BACKGROUND:Preventing mother-to-child transmission of hepatitis B (PMTCT) is crucial for reducing the incidence of new hepatitis B virus (HBV) infections. However, the current PMTCT interventions including maternal screening, antiviral prophylaxis, infant immunoprophylaxis, and post-vaccination serological testing, fail to reach a broader population, especially those in rural areas. This pilot study aimed to optimize the PMTCT strategy by integrating existing medical resources, with the goal of achieving high coverage of the complex intervention services. METHODS:This real-world pilot study was conducted from March 4, 2019, to May 27, 2020, in Zhangjiagang, a county under the jurisdiction of Suzhou, Jiangsu Province. We collaborated with multiple healthcare institutions to establish a comprehensive PMTCT strategy that combines decentralized and centralized service delivery. The intervention rate at each healthcare service related to PMTCT was the primary endpoint of the evaluation. RESULTS:A total of 11,181 pregnant women accepted HBV screening during their first antenatal care (ANC) visit. Among the 272 hepatitis B surface antigen (HBsAg) positive individuals, 64 (23.5%) were hepatitis B e antigen (HBeAg) positive. All 64 HBeAg-positive pregnant women (including one case of twin pregnancy) accepted the referral, of whom 53 met the criteria for antiviral prophylaxis, and 51 (96.2%) received the treatment. All 65 infants born to HBeAg-positive mothers completed post-vaccination serological testing (PVST) in designated institutions or others selected by their parents. The PVST results indicated complete success of the PMTCT strategy. CONCLUSIONS:By integrating centralized and decentralized healthcare services through collaboration among multiple healthcare institutions, it is feasible to establish a whole-process service that provides pregnant women with more timely and comprehensive services. This strategy can improve the rate of antiviral prophylaxis for high-risk pregnant women with HBV MTCT, which is of great significance for eliminating MTCT of HBV.

Background:Dyslipidemia, a risk factor of cardiovascular diseases, was a long-term adverse event of anti-retroviral drugs. Efavirenz (EFV) and lopinavir/ritonavir (LPV/r) were recommended and the widely used antiretroviral drugs while the proportion of taking integrase strand transfer inhibitors (INSTI)-based regimens are increasing recently in China. Regarding to the large population of people living with HIV (PLWH) in China and the regional fluctuations in prevalence of dyslipidemia, this meta-analysis aims to evaluate the prevalence of dyslipidemia and its correlation with anti-retroviral therapy (ART) among PLWH in China, especially the impact of LPV/r, EFV and INSTI-based regimens. Methods:We searched English and Chinese databases using MeSH terms to identify all relevant articles. The study participants were divided into ART-naïve and ART-experienced PLWH. The prevalence of dyslipidemia and mean difference of serum lipids were estimated using random-effects models. Subgroup analysis and univariate meta-regression were conducted to evaluate factors associated with prevalence of dyslipidemia among ART-experienced PLWH. Results:In this meta-analysis, we found dyslipidemia prevalence of 49.8% and 55.1% among ART-naïve and experienced PLWH in China. Elevated triglycerides(TG) and reduced high-density lipoprotein cholesterol (HDL-C) were the most prevalent dyslipidemia, irrespective of ART experience. Dyslipidemia was more common in PLWH residing in South China, with baseline CD4 cell count over 500 cells/μl or with a BMI ≥ 24 kg/m2. Notably, Traditional Chinese medicine adjuvant therapy was associated with higher prevalence of dyslipidemia. Moreover, INSTI-based regimens were significantly linked to higher prevalence of low HDL-C compared to other regimens. Conclusions:The routine assessment of lipid profiles should be advised among PLWH before and after the initiation of ART in China, especially in patients on INSTI-based regiments. Moreover, early interventions, including physical activity, dietary adjustments, and optimization of ART regimens, should be considered when the dyslipidemia is diagnosed in PLWH.

Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen’s behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4

Antiretroviral therapy (ART) aims to inhibit HIV replication, decrease CD4 T cell loss, and immune function recovery in order to reduce the morbidity and mortality associated with the infection. Treatment should also, improve quality of life and control HIV spread. However, incomplete viral suppression still occurs during ART. Viral suppression and virological failure (VF) thresholds vary between studies in terms of virological rebound (VR) states using different detection thresholds. Further understanding of influencing factors and adverse outcomes in various VR states should provide important guidance for HIV treatment.

Pay-it-forward incentives involve having a person receive a free test with community-generated messages and then asking if those who received a free test would like to donate money to support others to receive free testing. Here we undertook a two-arm cluster-randomized trial to evaluate pay-it-forward incentives with active community participation to promote hepatitis B virus (HBV) and hepatitis C virus (HCV) testing among men who have sex with men in China. Men randomized to the pay-it-forward arm received free HBV and HCV testing and were offered a chance to pay-it-forward by donating money to support the testing of another anonymous person. Each participant paid for their HCV and HBV test at 7.7 USD per test in the standard-of-care arm. The primary outcome was the proportion of men who tested for HBV and HCV. Between 28 March and 6 November 2021, 32 groups (10 men per group) of men were randomized to the pay-it-forward (n = 160, 16 clusters) and standard-of-care (n = 162, 16 clusters) arms, respectively. HBV and HCV rapid testing were higher in the pay-it-forward arm (59.4%) than in the standard-of-care arm (25.3%) (proportion difference 35.2%, 95% confidence interval 24.1-46.3%). No adverse events were reported. The community-led pay-it-forward incentives improved HBV and HCV testing among men who have sex with men. Clinical Trial registration: ChiCTR 2100046140.

Purpose: Pulmonary tuberculosis (PTB) is a severe chronic communicable disease that causes a heavy disease burden in China. Human Immunodeficiency Virus (HIV) and PTB coinfection dramatically increases the risk of death. This study analyzes the spatiotemporal dynamics of HIV, PTB and HIV-PTB coinfection in Jiangsu Province, China, and explores the impact of socio-economic determinants. Patients and Methods: The data on all notified HIV, PTB and HIV-PTB coinfection cases were extracted from Jiangsu Provincial Center for Disease Control and Prevention. We applied the seasonal index to identify high-risk periods of the disease. Time trend, spatial autocorrelation and SaTScan were used to analyze temporal trends, hotspots and spatiotemporal clusters of diseases. The Bayesian space-time model was conducted to examine the socioeconomic determinants. Results: The case notification rate (CNR) of PTB decreased from 2011 to 2019 in Jiangsu Province, but the CNR of HIV and HIV-PTB coinfection had an upward trend. The seasonal index of PTB was the highest in March, and its hotspots were mainly distributed in the central and northern parts, such as Xuzhou, Suqian, Lianyungang and Taizhou. HIV had the highest seasonal index in July and HIV-PTB coinfection had the highest seasonal index in June, with their hotspots mainly distributed in southern Jiangsu, involving Nanjing, Suzhou, Wuxi and Changzhou. The Bayesian space-time interaction model showed that socioeconomic factor and population density were negatively correlated with the CNR of PTB, and positively associated with the CNR of HIV and HIV-PTB coinfection. Conclusion: The spatial heterogeneity and spatiotemporal clusters of PTB, HIV and HIV-PTB coinfection are exhibited obviously in Jiangsu. More comprehensive interventions should be applied to target TB in the northern part. While in southern Jiangsu, where the economic level is well-developed and the population density is high, we should strengthen the prevention and control of HIV and HIV-PTB coinfection.

目的 了解江苏省不同流动性暗娼人群相关知识行为及其性传播疾病感染因素.方法 收集2016-2021年江苏省暗娼人群哨点监测数据,并根据在当地工作时间的差别进行分层,利用SPSS 23.0统计学软件进行数据整理和分析.结果 2016-2021年共监测66647人,年龄(31.5±8.6)岁.在本地工作1年以上暗娼居多(44.0％),三类人群在年龄构成比方面差异有统计学意义(x2=3393.020,P＜0.05),本地工作不足6个月的暗娼外省到江苏省务工比例,高于另外两组人群,差异有统计学意义(x2=2955.473,P＜0.05).暗娼人群总体艾滋病知识知晓率(93.9％)、最近1个月坚持使用安全套比例(76.0％)以及最近1年接受过艾滋病干预服务比例(94.3％)均呈逐年上升趋势(x2=380.748、4879.812、681.008,P＜0.05),检出艾滋病病毒(HIV)感染率为0.5‰,梅毒感染率为2.2％.多因素logistic回归分析结果,年龄段在40～49岁、非本省户籍、小学及以下文化水平、在本地工作不足6个月、吸毒、未坚持使用安全套、中低档次场所、缺乏艾滋病知识及未接受过艾滋病相关干预防服务是暗娼感染性传播疾病的相关因素.结论 江苏省仍有部分暗娼人群存在"知行分离"现象,且安全套坚持使用率仍有待提高.应对流动性较大的暗娼人群,开展有针对性的场所干预,控制艾滋病性病疫情蔓延.

Background In 2003, China implemented free antiretroviral therapy (ART) for people living with HIV (PLHIV), establishing an eligibility threshold of CD4 < 200 cells/μl. Subsequently, the entry criteria were revised in 2012 (eligibility threshold: CD4 ≤ 350 cells/μl), 2014 (CD4 ≤ 500 cells/μl), and 2016 (treat-all). However, the impact of treat-all policy on HIV care and treatment indicators in China is unknown. We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China. Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019, from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China. We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators: monthly proportion of 30-day ART initiation, mean CD4 counts (cells/μl) at ART initiation, and mean estimated time from infection to diagnosis (year). We built separate models according to gender, age, route of transmission and region. Results Monthly data on ART initiation and collection were available for 75,516 individuals [gender: 83.8% males; age: median 39 years, interquartile range (IQR): 28–53; region: 18.5% Northern China, 10.9% Northeastern China, 17.5% Southern China, 49.2% Southwestern China]. In the first month of treat-all, compared with the contemporaneous counterfactual, there was a significant increase in proportion of 30-day ART initiation [+ 12.6%, incidence rate ratio (IRR) = 1.126, 95% CI : 1.033–1.229; P = 0.007] and mean estimated time from infection to diagnosis (+ 7.0%, IRR = 1.070, 95% CI : 1.021–1.120; P = 0.004), while there was no significant change in mean CD4 at ART initiation (IRR = 0.990, 95% CI : 0.956–1.026; P = 0.585). By December 2019, the three outcomes were not significantly different from expected levels. In the stratified analysis, compared with the contemporaneous counterfactual, mean CD4 at ART initiation showed significant increases in Northern China (+ 3.3%, IRR = 1.033, 95% CI : 1.001–1.065; P = 0.041) and Northeastern China (+ 8.0%, IRR = 1.080, 95% CI : 1.003–1.164; P = 0.042) in the first month of treat-all; mean estimated time from infection to diagnosis showed significant increases in male (+ 5.6%, IRR = 1.056, 95% CI : 1.010–1.104; P = 0.016), female (+ 14.8%, IRR = 1.148, 95% CI : 1.062–1.240; P < 0.001), aged 26–35 (+ 5.3%, IRR = 1.053, 95% CI : 1.001–1.109; P = 0.048) and > 50 (+ 7.8%, IRR = 1.078, 95% CI : 1.000–1.161; P = 0.046), heterosexual transmission (+ 12.4%, IRR = 1.124, 95% CI : 1.042–1.213; P = 0.002) and Southwestern China (+ 12.9%, IRR = 1.129, 95% CI : 1.055–1.208; P < 0.001) in the first month of treat-all. Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes. To advance the work of rapid ART, efforts should be made to streamline the testing and ART initiation process, provide comprehensive support services, and address the issue of uneven distribution of medical resources.

ABSTRACT Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11–3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13–6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33–3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36–9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20–0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs.

BackgroundIn China, the HIV/AIDS epidemic among men who have sex with men (MSM) has been expanding in recent years. Substance abuse in MSM was not well studied as the independent risk factor for HIV and syphilis infection and other sexually transmitted diseases. The present review aimed to determine the correlation between HIV/Syphilis infections and substance abuse and other sexual risk behaviors among MSM.MethodsWe conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant articles of quantitative studies published between 2010 and May 31, 2022. Meta-analysis was performed using R software. Pooled estimated of the association-odds ratio, with 95% confidence intervals were calculated using random-effects models stratified by study design. Q statistics and I2 were used to measure the heterogeneity.ResultsOur meta-analysis included 61,719 Chinese MSM from 52 eligible studies. The pooled HIV prevalence rate among substance-abusing MSM was 10.0% (95% CI = 0.08–0.13). Substance abusers were more likely to have a higher prevalence of HIV (OR = 1.59) and syphilis (OR = 1.48) infections than non-substance abusers. Substance abusers were also more likely to seek sexual partners through the internet or social media applications (OR = 1.63), engage in unprotected anal intercourse (UAI) (OR = 1.69), group sex (OR = 2.78), and engage in commercial intercourse (OR = 2.04) compared to non-users. Regarding testing behaviors, substance abusers had a higher proportion of HIV or STI testing in their lifetime (OR = 1.70) compared with non-substance abusers (p < 0.05). They were also more likely to have had more sexual partners (≥2; OR = 2.31) and more likely to have consumed alcohol (OR = 1.49) in the past 6 months.ConclusionsOur study shows the correlation between substance abuse and HIV/Syphilis infection. Eliminating disparities in HIV/Syphilis infection among substance abusing men who have sex with men (MSM) can be achieved if the Chinese government and public health sectors could provide targeted knowledge popularization and diagnosis interventions among high-risk populations.

We aimed to explore the impact of sexual transmission modes on immune reconstitution after combined antiretroviral therapy (cART). We have retrospectively analyzed longitudinal samples from 1557 treated male patients with virological suppression (HIV-1 RNA < 50 copies/ml) for at least 2 years. Both heterosexuals (HET) and men who have sex with men (MSM) patients showed an increasing annual trend in CD4+ T cell counts after receiving cART (HET, β: 23.51 (cell/µl)/year, 95% CI: 16.70–30.31; MSM, β: 40.21 (cell/µl)/year, 95% CI: 35.82–44.61). However, the CD4+ T cell recovery rate was much lower in HET patients than MSM patients, determined by both the generalized additive mixed model (P < 0.001) and generalized estimating equations (P = 0.026). Besides HIV-1 subtypes, baseline CD4+ T cell counts and age at cART initiation, HET was an independent risk factor for immunological non-responders (adjusted OR: 1.73; 95% CI: 1.28–2.33). HET was also associated with lower probability of achieving conventional immune recovery (adjusted HR: 1.37; 95%CI: 1.22–1.67) and optimal immune recovery (adjusted HR: 1.48, 95%CI: 1.04-2.11). Male HET patients might have poorer immune reconstitution ability even after effective cART. Early initiation of cART after diagnosis and clinical monitoring for male HET patients should be highly emphasized.

BACKGROUND:This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. METHODS:We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. RESULTS:In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9-43%, I2  = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12-74%, I2  = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician-patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. CONCLUSION:This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.

Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%-65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%-81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%-55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.

目的 病毒载量在艾滋病防治中重要性逐步提高,了解新报告HIV/AIDS患者治疗前病毒载量的基线情况,可为艾滋病防治工作提供依据.方法 采用荧光定量PCR方法对2019年江苏省新报告HIV/AIDS患者样本进行HIV-1病毒载量检测,比较病毒载量在不同人口学特征下差异,分析高病毒载量影响因素.结果 3098例江苏省新报告HIV/AIDS患者病毒载量对数均值为4.33±1.05 log/mL,病毒载量＜5 000拷贝/mL患者占比20.85％(646/3 098).不同性别患者的病毒载量差异有统计学意义(P＜0.05),男性患者病毒载量水平较高.艾滋病病毒感染者与艾滋病患者病毒载量差异有统计学意义(P＜0.05),疾病状态诊断为艾滋病患者其病毒载量值相对偏高;未婚和已婚有配偶较离异或丧偶更易出现高病毒载量的情况.基线病毒载量水平较高时,抗病毒治疗后病毒学失败率也较高.结论 新报告HIV感染者/AIDS患者中病毒载量总体水平高,但存在一定比例的低病毒载量情况,提示在艾滋病防治工作中应加强对低病毒载量的随访;针对男性及未婚或已婚有配偶的人群加强干预措施,降低传播风险.

Objective To analyze the characteristics of HIV/AIDS-associated deaths in Jiangsu Province by evaluating the mortality trend and spatiotemporal distribution, and provide the scientific basis for controlling AIDS deaths.Methods The cumulative number of HIV/AIDS-associated deaths in Jiangsu Province was screened from the basic information system of AIDS prevention and treatment. The relevant information about the dead patients was obtained and analyzed. Results By the end of 2020, there were 4 556 HIV/AIDS-associated deaths in Jiangsu Province, of which 83.98% were males. The mean age at death was 49（38, 61） years. The source of HIV case detection was mainly from testing of other attenders in medical setting, accounting for 50.11% of total deaths. Death with the first CD4 cell count after HIV detection ＜200 cells/mm3 accounted for 55.01%. 53.86% did not receive ART at the time of death. 60.34% of deaths occurred within 1 year after HIV diagnosis. AIDS-associated deaths accounted for 28.05%. The three age groups（≤14 years old, 15-64 years old, and ≥65 years old） had significant differences in the route of HIV detection, first CD4 cell count, whether ART being received, survival time after diagnosis, and cause of death（P all ＜0.001）. From 2013 to 2020,crude mortality, standardized mortality and crude mortality of HIV/AIDS patients aged ≥65 increased from 0.42/100,000,0.41/100,000, and 0.44/100,000 in 2013 to 0.58/100,000, 0.54/100,000 and 1.37/100,000 in 2020, with an upward trend（t=6.46, P=0.001; t=5.50, P=0.002; t=6.66, P=0.001）. The number of deaths was higher in southern Jiangsu, but the cumulative proportion of deaths was highest in northern Jiangsu. In some areas of Nantong and Suzhou, there was a highhigh cluster of deaths. Conclusions The mortality rate of HIV/AIDS patients in Jiangsu Province is increasing. The number of deaths in Nantong City and Suzhou City showed a local cluster effect. Targeted scale-up testing, early detection of patients, and increased treatment coverage remain key strategies to control AIDS deaths.

Despite the proven virological advantages, there remains some controversy regarding whether first-line integrase strand transfer inhibitors (INSTIs)-based antiretroviral therapy (ART) contributes to reducingmortality of people living with HIV (PLHIV) in clinical practice. Here we report a retrospective study comparing all-cause mortality among PLHIV in China who were on different initial ART regimens (nevirapine, efavirenz, dolutegravir, lopinavir, and others [including darunavir, raltegravie, elvitegravir and rilpivirine]) between 2017 and 2019. A total of 41,018 individuals were included across China, representing 21.3% of newly reported HIV/AIDS cases collectively in the country during this period. Only the differences in all-cause mortality of PLHIV between the efavirenz group and the nevirapine group, the dolutegravir group and the nevirapine group, and the lopinavir group and the nevirapine group, were observed in China. After stratifying the cause of mortality, we found that the differences in mortality between initial ART regimens were mainly observed in AIDS-related mortality.

Background Healthcare disparities hinder the goal of ending the HIV pandemic by 2030. This review aimed to understand the status of healthcare disparities among people living with HIV (PLWH) in China and summarize driving factors. Methods We searched six databases: PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and China Wanfang. English or Chinese articles published between January 2000 and July 2022 were included if they focused on any disparities in access to and utilization of healthcare among PLWH in China. Grey literature, reviews, conferences, and commentaries were excluded. A random effects model was used to calculate the pooled estimates of data on healthcare access/utilization and identified the driving factors of healthcare disparities based on a socio-ecological framework. Results A total of 8728 articles were identified in the initial search. Fifty-one articles met the inclusion criteria. Of these studies, 37 studies reported HIV-focused care, and 14 focused on non-HIV-focused care. PLWH aged ≥ 45 years, female, ethnic minority, and infected with HIV through sexual transmission had a higher rate of receiving antiretroviral therapy (ART). Females living with HIV have higher adherence to ART than males. Notably, 20% (95% CI, 9-43%, I 2  = 96%) of PLWH with illness in two weeks did not seek treatment, and 30% (95% CI, 12-74%, I 2  = 90%) refused hospitalization when needed. Barriers to HIV-focused care included the lack of knowledge of HIV/ART and treatment side effects at the individual level, and social discrimination and physician-patient relationships at the community/social level. Structural barriers included out-of-pocket medical costs, and distance and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from healthcare providers, distrust of healthcare services at the community/social level. Conclusion This review suggests disparities in ART access, adherence, and utilization of non-HIV-focused care among PLWH. Financial issues and social discrimination were prominent reasons for healthcare disparities in PLWH care. Creating a supportive social environment and expanding insurance policies, like covering more medical services and increasing reimbursement rates could be considered to promote healthcare equity.

Summary: Background: Oral pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can effectively prevent HIV infections among men who have sex with men (MSM), but the emergence and transmission of HIV drug-resistance (HIVDR) may compromise their benefits. The costs and benefits of expanding PrEP and ART coverage in the presence of HIVDR in China remain unknown. Methods: We developed a comprehensive dynamic transmission model incorporating the transmitted (TDR) and acquired (ADR) HIV drug resistance. The model was calibrated by the HIV surveillance data from 2009 to 2019 among MSM in Jiangsu Province, China, and validated by the dynamic prevalence of ADR and TDR. We aimed to investigate the impact of eight intervention scenarios (no PrEP, 20%, 50% or 80% of PrEP, without (77% coverage) or with (90% coverage) expanded ART) on the HIV epidemic trend and cost-effectiveness of PrEP over the next 30 years. Findings: 20% or 50% PrEP + 90% ART would be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 25,417 (95% confidence interval [CI]: 12,390–38,445) or 47,243 (23,756–70,729), and would yield 154,949 (89,662–220,237) or 179,456 (102,570–256,342) incremental quality-adjusted life-years (QALYs) over the next 30 years. No PrEP + 90% ART would yield 125,211 (73,448–176,974) incremental QALYs and be cost-saving. However, 20–80% PrEP + 77% ART and 80% PrEP + 90% ART with ICER of $77,862–$98,338 and $63,332, respectively, and were not cost-effective. A reduction of 64% in the annual cost of oral PrEP would make it highly cost-effective for 50% PrEP + 90% ART. Interpretation: 20% or 50% PrEP + 90% ART is cost-effective for HIV control in the presence of HIVDR. Expanded ART alone may be the optimal policy under the current limited budgets. Funding: National Natural Science Foundation of China, the National S&T Major Project Foundation of China.

Abstract Hepatitis B virus (HBV) and hepatitis C virus (HCV) testing rates remain low in China, especially among men who have sex with men (MSM). Pay-it-forward involves having a person receive a free test with community-generated messages and then asks if those who received a free test would like to donate money or test to support subsequent other people to also receive free testing. This study aimed to evaluate the capacity of a pay-it-forward strategy with active community participation to promote HBV and HCV testing among MSM in China. We undertook a two-arm superiority cluster-randomized trial led by MSM community-based organizations in two cities in the Jiangsu Province, China. As part of the intervention, MSM peers were actively involved in planning and leading the trial. Enrolled MSM were randomized to the pay-it-forward (intervention) and standard-of-care (control) arms in groups of ten. Men randomized to the pay-it-forward arm received free HBV and HCV testing and were offered a chance to pay-it-forward by donating money to support the testing of another anonymous person. In the standard-of-care arm, each participant paid for their HCV and HBsAg antibody rapid test at US $7.7/test. Only the staff who performed data analyses were blinded. The primary outcome was the proportion of men tested for HBV and HCV. We pre-specified sub-analyses based on substance use, risky sexual behaviors, and people older than 30 years. The trial was registered in the China Clinical Trial Registry (ChiCTR 2100046140). Between March and October 2021, 322 MSM were randomized to the pay-it-forward (n=160) and standard-of-care (n=162) arms. HBV and HCV rapid testing was notably higher in the pay-it-forward arm (59.4%) than in the standard-of-care arm (25.3%) (proportion difference (PD) 34.4%, 95% CI lower bound 26.9%). Sub-analyses demonstrated that the pay-it-forward intervention was effective among people who use substances, people with risky sexual behaviors, and older individuals. Among men in the pay-it-forward arm, 101/160 (63%) donated some amount to future participants, and the total donation amount covered over half (68%) of the test cost in the pay-it-forward arm. Economic evaluation found that the pay-it-forward model was cheaper than the standard of care, considering economic or financial costs per person tested. The pay-it-forward approach improved HBV and HCV testing among an at-risk populations in a resource-constrained environment. Pay-it-forward model appeared to be managed successfully in a real-world setting, especially as a part of community-led efforts to reach higher-risk populations.

Objective: This study seeks to explore efficient and multiple-item detection modes in new-style HIV labs, as well as access the accuracy and reliability of CD4 cell count detected by point of care (POC) to analyze POC work feasibility in district or county labs. Methods: POC devices adopted in grassroots-level labs and flow cytometers adopted in prefecture-level labs were used to analyze the same group of blood samples. The individual results were collected and compared for parametric tests in correlation and consistency. Results: The Pearson correlation coefficients (r) between results detected by FACSPresto and that by FACSCalibur, FACSVia, FACSCantoII, and EPICSXL were 0.922, 0.938, 0.914, and 0.823, respectively; the average deviations were -25.64, 24.68, 3.05, and 70.97 cells/mu L, respectively; the Pearson correlation coefficient (r) between results by Pima and FACSCalibur, FACSVia, FACSCantoII, and EPICSXL were 0.900, 0.950, 0.954, and 0.876, respectively; and the average deviations were -73.99, -40.78, -29.32, and -22.75 cells/mu L, respectively. Discussion: Strong positive correlations and good consistency were observed between the CD4 count tested by POC and flow cytometers. These findings provide theoretical support for new-style HIV labs and one-stop services, which can provide shorter testing duration and simpler testing processes, so that the most comprehensive testing results can be obtained in the shortest amount of time.