected with HIV and whose present address were in Chongqing, were collected from Information System on the HIV/AIDS Prevention and Control. Information included the age when the information was inputted, address, occupation, education level, and marital status. The total number of MSM who were infected with HIV and reported was 6 604 in Chongqing. Those with unknown address were ruled out. The spatial autocorrelation analysis and the local spatial autocorrelation analysis were carried out by using ArcGIS 10.3. In addition, in November 2015 and May 2016, using a convenience sampling, we conducted one-on-one interviews among 23 MSM in the Chongqing Center for Disease Control and prevention.

INCLUSION CRITERIA

Receiving voluntary counseling and testing in the urban area of Chongqing and willing to participate in the interview by oral informed consent; male and self-described as MSM. The content of the interview included basic information, sexual orientation, sexual role, the main place of making friends, the main place of sexual behavior, a long-term experience in other provinces and drug abuse. Results: The HIV/AIDS reported number in Chongqing from 2004 to 2015 showed an uptrend, except in 2010. The age distribution of 6 604 cases of HIV positive patients was mainly concentrated in the 15-34 years old, about 68.5% (4 522 cases). There was a positive spatial autocorrelation in MSM, except 2005 (Moran's I=-0.046, P=0.823), form 2004 to 2015, Global Moran's I values were 0.308, 0.254, 0.335, 0.683, 0.673, 0.558, 0.620, 0.673, 0.685, 0.654 and 0.649, respectively; all P values were <0.01. The result of local spatial autocorrelation analysis showed that high-high accumulation area development in Chongqing city was divided into two stages in 2004-2015, which were Yuzhong, Jiangbei, and Shapingba district in 2004-2007 and the expanded Jiulongpo, Nan'an, and Yubei district in 2008-2015. Qualitative interviews results revealed that the age of the respondents was 20-44, and the mainly way of making friends were using mobile phone App and internet (17 participants). Most of the participants (11 participants) were making friends in the bar. The majority of respondents would ask the friends or themselves to use condoms when meeting with them the first time (19 participants), and 8 of respondents reported that they would not use condoms when their old friends refused to use condoms. Conclusion: The HIV infected MSM mainly aged between 15-34 years old and the spatial distribution of HIV/AIDS among MSM was clustered in economically developed main area in Chongqing. MSM began to make friends on the Internet, and could not adhere to using condom, which indicated that we should focus on internet intervention to find more efficacious interventions.

[Characteristics of HIV infections among over 50-year-olds population in China]

OBJECTIVE

To analyze the characteristics on demographical, spatial distribution and transmission mode of HIV infections among 50-year-old population.

METHODS

Related information on demography, spatial distribution, high risk behavioral and history of HIV infections among 50-year-old population were collected and analyzed. Possible time of infection based on their first CD4 testing results right after the HIV diagnoses, was estimated.

RESULTS

Since 2008, the number of new HIV/AIDS cases among the over-50-year-olds was reported increasing annually. The number of aged 50 and above in 2014 was 4.2 times than the number in 2008. 50-year-old or older population were infected mainly through heterosexual behavior (88.0%). Among these cases, 83.9% self-reported as having histories on extramarital sex intercourse and the number was increasing yearly. Among male cases who admitted as having heterosexual experience, 95.1% of them reported as having histories of extramarital sex intercourse while 53.4% of the female cases reported as having the same experiences. 46.6% of spouses of the females or with fixed partners were HIV positive. Through estimating the time of infection and the time interval between infection and diagnosis, we found that the proportion was 15.5%, from infection to diagnosis as 3 years among the 50 and older age groups, but the proportion of 8 years from infection to diagnosis was 43.6%. We estimated that 66.5% of the new HIV cases who were at age 50 and over, were infected when they were at that age span. The average time from infection and being tested was (6.8 ± 2.7) years.

CONCLUSION

The increasing number of being diagnosed on HIV among the 50-year-olds population might be related to both high risk exposure and belated diagnoses among this population, calling for the necessity of deriving the sources of HIV infection and tailoring the HIV prevention strategies in this population.