Stakeholders' solutions to antiretroviral therapy interruption during the COVID-19 pandemic in China: a short report.

Obtaining antiretroviral therapy (ART) was a challenge for people living with HIV (PLHIV) in China during the COVID-19 outbreak. On 26 January 2020, the Chinese Center for AIDS/STD Control and Prevention issued a nationwide directive to relax restrictions on where and when PLHIV could refill ART. This qualitative study explored unexpected barriers under this directive and recommendations to improve future ART delivery. Between February 11 and February 15 2020, in-depth interviews of 4 groups of stake holders related to ART refilling (i.e., PLHIV, community-based organization employees, CDC staff, infectious disease physicians and nurses), were conducted via WeChat. Data were managed by NVivo 11.0 and transcripts were coded using thematic analysis. Sixty-two interviews were conducted. The main barriers to refilling ART included: (1) inconsistent documentation requirements to refill ART, (2) lack of specific protocols on ART refilling, (3) insufficient staffing, and (4) regimen verification and drug shortages. The most common recommendations to improve future ART delivery were: (1) to establish a nationwide system to distribute ART and (2) increase the number of pills delivered with each ART refill. Strengthening protocols and systems to refill ART and improving collaboration is key to preventing interruptions in ART among PLHIV during public health emergencies.

Perceptions, precautions, and vaccine acceptance related to monkeypox in the public in China: A cross-sectional survey.

BACKGROUND: The World Health Organization declared monkeypox as a Public Health Emergency of International Concern. A cross-sectional online survey was conducted to understand beliefs, attitudes, perceived preventive measures, and vaccination acceptance related to monkeypox in the public in China. METHODS: Between August 30 and September 15, 2022, we recruited adults through an online survey platform. Demographic characteristics, perceptions, common knowledge, concerns, attitudes, willingness to adopt preventive measures (including hygiene practices, social distancing, and travel avoidance), and vaccination acceptance related to monkeypox were collected. Logistic regression was used to assess correlates of concerns about monkeypox, willingness to adopt preventive measures, and vaccination acceptance. RESULTS: 2135 participants were recruited (median age: 31.4 years). 62.7% were concerned about monkeypox. 33.2% were more concerned about monkeypox compared to COVID-19. Males (aOR 0.61, 95%CI 0.50-0.74), accessing monkeypox information from the Internet (0.77, 0.61-0.98), and willingness to adopt monkeypox vaccine (2.9, 2.38-3.53) were associated with concerns about monkeypox. Most participants were willing to adopt precautions (76.3% hygiene practices, 68.2% social distancing, 85.9% travel avoidance). Individuals who were concerned about monkeypox (hygiene practices: 2.09, 1.69-2.59; social distancing: 1.78, 1.46-2.16; travel avoidance: 1.74, 1.34-2.26) and had better knowledge about monkeypox (hygiene practices: 1.85, 1.48-2.31; social distancing: 2.17, 1.77-2.66; travel avoidance: 1.74, 1.34-2.26) were more likely to adopt precautions. 68.8% were willing to adopt monkeypox vaccine. Participants with older age (aged 40-49: 0.57, 0.38-0.85; aged 50 +: 0.50, 0.31-0.81), and higher income (¥6000-10,000: 0.61, 0.39-0.95; ≥¥10,000: 0.48, 0.30-0.77) were less likely to adopt the monkeypox vaccine. Being concerned more about monkeypox compared to COVID-19 (1.63, 1.31-2.02), and having better knowledge about monkeypox (1.34, 1.09-1.66) were associated with willingness to adopt vaccination. CONCLUSIONS: Compared with COVID-19, monkeypox attracted significantly less attention in the public in China, who currently have insufficient monkeypox knowledge. Interventions aimed at improving monkeypox knowledge and precautions among different groups of individuals in China are needed.

More or less deadly? A mathematical model that predicts SARS-CoV-2 evolutionary direction.

SARS-CoV-2 has caused tremendous deaths globally. It is of great value to predict the evolutionary direction of SARS-CoV-2. In this paper, we proposed a novel mathematical model that could predict the evolutionary trend of SARS-CoV-2. We focus on the mutational effects on viral assembly capacity. A robust coarse-grained mathematical model is constructed to simulate the virus dynamics in the host body. Both virulence and transmissibility can be quantified in this model. A delicate equilibrium point that optimizes the transmissibility can be numerically obtained. Based on this model, the virulence of SARS-CoV-2 might further decrease, accompanied by an enhancement of transmissibility. However, this trend is not continuous; its virulence will not disappear but remains at a relatively stable range. A virus assembly model which simulates the virus packing process is also proposed. It can be explained why a few mutations would lead to a significant divergence in clinical performance, both in the overall particle formation quantity and virulence. This research provides a novel mathematical attempt to elucidate the evolutionary driving force in RNA virus evolution.

Uptake of COVID-19 Vaccination and Its Associated Factors among College Students in China: A Nationwide Cross-Sectional Study.

Our study aims to assess the uptake of COVID-19 vaccination and its associated factors among Chinese college students. A web-based cross-sectional study was conducted from 18 May to 17 June 2022. A total of 3916 participants were included. The coverage of the first dose, complete vaccination and booster vaccination among college students was 99.49%, 81.96% and 79.25%, respectively. College students with an older age (AOR: 0.72, 95% CI: 0.57-0.90), non-medical major (0.47, 0.37-0.61) and studying in north-east China (0.35, 0.22-0.58) were less likely to complete vaccination. Individuals who were female (1.62, 1.35-1.94) and received a recombinant subunit vaccine (8.05, 5.21-12.45) were more likely to complete vaccination. Non-medical students (0.56, 0.43-0.73) and students studying in north-east China (0.28, 0.16-0.49) were less likely to receive a booster dose, while female students (1.51, 1.23-1.85) had a higher likelihood. The main reason for being unvaccinated was "contraindication" (75.00%), and the main reason for not receiving a booster dose was "being too busy to attend to it" (61.37%). This study demonstrated a high adherence to the COVID-19 vaccination policy among Chinese college students. Targeted strategies should be applied to remove barriers to COVID-19 vaccination among college students.

Perceptions and worries about monkeypox, and attitudes towards monkeypox vaccination among medical workers in China: A cross-sectional survey.

BACKGROUND: The World Health Organization (WHO) declared monkeypox a "public health emergency of international concern" on 23 June 2022. However, there is a lack of data on monkeypox perceptions among medical workers. The purposes of this study were to evaluate perceptions, worries about monkeypox, attitudes towards monkeypox vaccination and their correlates among medical workers in China. METHODS: Data were collected from medical practitioners using an online survey questionnaire between September 1 and September 30, 2022 in China. All the subjects completed an online questionnaire including general characteristics, perceptions/knowledge/worries about monkeypox, and attitudes towards monkeypox vaccination. Logistic regression was employed to examine the correlates of perceptions, worries about monkeypox, and attitudes toward monkeypox vaccination. RESULTS: In total, this study sample included 639 medical workers. The mean age was 37.9 ± 9.4 years old. Approximately 71.8% of individuals reported perceptions of monkeypox, 56.7% worried about monkeypox, and 64.9% supported the promotion of monkeypox vaccination. Medical workers who were older than 50 years (aOR 3.73, 95%CI 1.01-13.85), worked in the Infectious Diseases/Dermatology/Venereal Diseases departments (3.09, 1.61-5.91), and provided correct answer to monkeypox transmission route (10.19, 5.42-19.17) were more likely to know about monkeypox/monkeypox virus before investigation. 30.7% reported that they were more worried about monkeypox than the coronavirus (COVID-19). Participants reported that the key population most in need of monkeypox vaccination were health practitioners (78.2%) and people with immunodeficiency (74.3%), followed by children (65.4%) and older adults (63.2%). CONCLUSION: Awareness of monkeypox was high and attitude towards the promotion of monkeypox vaccination was positive among medical staff in China. Further targeted dissemination of monkeypox common knowledge among health care providers might improve their precaution measures and improve the promotion of monkeypox vaccination among key populations.

COVID-19 vaccination perception and uptake among cancer patients in Guangzhou, China.

Patients with cancer are considered at high risk of COVID-19 related complications with higher mortality rates than healthy individuals. This study investigated the perception, acceptance, and influencing factors of COVID-19 vaccination among cancer patients in Guangzhou, China. A cross-sectional survey was conducted in Guangzhou, China from August to November 2021 in two tertiary medical centers. Outpatients were recruited through hospital posters to complete a questionnaire including demographics, medical history, knowledge, and attitude toward COVID-19 vaccines and COVID-19 vaccination status. Chi-square tests and multivariable logistic regression were used to analyze predictors for acceptance of COVID-19 vaccination. In total, only 75 out of 343 patients (21.87%) had received at least one dose of COVID-19 vaccine. Twenty-one patients (6.12%) had received a recommendation about COVID-19 vaccination from their physicians. Patients who were recommended by physicians to get vaccinated (aOR = 11.71 95% CI: 2.71-50.66), with a monthly income of more than CNY 5000 (aOR = 3.94, 95% CI: 1.88-8.26) were more likely to have received COVID-19 vaccination. Cancer patients who had been diagnosed for more than one year (aOR = 0.21, 95% CI: 0.09-0.51), had received multiple cancer treatment strategies (aOR = 0.34, 95% CI: 0.16-0.74), worried about the safety of COVID-19 vaccines (aOR = 0.21, 95% CI: 0.11-0.40), were less likely to have received COVID-19 vaccination. COVID-19 vaccination uptake among cancer patients was insufficient. The proportion of cancer patients receiving vaccination recommendations from physicians remains inadequate. Physicians are expected to play an essential role in patients' knowledge of the safety and effectiveness of COVID-19 vaccines.

COVID-19 vaccine uptake and hesitancy among HIV-infected men who have sex with men in mainland China: a cross-sectional survey.

BACKGROUND: Men who have sex with men (MSM), a population bearing the greatest HIV burden in many countries, may also be vulnerable to COVID-19. COVID-19 vaccines are essential to containing the pandemic. However, vaccine hesitancy may compromise vaccine coverage. We aimed to understand the uptake of COVID-19 vaccine and factors associated with COVID-19 vaccine hesitancy among HIV-infected MSM in mainland China. METHODS: A cross-sectional online survey among HIV-infected MSM was conducted between 13 and 21 February 2021 in mainland China. Variables including demographics, mental health status, HIV characteristics, and knowledge of and attitudes toward COVID-19 pandemic and COVID-19 vaccine were collected. Chi-square tests and multivariable logistic regression were used to analyze factors associated with COVID-19 vaccine hesitancy. RESULTS: A total of 1295 participants were included. The median age was 29.3 years (interquartile range [IQR] 25.2-34.0 years). The uptake of COVID-19 vaccine was 8.7%. Two main reasons for receiving vaccines were "regarded vaccination as self-health protection" (67.3%) and "trust in domestic medical technology" (67.3%). Among participants who did not initiate vaccination, concern about side effects (46.4%) and disclosure of HIV infection (38.6%) were top two reasons, and 47.2% had higher vaccine hesitancy. Men who had with high antiretroviral therapy (ART) adherence (adjusted odds ratio [aOR] 0.53, 95% confidence interval [CI] 0.35-0.80), often (0.26, 0.17-0.40) or sometimes (0.46, 0.31-0.67) paid attention to information about the COVID-19 vaccine, preferred domestic vaccines (0.37, 0.24-0.59), thought the pandemic had moderate (0.58, 0.38-0.90) and moderately severe or severe impact (0.54, 0.38-0.78) on immunity, who were waiting for vaccination programs organized at workplace (0.60, 0.44-0.81) and who were unaware of where to get COVID-19 vaccine (0.61, 0.45-0.82) had lower degree of COVID-19 vaccine hesitancy. Men who were concerned about the efficacy (1.72, 1.16-2.54) and side effects (2.44, 1.78-3.35) had higher degree of COVID-19 vaccine hesitancy. CONCLUSION: COVID-19 vaccine uptake among HIV-infected MSM is still suboptimal. Understanding influencing factors of vaccine hesitancy among this group and making tailored measures to alleviate hesitancy would help improve the coverage of COVID-19 vaccination in this population.

Uptake and adverse reactions of COVID-19 vaccination among people living with HIV in China: a case-control study.

OBJECTIVES: The coronavirus disease-2019 (COVID-19) pandemic continues to ravage the world. People living with HIV (PLHIV) are one of the most vulnerable groups. This study aims to identify the factors associated with the uptake and adverse reactions of COVID-19 vaccination. METHODS: We recruited PLHIV in China by convenience sampling between 7 and 23 February 2021. Participants were asked to complete an online questionnaire. Chi-squared test and multivariable logistic regression were used to assess factors associated with vaccine uptake. RESULTS: A total of 527 vaccinated and 1091 unvaccinated PLHIV were recruited. Individuals who had a higher education, engaged in occupations with a higher risk of COVID-19 infection, received influenza or pneumonia vaccine in the past 3 years (5.40, 3.36-8.77), believed in the effectiveness of vaccines (3.01, 2.20-4.12), and received media information regarding COVID-19 vaccine (2.23, 1.61-3.11), were more likely to be vaccinated. Concerning about adverse reactions (0.31, 0.22-0.44), negative impact on the progression of HIV/AIDS (0.36, 0.26-0.50) or antiretroviral therapy (ART) (0.61, 0.44-0.85), disclosure of HIV infection status (0.69, 0.49-0.96), comorbidities (0.33, 0.22-0.47), being unmarried (0.43, 0.28-0.66) and older age were negatively associated with vaccination. Of the 527 vaccinated PLHIV, 155 (29.4%) PLHIV reported adverse reactions, with pain at the injection site being the most common (18.2%). CONCLUSIONS: PLHIV, who are concerned about adverse reactions, negative impact on ART outcome and disclosure of HIV infection status, were less likely to adopt COVID-19 vaccination. To increase vaccination coverage among PLHIV, health-care professionals should emphasize the benefits and necessity of vaccination and provide consultancy regarding adverse reactions.

Stakeholder efforts to mitigate antiretroviral therapy interruption among people living with HIV during the COVID-19 pandemic in China: a qualitative study.

INTRODUCTION: The COVID-19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID-19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders. METHODS: Between 11 February and 15 February 2020, we interviewed PLHIV, community-based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi-structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID-19 pandemic were discussed. Themes were identified by transcript coding and mindmaps. RESULTS: Sixty-four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID-19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out-of-pocket ART. CONCLUSIONS: Social and institutional disruption from COVID-19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.

Antiretroviral treatment interruption among people living with HIV during COVID-19 outbreak in China: a nationwide cross-sectional study.

INTRODUCTION: Social disruption associated with coronavirus disease 2019 (COVID-19) threatens to impede access to regular healthcare, including for people living with HIV (PLHIV), potentially resulting in antiretroviral therapy (ART) interruption (ATI). We aimed to explore the characteristics and factors associated with ATI during the COVID-19 outbreak in China. METHODS: We conducted an online survey among PLHIV by convenience sampling through social media between 5 and 17 February 2020. Respondents were asked to report whether they were at risk of ATI (i.e. experienced ATI, risk of imminent ATI, threatened but resolved risk of ATI [obtaining ART prior to interruption]) or were not at risk of ATI associated with the COVID-19 outbreak. PLHIV were also asked to report perceived risk factors for ATI and sources of additional ART. The factors associated with the risk of ATI were assessed using logistic regression. We also evaluated the factors associated with experienced ATI. RESULTS: A total of 5084 PLHIV from 31 provinces, autonomous regions and municipalities in mainland China completed the survey, with valid response rate of 99.4%. The median age was 31 years (IQR 27 to 37), 96.5% of participants were men, and 71.3% were men who had sex with men. Over one-third (35.1%, 1782/5084) reported any risk of ATI during the COVID-19 outbreak, including 2.7% (135/5084) who experienced ATI, 18.0% (917/5084) at risk of imminent ATI and 14.4% (730/5084) at threatened but resolved risk. PLHIV with ATI were more likely to have previous interruptions in ART (aOR 8.3, 95% CI 5.6 to 12.3), travelled away from where they typically receive HIV care (aOR 3.0, 95% CI 2.1 to 4.5), stayed in an area that implemented citywide lockdowns or travel restrictions to control COVID-19 (aOR 2.5, 95% CI 1.4 to 4.6), and be in permanent residence in a rural area (aOR 3.7, 95% CI 2.3 to 5.8). CONCLUSIONS: A significant proportion of PLHIV in China are at risk of ATI during the COVID-19 outbreak and some have already experienced ATI. Correlates of ATI and self-reported barriers to ART suggest that social disruptions from COVID-19 have contributed to ATI. Our findings demonstrate an urgent need for policies and interventions to maintain access to HIV care during public health emergencies.