Delay analysis of pulmonary tuberculosis in the eastern coastal county of China from 2010 to 2021: evidence from two surveillance systems.

Background: Tuberculosis (TB) remains a major public health challenge. However, indicators of delays in assessing effective TB prevention and control and its influencing factors have not been investigated in the eastern coastal county of China. Methods: All notified pulmonary tuberculosis (PTB) cases in the Fenghua District, China were collected between 2010 and 2021 from the available TB information management system. Comparison of delays involving patient, health system, and total delays among local and migrant cases. Additionally, in correlation with available Basic Public Health Service Project system, we performed univariate and multivariate logistic regression analyses identified the influencing factors associated with patient and total delays in patients aged >60 years. Results: In total, 3,442 PTB cases were notified, including 1,725 local and 1,717 migrant patients, with a male-to-female ratio of 2.13:1. Median patient and total delays of local TB patients were longer than those for migrant patients; the median health system delay did not show any significant difference. For patient delay among the older adult, female (cOR: 1.93, 95% CI: 1.07-3.48), educational level of elementary school and middle school (cOR: 0.23, 95% CI: 0.06-0.84) had a statistical difference from univariable analysis; however, patients without diabetes showed a higher delay for multiple-factor analysis (aOR: 2.12, 95% CI: 1.02-4.41). Furthermore, only the education level of elementary school and middle school presented a low total delay for both univariate (cOR: 0.22, 95% CI: 0.06-0.82) and multivariate analysis (aOR: 0.21, 95% CI: 0.05-0.83) in the older patients. Conclusion: The delay of TB cases among migrants was lower than the local population in the Fenghua District, which may be related to the "healthy migrant effect". It highlights that women, illiterate people, and people without diabetes are key groups for reducing delays among older adults. Health awareness should focus on these target populations, providing accessible health services, and reducing the time from symptom onset to diagnosis.

Low body mass index and efavirenz use are independently associated with self-reported fatigue in HIV-infected patients.

This retrospective cohort study was conducted from January 2009 to July 2016 to explore the occurrence and risk factors of self-reported fatigue within the first 6 months after receiving antiretroviral treatment (ART) among patients living with HIV in Taizhou City of Zhejiang province, Eastern China. In total, 1163 HIV-infected patients with a median follow-up duration of 27.8 months were included in the analysis. Among them, 261 (22.4%) reported fatigue within the first 6 months after ART. In the multivariable logistic regression analysis, self-reported fatigue within the first 6 months after ART was negatively associated with junior middle-school education or above, baseline CD4 cell count of 200-349 and >350 cells/µL (vs < 200 cells/µL), overweight at baseline (vs normal weight) but positively associated with ≥50 years old at initiation of ART (vs <30 years old), underweight at baseline, use of efavirenz (EFV) in the first-line regimen. Our data suggest that earlier initiation of ART and higher body mass index are preferred to restore the energy of HIV-infected patients with the EFV use in the era of ART in China.

Interaction Effects between HIV and Aging on Selective Neurocognitive Impairment.

HIV infection and aging are each associated with neurocognitive impairment (NCI). This study examined the combined effects of HIV infection and aging on NCI. We performed a cross-sectional survey among 345 HIV-infected and 345 HIV-uninfected participants aged at least 40 years. The International HIV Dementia Scale (IHDS) and Chinese version of Mini-mental State Examination (MMSE) were administered to screen for NCI. HIV-infected individuals had higher prevalence of NCI than uninfected individuals (46.7% vs 15.1% for IHDS using cut-off of ≤ 10; 17.1% vs 2.6% for MMSE). Significant main effects of HIV and age were observed on IHDS and MMSE composite scores and all domains except for HIV on attention and calculation. Significant interaction effects between HIV and age were observed on motor speed, orientation, registration and recall, and mainly attributed to the inferior performance of HIV-infected patients aged over 60 years. Among HIV-infected individuals, in multivariable logistic models, older age, depressive symptoms and history of nevirapine treatment were associated with NCI using both IHDS and MMSE, whereas lower education current smoker and current CD4 ≥ 800 cells/µL were associated only with NCI using IHDS, and hypertension was associated only with NCI using MMSE. Findings suggest that HIV and older age may confer interactive effects on cognitive function in several domains with older HIV-infected adults experiencing greater NCI, which requires further longitudinal investigation. Furthermore, HIV early diagnosis and treatment may prevent or reverse NCI, but extra attention should be given to adverse effects including metabolic changes associated with long-term treatment.

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China.

We assessed the factors that influenced improvement or progression in human immunodeficiency virus (HIV)-infected patients who were receiving combination antiretroviral therapy (cART). This was a retrospective cohort study of HIV-infected patients receiving cART in Taizhou, Zhejiang, China, 2009-2015. Liver fibrosis was assessed by Fibrosis-4 (FIB-4) score. Improvement of liver fibrosis was defined as having > 30% decrease in FIB-4 from baseline, whereas progression of liver fibrosis was defined as having > 30% increase in FIB-4 score from baseline. A total of 955 HIV-infected patients were included. Of these, 808 (84.6%) were HIV-monoinfection, 125 (13.1%) were HIV/hepatitis B virus (HBV) coinfection and 29 (3.0%) were HIV/hepatitis C virus (HCV) coinfection. The median duration of treatment was 15 months. After treatment, 37.1% participants had > 30% decreases in FIB-4 index, 14.8% had > 30% increases in FIB-4 index, while the remaining 48.2% had stabilized FIB-4 index. In multivariate analysis, improvement of liver fibrosis was negatively associated with an older age, but was positively associated with baseline FIB-4 index and > 30% increases in CD4 cell count after ART. Progression of liver fibrosis was positively associated with an older age, but was negatively associated with gender and HIV transmission mode (male homosexual vs. male heterosexual, female heterosexual vs. male heterosexual), and baseline FIB-4 index. Our findings indicate that improvement of liver fibrosis could be achieved by early initiation of ART through better CD4 cell recovery. Liver fibrosis and hepatotoxicity associated with ART should be monitored as early as possible and throughout till the end of treatment, with special attention to the elderly and heterosexual men.

[Co-infection of hepatitis C virus among newly diagnosed HIV-infected adults in Taizhou prefecture of Zhejiang province, China].

OBJECTIVE: To examine the prevalence and correlates of hepatitis C virus (HCV) co-infection as well as plasma HCV viral load among newly diagnosed HIV-infected adults during 2009-2012 in Taizhou prefecture of Zhejiang province, China. METHODS: Five hundred and seventy-two adults who were newly diagnosed as HIV-infection were screened for anti-HCV immunoglobulin G (IgG). Plasma HCV RNA was quantified if positive for HCV IgG. RESULTS: Forty-two (7.3%) out of the 572 HIV-infected adults were tested positive for HCV IgG. HCV infection was more likely to occur among participants who were infected with HIV through blood transmission (OR = 49.46, 95% CI: 13.71-178.48). Otherwise, HCV infection was less likely to occur among participants who were under 46-86 years of age (OR = 0.12, 95% CI: 0.02-0.58), those with mode of homosexual transmission of HIV (OR = 0.11, 95% CI: 0.01-0.86), with education of high school or above (OR = 0.13, 95% CI: 0.02-0.78). Thirty-three (78.6%) of the total 42 HIV-HCV patients with coinfection had detectable plasma HCV RNA, whereas 9 (21.4%) had undetectable plasma HCV RNA (i.e., lower than 5.0 × 10² IU/ml) or known as relative HCV viral suppression. No significant associations were noticed on factors as: HCV viral suppression and demographics, HIV transmission route and CD4⁺T-cell counts according to univariate regression analyses. CONCLUSION: Prevalence of HCV co-infection was relatively high among newly diagnosed HIV-infected adults in this study area. Majority of the HIV-HCV coinfected patients had detectable plasma HCV RNA, of which the long term impact on disease progression deserves called for further research.

High Prevalence of HIV Infection and Bisexual Networks among a Sample of Men Who Have Sex with Men in Eastern China.

OBJECTIVE: To examine homosexual and heterosexual behaviors, behavioral networks and HIV infection among men who have sex with men (MSM) in Eastern China. METHODS: A cross-sectional survey was conducted among MSM in 2013 in a rural prefecture of Zhejiang province. Participants were interviewed for their sexual behaviors and sexual networks and were tested for HIV infection. RESULTS: A total of 620 MSM from gay bath houses and bars participated in the survey. Of them, 58.2% aged 18 to 39 years and 49.5% were currently married with a female. The age of first homosexual contact was 26.7 years on average, ranging from 12 to 66 years. 91.0% had multiple male sex partners and 86.1% also had female sex partners in lifetime. 70 (11.3%) of the participants were tested HIV-positive. A total of 620 independent egocentric sexual networks involving 620 study participants and 1,971 reported sexual partners in the past 12 months were constructed, including 70 networks for the 70 HIV-positive participants with their 221 sexual partners and 550 networks for the 550 HIV-negative participants with their 1,750 sexual partners. The median network degree was 3 (IQR 2-4) overall and was not different between HIV-positive participants (Median: 3; IQR: 2-4) and HIV-negative participants (Median: 3; IQR: 2-4) (Mann-Whitney test, Z=-0.015, P=0.998). The proportion of networks with a multiple male sexual partnership was 63.7% overall, 62.8% for HIV-positive participants and 63.8% for HIV-negative participants (χ2=0.025, P=0.875). The proportion of networks with both male and female sexual partners was 44.8% overall, 47.1% for HIV-positive participants and 44.5% for HIV-negative participants (χ2=0.169, P=0.681). Consistent condom use and knowledge of HIV infection status were rare within the network partners. CONCLUSIONS: The currently high HIV prevalence and complicated bisexual networks among MSM in the study area provides enhanced evidence for developing tailored prevention strategies for HIV transmission among and beyond the MSM population.

[Prevalence and network-characteristics of risky sexual behaviors among clients receiving methadone maintenance treatment at clinics in Taizhou prefecture of Zhejiang province].

OBJECTIVE: To investigate the risky sexual behaviors, associated factors and characteristics of sexual network among clients receiving methadone maintenance treatment (MMT) at the clinics in Taizhou prefecture of Zhejiang province. METHODS: A cross-sectional survey was conducted. Data was collected through questionnaire and from the national unified MMT system. Urine was collected to test heroin, methamphetamine, 3, 4-methylenedioxymethamphetamine (MDMA) and ketamine. Blood was collected to test infections on HIV, hepatitis C virus (HCV) and syphilis. RESULTS: Totally, 362 clients were recruited. Most of the clients were male (88.7%), 31-40 year-olds (54.5%), married (61.6%) and having received junior high school education (56.6%). 85.1% of them received urine test with 82(26.6%)positive for heroin, 21 (6.8%) positive for methamphetamine, 19(6.2%) positive for MDMA and none for ketamine. 77.1% of them received blood test, and prevalence rates for HIV, HCV and syphilis were 1.1% , 36.7% and 3.6% . 19.5% of the clients who had sex in the past 6 months. Factors as having multiple sexual partners and positive for club drugs were under higher risk. Sexual networking seemed to be loose, linear and acyclic among this population but overlapping with the drug-using network. CONCLUSION: Effective and targeted interventions should be taken among the MMT clients since continuing drug use and HIV/STD related sexual behavior were found common in them, suggesting there was a risk of HIV/STD transmission in this population.

[Estimation and projection on HIV/AIDS through application of Estimation and Projection Package and Spectrum models, in Taizhou prefecture, Zhejiang province].

OBJECTIVE: To apply Estimation and Projection Package (EPP) and Spectrum models for the estimation and projection on HIV/AIDS epidemics in areas with relatively low HIV/AIDS prevalence in China, and to explore the influences of antiretroviral therapy (ART) on the outputs of the models. METHODS: Taizhou prefecture in Zhejiang province was selected as the study site. Social and demographic data as well as all the information on HIV/AIDS epidemics in Taizhou prefecture were collected, managed, input to EPP and Spectrum models to estimate and project the HIV/AIDS epidemic in Taizhou prefecture. Impact of ART on the HIV/AIDS epidemic was also assessed. RESULTS: According to the estimates from both EPP and Spectrum model, the HIV/AIDS epidemic in Taizhou prefecture was at a relatively low level. HIV prevalence rates among men having sex with men (MSM) and injection drug users (IDU) were relatively high and rapidly increasing. It was estimated that 1773 (1384 - 2449) people were living with HIV in 2010 in Taizhou prefecture, with an overall HIV prevalence of 0.03% (0.02% - 0.04%). ART had reduced and would continue to reduce new HIV infections and AIDS deaths, but had no significant impact on the overall HIV prevalence and the numbers of people living with HIV and adults who were in need of ART. CONCLUSION: EPP and Spectrum models seemed to be suitable and useful tools for estimation and projection on HIV/AIDS in Taizhou prefecture, and the results could provide reference for the further studies in other areas with a relatively low epidemic level of HIV/AIDS. ART appeared effective for HIV/AIDS prevention and control.

[Risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province].

OBJECTIVE: To understand the risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province. METHODS: Newly reported HIV infections from May 2008 through March 2010 in Taizhou prefecture were invited to participate in a cross-sectional survey which requested numbers and contact information of individuals with whom they had had high risk contacts as well as risk behavioral acts with them. Persons having had risky contacts with HIV-infected cases were thereof approached to participate in this survey and to receive HIV testing. Those who tested positive for HIV were subject to further round of the surveys. RESULTS: A total of 267 HIV cases were newly reported during this study period. Among them, 191 participated in the survey and served as 'index cases', including 158 cases identified from routine HIV surveillance programs and 33 cases identified from the present survey. Heterosexual transmission was the primary transmission route (74.9%, or 143/191), followed by homosexual transmission (19.4%, or 37/191) and injection drug use (5.8%, or 11/191). These 191 HIV cases reported a total of 1152 individuals with whom they had had risky contacts. They were able to provide contact information of 461 risk contacts. Of them, 129 received HIV testing and 61 (47.3%) tested positive for HIV. HIV prevalence was the highest among spouses or long-term sex partners of HIV cases (45.6%, or 47/103) and male sex partners of HIV-infected men having sex with men (MSM) (60.0%, or 12/20). Condom use was very low among them, with only 33.9% consistently using condoms for sex. CONCLUSION: Newly reported HIV infections in Taizhou prefecture reported a large and complicated risk behavioral networks and low condom use, suggesting a potential risk of HIV among these connected people, especially among MSM. Much efforts are needed to intervene these high risk subgroups and high risk behavioral networks.