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BACKGROUND@#Youths are disproportionally affected by the human immunodeficiency virus (HIV) infection. We aimed to assess anti-retroviral therapy (ART) initiation and viral suppression rates among student and non-student youths in Hangzhou, China.@*METHODS@#Data were taken from the Chinese HIV/acquired immune deficiency syndrome Comprehensive Response Information Management System. Youths aged 15 to 24 years who were newly diagnosed with HIV between 2012 and 2016 and were living in Hangzhou were included in the study. Comparisons between student and non-student youths were made for ART initiation within 30 days, 90 days, and 12 months of HIV diagnosis, and the viral suppression rate at 12 months of HIV diagnosis and at 12 months of ART initiation.@*RESULTS@#A total of 707 cases met inclusion criteria, 29.6% of which were students and 70.4% were non-student youths. The student group had a higher proportion of ART initiation compared with the non-student group within 30 days of diagnosis (45.5% vs. 37.0%, P = 0.044), and a slightly higher but not statistically significant proportion at 90 days (67.0% vs. 62.7%), and 12 months (83.7% vs. 78.5%) of HIV diagnosis. ART initiation within 30 days improved from 90% in 2016. A smaller proportion of students experienced viral suppression compared with the non-student group (9.6% vs. 17.1%, P = 0.011) at 12 months after HIV diagnosis, but the suppression rate was similar at 12 months of ART initiation (69.9% vs. 71.1%, P = 0.743).@*CONCLUSIONS@#ART initiation in both student and non-student youths has significantly improved between 2012 and 2016. However, the viral suppression rate remained unacceptably low at 12 months of HIV diagnosis in both student and non-student groups. Specific intervention strategies must be taken to address this challenge.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Anti-HIV Agents , Therapeutic Uses , China , Continuity of Patient Care , HIV Infections , Diagnosis , Drug Therapy , Students , Time FactorsABSTRACT
Background@#Youths are disproportionally affected by the human immunodeficiency virus (HIV) infection. We aimed to assess antiretroviral therapy (ART) initiation and viral suppression rates among student and non-student youths in Hangzhou, China.@*Methods@#Data were taken from the Chinese HIV/acquired immune deficiency syndrome Comprehensive Response Information Management System. Youths aged 15 to 24 years who were newly diagnosed with HIV between 2012 and 2016 and were living in Hangzhou were included in the study. Comparisons between student and non-student youths were made for ART initiation within 30 days, 90 days, and 12 months of HIV diagnosis, and the viral suppression rate at 12 months of HIV diagnosis and at 12 months of ART initiation.@*Results@#A total of 707 cases met inclusion criteria, 29.6% of which were students and 70.4% were non-student youths. The student group had a higher proportion of ART initiation compared with the non-student group within 30 days of diagnosis (45.5% vs. 37.0%, P = 0.044), and a slightly higher but not statistically significant proportion at 90 days (67.0% vs. 62.7%), and 12 months (83.7% vs. 78.5%) of HIV diagnosis. ART initiation within 30 days improved from <15% in 2012 to over 65% in 2016 in both groups, and ART initiation within 90 days improved from <30% in 2012 to >90% in 2016. A smaller proportion of students experienced viral suppression compared with the non-student group (9.6% vs. 17.1%, P = 0.011) at 12 months after HIV diagnosis, but the suppression rate was similar at 12 months of ART initiation (69.9% vs. 71.1%, P = 0.743).@*Conclusions@#ART initiation in both student and non-student youths has significantly improved between 2012 and 2016. However, the viral suppression rate remained unacceptably low at 12 months of HIV diagnosis in both student and non-student groups. Specific intervention strategies must be taken to address this challenge.
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Objective To learn the prevalence of HIV, syphilis and HCV and to identify the potential risk factors among drug users in Hangzhou. Methods A consecutive cross-sectional survey was conducted from 2012 to 2016. The drug users from compulsory rehabilitation center, community and methadone clinic were interviewed face to face with questionnaires to collect the information about their demographic characteristics, drug use behaviors and sexual behaviors. Blood specimens were collected for HIV, syphilis and HCV testing. Results Totally 4067 drug users were included during this 5-year study. The infection rates of HIV, syphilis and HCV were 0.64％, 7.25％ and 22.69％, respectively. Multivariate logistic regression analysis indicated that the risk factors for syphilis infection were female (OR=4.411, 95％ CI: 3.273-5.945) , single (married/cohabited:OR=0.664, 95％ CI: 0.482-0.915; divorced/widowed: OR=0.534, 95％ CI: 0.353-0.810) , club drug user (OR=5.064, 95％CI: 3.287-7.803) and mixed drug user (OR=2.663, 95％CI: 1.191-5.954); the risk factors for HCV infection were age (OR: 2.168-2.878), place of domicile (OR=1.747, 95％CI: 1.398-2.184), injecting drug use (OR=3.120, 95％CI: 2.534-3.840) and conventional drug use (club drug user: OR=0.348, 95％CI: 0.277-0.438; mixed drug user: OR=0.611, 95％CI: 0.390-0.959) . Conclusion The infection rate of syphilis and HIV is high among drug users in Hangzhou. Female, single, club drug use and mixed drug use may increase the risk of syphilis infection. high age, drug injection and migrant population are risk factors for HCV infection.
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Objective To explore the epidemiological characteristics of young students with HIV/AIDS in Hangzhou and to provide scientific basis for AIDS prevention and control in school settings. Methods Data on HIV/AIDS patients was collected from HIV Comprehensive Prevention and Control Information System, and retrospective survey was conducted to those who were students and whose current residential address was Hangzhou. Results A total of 132 HIV/AIDS student cases were surveyed. The average age was (21.42±2.65) years, and 98.48％ were male. The proportion of homosexual transmission was 83.33％. Before positive confirmation, 55.45％ had homosexual partners both from students and non-students, 90.91％ had temporary sexual behavior, five cases had heterosexually fixed partners and two cases had heterosexually temporary partners.The proportions of condom use in all types of sexual partners ranged from 0.00％-50.00％. Seventy-two (54.55％) HIV/AIDS student cases thought they were impossible to be infected by HIV. Only 23.48％ of cases did HIV antibody test before positive confirmation. The proportion of HARRT was 80.30％. The proportion of co-infected with syphilis was 18.03％. Conclusion Homosexual behavior is the main route of transmission for HIV infection among young students in Hangzhou. Dangerous behaviors are prevalent, and the situation of AIDS prevention and control among students is severe.
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Objective To analyze the association between baseline level of CD4+T and the therapeutic effects of highly active antiretroviral therapy (HAART) for MSM HIV/AIDS in Hangzhou City. Methods We recruited MSM HIV/AIDS who initiated HAART from July 1st 2014 to June 30th 2016 into the study in Hangzhou City. MSM HAART patients whose baseline CD4+T≥500 copies/μL was set as observation group, and baseline CD4+T<500 copies/μL was set as control group. Patients were tested CD4 count and viral load regularly. We compared HAART effects of observation group and control group. Results We recruited 1206 MSM patients with access to HAART in our study in Hangzhou City. And 1026 patients were set in control group, and 180 patients were set in observation group. In the 12th month, the rates of two groups' patients with CD4 successfully recovered (reached 719 cells/μL) were 12.50% and 39.13%. In the 18th month, the rates were 13.75% and 38.71%. The median time of patients with CD4 first successfully recovered to 719 cells/μL was 7.2 month s in observation group, while the median time of control group was 20.4 months, which was longer than observation group (P<0.05) . A total of 375 patients were tested viral load, and the successful suppression rate of viral load was 97.33%. The rates of observation and control group were 96.34% and 97.50% (P>0.05) . Conclusion The rates of viral successful suppression were similar between baseline CD4 counts ≥500 cells/μL group and<500 cells/μL group among MSM HAART patients. Recovery time in baseline CD4 counts ≥500 cells/μL group was shorter than baseline CD4 counts<500 cells/μL group.
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Objective To analyze the influence of medical insurance paying proportion to hierarchical diagnosis and treatment, and to provide basis for the improvement of hierarchical diagnosis and treatment. Methods Data about average number of visits of insured residents in 2015 were obtained from Hangzhou medical insurance service database. Differences between visits to Community Health Service Centers (CHSC) of residents having Medical Insurance of Urban and Rural Residents (MIURR) and residents having Urban Employees' Basic Medical Insurance (UEBMI) were compared. And differences stratified by signed contracted services offered by General Practitioners (GPs) or not were further analyzed. Results Proportion of visits to CHSCs in all visits to medical institutions in residents with MIURR was 77.22%, which was significantly higher than the proportion in residents with UEBMI was 51.26%. In the residents with UEBMI, and the proportion of visits to CHSCs in all visits to medical institutions of the group sighed contracted services offered by GPs was significantly higher than the group non-sighed. Conclusion Increasing the gap between reimbursement ratio of CHSCs and higher medical institutions plays an important role in guiding health-seeking behavior of residents. Reformation of medical insurance payment and contracted services will guide residents to seek medical treatment and effective referral.
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Objective The paper aims to leavn the direct non-medical costs of the major diseases associated with smoking in Hangzhou. Methods We investigated four general hospitals and a cancer hospital in Hangzhou by typical sampling method. The survey included fee of transportation, nutrition, care, travel and so on. Six major Smoking-related diseases were identified through literature review, and the attributable risk (AR) and the price index were obtained. Results In 2013, the direct non-medical costs of tobacco-related diseases in Hangzhou were as follows: lung cancer, gastric cancer, breast cancer, cerebrovascular diseases cost 427.1, 243.1, 71.6 , 1564.6 thousand yuan, respec tively and coronary heart disease cost 92632.3 thousand yuan and COPD cost 11252.0 thousand yuan. Conclusion The direct non-medical cost contributed by smoking is an important part of the burden of Smoking-related diseases and should be taken seriously.
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Objective To analyze the disease burden of Hangzhou City in 2013 due to smoking.Methods Using attributable risk of smoking from literatures,the demographic data,mortality surveillance,medical insurance information system of smoking related diseases expense,the direct economic burden and indirect economic burden due to smoking in Hangzhou were measured.Main indicators including disability adjusted life year (DALY),direct medical economic burden,production years of losses,early death of indirect economic loss and smoking cause cost and cost of passive smoking were calculated.Results In 2013,The DALY of Hangzhou 6 city area attributed to smoking was 8.11 years over one thousand people.That was less than other domestic cities.There were 1.118 174 1 billion Yuan due to the direct medical economic burden .And the production loss of smoking was 834.41 years.The early death of indirect economic loss of smoking was 57.659 4 million Yuan,and the cost of pathogenic of smoking was 56.936 2 million Yuan,and the cost of pathogenic of passive smoking was 50.915 1 million Yuan.Conclusion The total economic burden of Hangzhou due to smoking was still at a higher level,which could lead to more serious consequences for the health of people and social economic development.Measures should be conducted to strengthen the control of tobacco.