What is already known about this topic?:HIV transmission among serodiscordant couples remains a persistent issue in China. However, the practice of combining counseling with antiretroviral therapies (ART) to enhance ART adherence is not widely implemented or recommended in Chinese health guidelines. What is added by this report?:This randomized controlled trial suggests that increased follow-up, counseling, and awareness of HIV risk can enhance ART compliance, thereby maximizing treatment efficacy. What are the implications for public health practice?:Early testing and counseling of serodiscordant couples, following the identification of a human immunodeficiency virus (HIV) positive spouse, is crucial for initiating ART and reducing the risk of seroconversion in the uninfected partner. Implementing a combination of ART and adjunct counseling in China is advisable.

Nucleic acid testing is the gold standard for diagnosing HCV infection, and it is of great significance to guide the treatment of HCV patients and change the follow-up strategy. In recent years, its detection technology has become increasingly mature. This article summarizes the necessity and current status of nucleic acid testing for hepatitis C through the analysis of domestic and foreign literature, in order to provide reference for the formulation of relevant policies to eliminate hepatitis C in China.

Medical care cascade, a population based method for tracking disease progression from diagnosis to cure, is a framework for monitoring gaps between current health service strategy and achievement of health goals. This paper summarizes the application of medical care cascade in hepatitis C prevention and treatment to facilitate the improvement in this field.

Objective: To discuss the diagnostic value of superb microvacular imaging (SMI) in renal solid tumors of different sizes. Methods: A total of 142 patients with 146 renal tumors detected by ultrasound in Tianjin Medical University Cancer Institute and Hospital from September 2017 to March 2019 were retrospectively analyzed. The maximum diameter of lesions was 0.8-7.3 cm, and patients were divided into the maximum diameter ≤3.0 cm group (61 patients, 64 lesions) and the maximum diameter >3.0 cm group (61 patients, 82 lesions). All of the tumors were separately evaluated by SMI and color Doppler flow imaging (CDFI) with Adler grade, vascular morphology and peripheral blood flow. Results: In the group with maximum diameter ≤3.0 cm, 50 lesions were malignant and 14 were benign. In the group with maximum diameter >3.0 cm, 62 lesions were malignant and 20 were benign. In the group with maximum diameter ≤3.0 cm, there were no significant differences in location, boundary, echo, homogeneity and small cystic area between malignant tumors and benign tumors (P>0.05). In the group with maximum diameter >3.0 cm, there were significant differences in echo, homogeneity and small cystic area between malignant tumors and benign tumors (P<0.05). For all of the benign tumors, there were no significant difference between CDFI and SMI in evaluating Adler grade, vascular morphology and peripheral blood flow (P>0.05). For malignant tumors with maximum diameter ≤3.0 cm, 43 lesions with Adler grade 2-3 were detected by SMI, which was higher than CDFI (32, P<0.05). There were 38 lesions with dendritic and irregular vascular morphology detected by SMI, which was higher than CDFI (7, P<0.05). The detected rate of peripheral annular or semi-annular blood flow in lesions was 80.0% (40/50), higher than CDFI (18/50, P<0.05). While in malignant tumors with maximum diameter >3 cm, the lesion with peripheral annular or semi-annular blood flow detected by SMI was 38, higher than 22 of CDFI (P<0.05). The area under the receiver operating characteristic (ROC) curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter ≤3.0 cm was 0.627 (sensitivity: 54.0%, specificity: 71.4%) and 0.791 (sensitivity: 94.0%, specificity: 64.3%), respectively, with statistically significant difference (P=0.039). The area under the ROC curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter>3.0 cm was 0.852 (sensitivity: 85.5%, specificity: 85.0%) and 0.860 (sensitivity: 91.9%, specificity: 80.0%), respectively, without statistically significance (P=0.858). Conclusions: SMI is superior to CDFI in detecting low-velocity blood flow and microvessels in both malignant and benign renal tumors, and can effectively improve the display rate of peripheral blood flow in malignant tumors. Otherwise, SMI can provide better diagnostic efficiency for renal tumors with the maximum diameter ≤3.0 cm.

Four feeding levels (40%, 60%, 80% and 100% of satiation) were designed as the different treatment groups to assess its effects on water quality and plankton community structure in the yellow catfish rearing enclosure ecosystem. The results showed that the weight gain and specific growth rate decreased significantly as the feeding level decreased. The soluble nutrients (except for NO2-N) concentrations were significantly affected by the feeding level with the prolonging of rear time. A significant increase in phytoplankton biomass before 9 days was observed in all the treatments, and then decreased significantly until 21 days, while the zooplankton biomass was significantly increased during the entire experiment. Both the phytoplankton and zooplankton biomass were significantly affected by the feeding level. Our results suggested that the increment of nitrogen compounds before 9 or 12 days could be explained by the input of compound diets, while the decrement of nitrogen compounds afterward and phosphorous compounds could be explained by the changes of zooplankton biomass. Based on water quality and plankton structure, moderate nutrient restriction (60%80% of satiation) is a feasible feeding strategy for better growth performance as well as better water quality and balanced plankton structure. On the other hand, input of moderate phosphorus by dietary supplementation and/or fertilization is necessary in yellow catfish culture both for the better plankton structure and the health of fish. In addition, the polyculture of the minority members of zooplankton filter feeders might be a feasible strategy to control the excessive zooplankton.

目的 分析目前我国医疗机构丙型肝炎(简称“丙肝”)诊断治疗能力及有关工作情况.方法 选取14个省(自治区、直辖市)56个县区的当地居民就诊较多的二级及以上医院为调查对象,采用横断面调查方式,了解医院基本情况、开展丙肝病毒(HCV)抗体检测、HCV核酸检测及丙肝治疗情况等,并对不同级别的医院进行比较.结果 共调查76家医院,均开展HCV抗体检测项目,HCV抗体检测率为48.4％,二级医院HCV抗体检测率(59.9％)高于三级医院(40.7％).35家(46.1％)医院开展HCV核酸检测项目,HCV核酸检测率为34.9％,二级医院HCV核酸检测率(21.2％)低于三级医院(65.3％).32家(42.1％)对丙肝患者开展治疗,但仅8家(10.5％)能提供规范诊断及治疗方案,规范诊疗率仅11.8％(1 150/9723).结论 本次所调查医疗机构普遍具备HCV抗体检测能力,但提供HCV核酸检测服务的医院不足半数,二级医院HCV核酸检测率明显低于三级医院;丙肝规范诊疗率低下,亟待加强有关能力建设.

目的 了解驻马店市2016-2018年丙型肝炎(简称丙肝)病毒(HCV)检测和报告情况,为促进当地丙肝病例的检测发现提供参考.方法 收集驻马店市部分医院2016-2018年实验室的血液丙肝病毒抗体(抗-HCV)和HCV核糖核酸(RNA)检测信息,分析血液抗-HCV检测率和阳性率、HCV RNA检测率和阳性率;收集所调查医院报告的HCV RNA阳性病例信息,与医院实验室检测出的血液HCV RNA阳性病例进行比较,分析HCV RNA阳性病例报告率.结果 2016-2018年,6家医院就诊者中抗-HCV平均检测率为5.6％.三级医院检测出的血液抗-HCV阳性率平均为2.3％,HCV RNA检测率平均为54.9％,HCV RNA阳性检出率为81.7％,HCVRNA阳性报告率为52.2％.二级医院检测出的抗-HCV阳性率平均为5.2％,HCV RNA检测率平均为50.5％,HCVRNA阳性检出率为79.9％,HCV RNA阳性报告率为16.9％;三级医院(x2趋势=5.93,P＜0.01)与二级医院(x2趋势=8.02,P＜0.01)HCV RNA检测率三年间均呈上升趋势.结论 驻马店市医疗机构HCV RNA阳性病例报告率整体仍较低,特别是二级医院.医疗机构需强化丙肝报告能力提高报告数量和质量,为卫生行政部门制定丙肝防治政策提供准确信息.

China's approach to HIV case management has evolved from little to none before the "Four Frees and One Care" policy was issued in 2004 to a complex two-stage system whereby people with diagnosed HIV infection were managed differently depending on whether they were or were not eligible for antiretroviral therapy (ART). Those in the pre-ART period were followed by local epidemiologists, while those who had initiated ART were followed by ART doctors. Unfortunately, many PLWH were lost to follow-up in the pre-ART period. However, after CD4 count-based ART eligibility requirements were abolished in 2016, HIV case management could be integrated into ART service delivery. This evolution reflects China's consistent, pragmatic approach to evidence-based policymaking that allows new findings and innovative strategies to be quickly adopted in order to benefit as many PLWH as possible.

Early in China's HIV/AIDS response, many separate data collection and information management systems arose to meet the needs of different programs and stakeholders. The data were not standardized across systems, and there were both gaps and redundancies between systems, limiting the value of the information. Meanwhile, inefficiencies were rapidly growing. Thus, a massive project was undertaken to create China's National HIV/AIDS Comprehensive Response Information Management System (CRIMS), the largest HIV information system in the world. CRIMS is an integrated, web-based system for real-time collection and reporting that facilitates timely monitoring and evaluation of all aspects of China's HIV epidemic. CRIMS, through its automatic alert functionality, real-time updates, database integrity controls, and easy accessibility of both raw data and summary statistics, has made a major contribution to the prevention and control of HIV in China. Data generated from the system have been used to support the implementation of large-scale national-level HIV prevention programs and modification of testing and treatment protocols nationwide. It has provided scientific evidence for HIV-related policy decisions at all levels, national, provincial, and even down to individual counties, towns, and villages. Furthermore, CRIMS has contributed immensely to the conduct of critical HIV research.

Objective To explore the value of superb microvascular imaging (SMI) and contrastenhanced ultrasound (CEUS) in differential diagnosis of small renal masses.Methods A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital.There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54± 10) years old.These tumors were all examined by using SMI and CEUS.And the imaging diagnostic results were compared based on the pathological results.Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign,2-3 grade was malignant.Besides,the patterns and enhancement of the small renal masses were observed in CEUS.The main diagnostic criteria of malignant tumors were "fast forward","rapid regression" and "high perfusion".Some special types of renal cell carcinoma were diagnosed by "slow in","rapid regression" and "hypo-perfusion".Benign tumors were diagnosed by "slow in","slow down" and "hypo-perfusion".Results Among 86 cases,76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis.By SMI,Adler grade of 89.5％(68/76) malignant tumors were 2-3,Adler grade of 6/10 benign tumors were 0-1.By CEUS,77.6％(59/76) of malignant tumors were "fast forward",82.9％(63/76) were "rapid regression",76.3％(58/76) were "high perfusion";7/10 of benign tumors were "slow in",5/10 were "slow down" and 6/10 were "low perfusion".The accuracy,sensitivity,specificity,positive predictive value,negative predictive value and AUC of SMI were 86.0％,89.5％,60.0％,94.4％,42.9％ and 0.747 respectively.The values for CEUS were 89.5％,92.1％,70.0％,95.9％,53.8％ and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (P=0.288).Conclusions Although there is no statistical significance between SMI and CEUS,the accuracy,sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses.In brief,SMI provides a new method in the differential diagnosis of small renal masses.

Objective: To understand the current status of follow up of people living with HIV/AIDS by health service at grass root in rural area of Jiangxi province and related factors, and provide references for the promotion of the follow up by grass root health service. Methods: People living HIV/AIDS aged ≥18 years and diagnosed before 31 December 2017 in 6 townships of Xinjian, Yushan counties and Guixi city were included in the study in Jiangxi province. They had been followed up for more than one time after the first epidemiologic survey. The information about their demographic characteristics and HIV infection status were collected by using self-designed questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify the factors that influencing the acceptance of follow up by grass root health service. Results: Of the 373 surveyed HIV infected subjects aged (53.06±16.15) years, 261 were males (70.0%, 261/373). Among the surveyed subjects, the illiteracy and people who received only primary school education accounted for 54.7% (204/373). The rate of follow up of the HIV infected subjects by grass root health service was 55.8% (208/373), and those through heterosexual contact were 58.5% (190/325). The multivariate regression analysis showed that the acceptance of follow up by grass root health service was higher in those who were farmers (OR=7.36, 95%CI: 2.52-21.45), had family support (OR=16.01, 95%CI: 2.25-49.73), didn't worry about discrimination (OR=12.97, 95%CI: 4.75-35.42), trusted health care provider (OR=5.07, 95%CI: 2.19-11.76) and showed AIDS symptoms (OR=10.58, 95%CI: 2.25- 49.73). Conclusions: The performance of follow up of people living with HIV/AIDS by grass root health service was well, suggesting it is a feasible management model. Being famer or not, family member supporting or not, worry about discrimination or not, trusting health care provider or not and showing AIDS symptoms or not were the main factors influencing the acceptance of follow up by grass root health service.

BackgroundAlthough increasingly studied in high-income countries, there is a paucity of data from the Chinese population on the patterns of cancer among people living with HIV (PLHIV).MethodsWe conducted a nationwide follow-up study using routinely collected data for adult PLHIV diagnosed on or before 31 December 2011 and alive and in care as of 1 January 2008. Participants were observed from 1 January 2008 (study start) to 30 June 2012 (study end). Main outcome measures were gender-stratified age-standardized incidence rates for China (ASIRC) and standardized incidence ratios (SIR) for all malignancy types/sites observed.ResultsAmong 399,451 subjects, a majority was aged 30-44 years (49.3%), male (69.8%), and Han Chinese (67.9%). A total of 3,819 reports of cancer were identified. Overall, ASIRC was 776.4 per 100,000 for males and 486.5 per 100,000 for females. Malignancy sites/types with highest ASIRC among males were lung (226.0 per 100,000), liver (145.7 per 100,000), and lymphoma (63.1 per 100,000), and among females were lung (66.8 per 100,000), lymphoma (48.0 per 100,000), stomach (47.8 per 100,000), and cervix (47.6 per 100,000). Overall SIR for males was 3.4 and for females was 2.6. Highest SIR was observed for Kaposi sarcoma (2,639.8 for males, 1,593.5 for females) and lymphoma (13.9 for males, 16.0 for females).ConclusionsThese results provide evidence of substantial AIDS-defining and non-AIDS-defining cancer burden among adult Chinese PLHIV between 2008 and 2011. Although further study is warranted, China should take action to improve cancer screening, diagnosis, and treatment for this vulnerable population.

目的 分析芒市2005-2015年艾滋病流行特征及趋势,了解德宏州三轮防艾人民战争对芒市艾滋病疫情的影响,总结有效措问题,为下一步制定芒市艾滋病防治策略提供科学依据.方法 2016年1月下载《中国疾病预防控制信息系统艾滋病综合防治信息系统》中2005-2015年新报告的HIV/AIDS病例,采用描述性方法分析检测及病例报告、晚发现、治疗和死亡情况.结果 2005-2015年累计报告HIV/AIDS4 388例,其中本县区有2 049例,外县有1 369例,外籍有970例,外籍病例构成比从2008年的17.65％上升到2015年的41.96％;累计报告病例性传播占74.07％,每年新报告性传播比例从2005年的55.60％上升到2015年的77.33％,40岁以上中老年人从2005年的19.30％上升到2015年39.91％;男性、已婚、大年龄,服务业、干部职员相对其他类别人群晚发现率高;抗病毒治疗者死亡率较未治疗者低.结论 通过三轮防艾人民战争的开展,芒市迅速上升的艾滋病疫情形式有所控制,但性传播、边境防控和中老年人健康教育都成为新的挑战,疫情形势依然不容乐观,需要进一步探索更有针对性的防治措施.

Objective To analyze the CD4+T cell testing (CD4 test) among newly reported HIV/AIDS cases between 2012 and 2016, to provide reference for starting ART in time.Methods Data were collected from HIV/AIDS case reporting cards and follow-up cards as of December 31st, 2017.The first CD4 test of newly reported cases between 2012 and 2016 were analyzed by frequency distribution and binary logistic regression model.Results The proportions of CD4 test within 14 days in newly reported cases increased from 49.2％in 2012 to 60.0％in 2016 (χ2=2 483.079, P＜0.001).Binary logistic regression analysis showed that lower proportion of CD4 test timeliness among those who were in high age group, male, never married, divorced/widowed, people whose occupation was listed as homemaker or unemployed, retired, being transmitted through injecting drug use and diagnosed at hospitals/clinics, detention center or blood donation station.The rate of less than 200 CD4+T cells perμL decreased from2012 to 2016 (χ2=254.088, P＜0.001).People who were in high age group and diagnosed at hospital/clinics had higher risks of less than 350 CD4+T cell perμL.Conclusion The proportion of CD4 test timeliness of newly reported cases increased in recent years.Highly effective counseling and recommendation of CD4 test and ART should focus on those who are in high age group, being transmitted through injecting drug use and diagnosed at hospital/clinics.

Timely HIV testing and initiation of antiretroviral therapy are two major determinants of survival for HIV-infected individuals. Our study aimed to explore the trend of late HIV/AIDS diagnoses and to assess the factors associated with these late diagnoses in China between 2006 and 2014.

Background: HIV long-term non-progressors (LTNP) may hold clues to novel treatment and prevention strategies. We aimed to establish a cohort of HIV LTNP in China and investigate characteristics and determinants of LTNP.

Objective: To analyze the mobility, status of follow-up and CD(4)(+)T cell testing (CD(4) testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission. Methods: Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system. Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software. Results: The number of newly reported inter-provincial mobile PLHIV had been increasing, with proportions of the total reported cases from 10.0% (5 576/55 805) in 2011 to 13.3% (15 348/115 231) in 2015. After adjusting for related confounders, percentages of follow-up and CD(4) testing were lower in inter-provincial and inter-prefectural mobile cases than those without. Conclusion: Service regarding the follow-up and CD(4) testing programs was affected by mobility of people living with HIV/AIDS. Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV. Information on potential mobility of PLHIV should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD(4) testing on patients.

Background:Human immunodeficiency virus (HIV) care continuum attrition is a major global public health challenge. Few studies have examined this problem in resource-limited settings. We aimed to assess cumulative, current, and historical achievement along China's HIV continuum of care.Methods:A nationwide, serial cross-sectional study of all individuals with HIV infection diagnosed in China between 1 January 1985 and 31 December 2015 was conducted using data from China's HIV/AIDS information systems. Biennial estimates of the number of persons living with HIV were also used. We defined 7 steps in HIV care continuum as infected (estimated), diagnosed, linked, retained, enrolled, receiving antiretroviral therapy (ART), and virally suppressed. Cumulative, 30-year performance, and biennial performance during the most recent 10 years were examined.Results:A total of 573529 persons diagnosed with HIV infection were included. Cumulatively, 94% were linked, 88% were retained, 73% were enrolled, 67% were receiving ART, and 44% were suppressed. Greatest attrition was observed for adolescents, minorities, and those who reported injecting drug use as their route of infection. Improvement was observed from 2005 to 2015. As of the end of 2015, 68% among those infected were diagnosed, 67% among diagnosed were receiving ART, and 65% among those receiving ART were virally suppressed. After adjusting for those without viral load testing, the proportion suppressed increased to 89%.Conclusions:Despite dramatic improvements, China faces serious challenges in achieving the Joint United Nations Programme on HIV/AIDS 90-90-90 targets, because of substantial attrition along its continuum of HIV care.

Objective: To determine the prevalence and relative factors on those who missed the follow-up service among newly reported HIV/AIDS cases that were infected by homosexual behavior. Methods: Data were extracted from both HIV/AIDS case-reporting and follow-up cards on HIV/AIDS in the Comprehensive Response Information Management System, between December 2008 and December 2015. Data was analyzed, using the generalized estimating equations (GEE) to explore the relative factors of influence. Results: Among the newly reported HIV infection among MSM, the proportion of those who missed the follow-up services was 5.06% (6 037/119 358), and decreased dramatically, from 37.57% (1 261/3 356) to 0.84% (267/31 935) (trend χ(2)=103.43, P<0.01). In MSM population, the younger than 20-year olds (OR=1.30, 95%CI: 1.11-1.52), 20-year olds (OR=1.52, 95%CI: 1.36-1.69), 30-year olds (OR=1.22, 95%CI: 1.12-1.34), 40-year olds (OR=1.10, 95%CI: 1.01-1.20) were receiving less follow-up services than those 50-year olds. Those who had received either junior (OR=1.52, 95%CI: 1.37-1.69) or senior high school education (OR=1.35, 95%CI: 1.23-1.49) were receiving less follow-up service than those who were more educated. MSM with the following characteristics as unspecified occupation (OR=2.06, 95%CI: 1.49-2.87),unemployed (OR=1.54, 95%CI: 1.30-1.83), working in commercial service (OR=1.31, 95%CI: 1.15-1.49) or being student (OR=1.34, 95%CI: 1.18-1.52) were more difficult to be traced or followed than the cadres. Cases being identified on site (OR=2.99, 95%CI: 2.26-3.95) or under special investigation (OR=1.43, 95%CI: 1.29-1.59) had received less follow-up service than those being identified through voluntary counsel testing service. Floating population (OR=1.46, 95%CI: 1.28-1.66) were getting less follow-up service than local residents. Conclusions: The prevalence of those who had missed the follow-up services in the newly discovered MSM HIV cases declined dramatically. Among the MSM HIV cases, those having the following characteristics as: younger than 50-year old, with less school education, with unspecified occupation or unemployment, working in commercial service, being student, having history of incarceration, recruited from special investigation, and floating population were prone to miss the follow-up program, suggesting that the follow-up service should be targeting on these patients.

Objective To analyze first follow-up and CD4+T (CD4) cell count test of newly reported students HIV cases in China from 2013 to 2017. Methods Data were collected from both Case Reporting Cards and Follow-up Cards from China Information System for HIV/AIDS Control and Prevention between 1st January 2013 and 31stDecember 2017. The inclusion criteria are 15-24 years old students who were newly diagnosed with HIV infection. Logistic regression model was used to analyze relevant factors of the first CD4 test results less than 200 CD4cells/μl. Results There were 12 037 newly diagnosed students HIV cases from 2013 to 2017. Most cases were male (97.7%), 19-22 years old (65.1%) and Han ethnicity (90.5%). At the time of diagnosis, the route of HIV infection was most frequently homosexual contact (82.2%). The majority of cases (46.9%) were diagnosed at HIV voluntary counseling and testing (VCT) location. About 2 465 (20.6%) students had unprotected intercourse in the past 3 months, of which 1 387 (56.8%) had 1 sexual partner, 610 (25.0%) with 2 sexual partners, 273 (11.2%) with 3 partners and 170 (7.0%) with more than 4 partners. 11.0% and 28.9% of cases had initial CD4counts less than 200 cells/μl and 200-349 cells/μl. Compared to the male, younger than 18 years old and diagnosed at VCT location, female (OR=2.09, 95%CI:1.51-2.89), aged 21 to 22 years ( OR=1.25, 95%CI : 1.06-1.47), diagnosed in hospital settings ( OR=2.20, 95%CI : 1.89-2.57) and preoperative testing ( OR=1.36, 95%CI : 1.07-1.73) had greater proportion of the first CD4test result less than 200 CD4cells/μl. Conclusion The number of newly diagnosed students HIV cases significantly increased in past 5 years, and the proportion of late diagnosis was high. Female, aged 21 to 22 years, diagnosed in hospital settings and preoperative testing were related to the first CD4test result less than 200 CD4cells/μl.