Estimated glucose disposal rate (eGDR), a surrogate marker of insulin resistance, has been associated with all-cause mortality, but most studies have treated eGDR as a static exposure based on a single baseline measurement. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we examined the associations of short-term eGDR change patterns and cumulative eGDR with all-cause mortality in middle-aged and older Chinese adults. Short-term eGDR change-pattern classes between 2012 and 2015 were identified using K-means clustering based on two repeated measurements. Cox proportional hazards models were used to evaluate the associations of eGDR change-pattern classes and cumulative eGDR with all-cause mortality, and restricted cubic spline regression was applied to assess the potential nonlinear association of cumulative eGDR with mortality risk. Over 52,853.24 person-years of follow-up, 428 deaths occurred among 5,966 participants. Compared with Class 1, the adjusted hazard ratios (95% confidence intervals) for all-cause mortality were 1.25 (0.87-1.79) for Class 2, 1.68 (1.25-2.24) for Class 3, and 1.77 (1.40-2.24) for Class 4. Cumulative eGDR was inversely associated with all-cause mortality. These findings suggest that dynamic and cumulative assessment of eGDR may provide prognostic information beyond a single baseline measurement.

BACKGROUND:Men who have sex with men (MSM) in China experience high HIV prevalence, yet little is known about the HIV testing behaviors of MSM among those who engage in sexualized drug use (SDU). Clarifying these patterns is essential for designing targeted HIV prevention interventions. METHODS:We analyzed baseline survey data from 1,800 MSM recruited in Chengdu, Suzhou, and Wuhan (2021-2022). Participants reported HIV testing history and SDU, including alcohol, rush/poppers, amphetamines, and other drugs (ketamine, marijuana, heroin, Ma Gu). Logistic regression estimated associations between SDU and HIV testing within 6 months, adjusting for demographics. RESULTS:The mean age was 31.1 years; nearly half held a bachelor's degree or higher. Alcohol (68%) and rush/poppers (43%) were the most common substances used before or during sex, while amphetamines (1.8%) and other drugs (1.7%) were rarely used. Any drug use excluding alcohol was positively associated with recent HIV testing (adjusted OR = 1.35; 95% CI: 1.08-1.68). Rush/poppers use specifically was linked to higher odds of testing (adjusted OR = 1.32; 95% CI: 1.05-1.63). CONCLUSIONS:SDU-particularly rush/poppers use-is prevalent among Chinese MSM and associated with greater HIV testing uptake. Tailored interventions that integrate substance use counseling with HIV testing promotion may help sustain high testing uptake and reduce transmission risk.

Men who have sex with men (MSM) in China bear approximately 23

Promoting HIV self-testing (HIVST) among men who have sex with men (MSM) is an effective strategy for preventing and controlling HIV infection. We aimed to explore the prevalence, associated factors, and probabilistic dependencies of HIVST uptake among HIV-negative MSM who engaged in condomless sex during the past 6 months in China using logistic regression and Bayesian networks. We performed analysis of baseline data from a large longitudinal randomized controlled trial. In total, 1800 MSM were included and 37.5

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

Background:: Men who have sex with men (MSM) in China have a high risk for HIV infection but experience suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled “WeTest-Plus” (WeTest+) as a user-centered “one-stop service” approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care. Objective:: The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM. Methods:: Participants completed a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. “Click-through” rates were assessed to examine engagement with online content. Results:: 28 participants were included, and the average age was 27.6 years (standard deviation = 6.8). Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features. Conclusion:: This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services for MSM in China. Findings underscore the utility of a user-centered approach to mHealth program design.

BACKGROUND:Healthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children. METHODS:Children admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility. RESULTS:Of 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896-0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs. CONCLUSIONS:The present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.

目的 建立适合武汉市MSM人群线上使用的风险评估模型，为后续开发电子化风险评估工具提供科学基础。方法 通过武汉市MSM人群“互联网+HIV自检服务平台”进行问卷调查。2020年6月1日—12月31日期间获得合格调查问卷2 843份。使用列线图和专家评估法建立风险评估模型，根据受试者工作特征曲线和曲线下面积对模型进行选择，并用C指数对模型预测能力进行评估。结果 参与互联网线上自检的MSM人群HIV检出率为1.8%。逐步logistic回归构建的模型预测能力较好且预测变量较少，最终筛选出的危险因素是近6个月HIV阳性性伴情况、近6个月有性病感染症状或被诊断为性病、近6个月性角色、文化程度和月经济收入，根据筛选出的危险因素建立的列线图C-指数为0.790。结论 本研究构建的MSM人群HIV感染个体风险评估模型具有较好的区分能力和校准度，可为后续有针对性地干预提供科学依据。

Background The prevalence of syphilis is very high in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), and effective interventions are needed to educate HIV-positive individuals about behavioral and biological risk factors. Therefore, we developed a standard case management process and conducted a randomized controlled study to investigate the impact on risky sexual behaviors and syphilis in HIV-positive MSM. Methods Men who have sex with men (n = 220) were enrolled and randomized to the case management intervention group and the control group between May 2016 and January 2017. The control group received routine HIV-related care. In addition to routine HIV-related care, those in the intervention group regularly received extended services from a well-trained case manager. Epidemiological information was collected during the baseline face-to-face interviews by a trained investigator. Serological tests for syphilis and assessments of risky sexual behaviors were performed at baseline and 6 and 12 months after the initiation of treatment. Results The syphilis incidence rates in the intervention and control groups were 11.3 per 100 person-years and 20.6 per 100 person-years, respectively. The multivariable-adjusted hazard ratio (95% confidence inter) for syphilis in case management group was 0.34 (0.14-0.87). The percentages of participants who resumed risky sexual behaviors in both groups were significantly reduced (P < 0.05) but did not significantly differ between the 2 groups. Conclusions A case management intervention reduced the incidence of syphilis in HIV-positive MSM. We should further increase the content of case management on the basis of providing routine HIV-related care to those people.

目的 探究武汉市HIV/AIDS患者ART前后生存质量变化及其影响因素.方法 选取2013年6月至2014年10月在武汉市艾滋病抗病毒治疗定点医院准备接受ART的HIV/AIDS患者为研究对象,采用前瞻性纵向研究设计,使用世界卫生组织艾滋病生存质量简表(WHOQOL-HIV BREF)对其治疗后4年内的生存质量进行重复测评.结果 本研究共纳入330例HIV/AIDS患者,1年期和4年期随访调查完成率分别为92.73％和90.30％.研究对象在不同治疗时期生理领域、独立性领域、社会关系领域、环境领域、总体生存质量及生存质量总分差异有统计学意义(P均＜0.05);精神/支柱/个人信仰领域得分在抗病毒治疗1年期显著提高,而后趋于平稳;心理领域得分在抗病毒治疗1年期无显著变化,但在治疗4年期显著提高.文化程度、婚姻状况、经济收入、样本来源、治疗机构和基线CD4细胞水平是影响生存质量变化的主要因素.结论 持续接受ART是提高HIV/AIDS患者生存质量的有利因素,在ART初期应加强心理干预,重点关注文化程度低、离异或丧偶、低收入水平者,充分发挥社会组织作用,倡导个案管理模式,动员患者尽早接受ART,可持续提高HIV/AIDS患者生存质量.

BackgroundWuhan was the epicentre of the COVID-19 outbreak in China. We aimed to determine the seroprevalence and kinetics of anti-SARS-CoV-2 antibodies at population level in Wuhan to inform the development of vaccination strategies.MethodsIn this longitudinal cross-sectional study, we used a multistage, population-stratified, cluster random sampling method to systematically select 100 communities from the 13 districts of Wuhan. Households were systematically selected from each community and all family members were invited to community health-care centres to participate. Eligible individuals were those who had lived in Wuhan for at least 14 days since Dec 1, 2019. All eligible participants who consented to participate completed a standardised electronic questionnaire of demographic and clinical questions and self-reported any symptoms associated with COVID-19 or previous diagnosis of COVID-19. A venous blood sample was taken for immunological testing on April 14–15, 2020. Blood samples were tested for the presence of pan-immunoglobulins, IgM, IgA, and IgG antibodies against SARS-CoV-2 nucleocapsid protein and neutralising antibodies were assessed. We did two successive follow-ups between June 11 and June 13, and between Oct 9 and Dec 5, 2020, at which blood samples were taken.FindingsOf 4600 households randomly selected, 3599 families (78·2%) with 9702 individuals attended the baseline visit. 9542 individuals from 3556 families had sufficient samples for analyses. 532 (5·6%) of 9542 participants were positive for pan-immunoglobulins against SARS-CoV-2, with a baseline adjusted seroprevalence of 6·92% (95% CI 6·41–7·43) in the population. 437 (82·1%) of 532 participants who were positive for pan-immunoglobulins were asymptomatic. 69 (13·0%) of 532 individuals were positive for IgM antibodies, 84 (15·8%) were positive for IgA antibodies, 532 (100%) were positive for IgG antibodies, and 212 (39·8%) were positive for neutralising antibodies at baseline. The proportion of individuals who were positive for pan-immunoglobulins who had neutralising antibodies in April remained stable for the two follow-up visits (162 [44·6%] of 363 in June, 2020, and 187 [41·2%] of 454 in October–December, 2020). On the basis of data from 335 individuals who attended all three follow-up visits and who were positive for pan-immunoglobulins, neutralising antibody levels did not significantly decrease over the study period (median 1/5·6 [IQR 1/2·0 to 1/14·0] at baseline vs 1/5·6 [1/4·0 to 1/11·2] at first follow-up [p=1·0] and 1/6·3 [1/2·0 to 1/12·6] at second follow-up [p=0·29]). However, neutralising antibody titres were lower in asymptomatic individuals than in confirmed cases and symptomatic individuals. Although titres of IgG decreased over time, the proportion of individuals who had IgG antibodies did not decrease substantially (from 30 [100%] of 30 at baseline to 26 [89·7%] of 29 at second follow-up among confirmed cases, 65 [100%] of 65 at baseline to 58 [92·1%] of 63 at second follow-up among symptomatic individuals, and 437 [100%] of 437 at baseline to 329 [90·9%] of 362 at second follow-up among asymptomatic individuals).Interpretation6·92% of a cross-sectional sample of the population of Wuhan developed antibodies against SARS-CoV-2, with 39·8% of this population seroconverting to have neutralising antibodies. Our durability data on humoral responses indicate that mass vaccination is needed to effect herd protection to prevent the resurgence of the epidemic.FundingChinese Academy of Medical Sciences & Peking Union Medical College, National Natural Science Foundation, and Chinese Ministry of Science and Technology.TranslationFor the Chinese translation of the abstract see Supplementary Materials section.

目的探索个案管理对改善MSM中新诊断HIV感染者焦虑、抑郁心理及睡眠质量的影响。方法按照随机分组方法,在ART定点医院采用医院焦虑抑郁量表（HADS）和匹兹堡睡眠质量指数（PSQI）重复测量个案管理组（个案组）和非个案管理组（对照组）MSM中新诊断HIV感染者的情绪状态和睡眠质量,采用广义估计方程（GEE）分析比较1年随访期内两组患者在焦虑、抑郁心理及睡眠质量方面改善有无差异。结果个案组患者焦虑阳性、抑郁阳性及睡眠障碍比例分别由治疗前的46.4%、30.0%和60.0%下降至1年后的12.5%、13.5%和14.6%,对照组患者焦虑阳性、抑郁阳性及睡眠障碍比例分别由治疗前的41.3%、30.3%和59.3%下降至1年后的32.5%、30.1%和39.8%,个案组病例在焦虑、抑郁及睡眠质量方面的改善优于对照组（P＜0.05）。结论基于心理行为干预的个案管理服务可以明显改善MSM中新诊断HIV感染者焦虑、抑郁心理和睡眠质量,应尽早识别新诊断患者可能存在的心理状态及睡眠障碍,为该人群提供基于个案管理服务的社会心理综合关怀,提高生存质量。

目的 探索特殊情况下艾滋病患者抗病毒治疗药物保障措施.方法 应对新型冠状病毒肺炎(简称新冠肺炎)期间采用电话调查的方法了解2020年1月1日至3月8日武汉市艾滋病患者抗病毒治疗药物领取情况,根据调查结果评估并解决其缺药风险.结果 截至3月8日,武汉市正在接受抗病毒治疗艾滋病患者5 517人,经评估5 095人(92.35％)未来15天无缺药风险,228人(4.13％)缺药低风险,194人(3.52％)已缺药.疫情应对期间共4 500人领药,其中2 084人(46.31％)门诊自行取药,157人(3.49％)通过疾病预防控制中心或防艾志愿者上门送药获得药物,1735人(38.56％)通过邮寄方式获得药物,524人(11.64％)外地门诊借药.结论 应对新冠肺炎期间,武汉市在治艾滋病患者存在缺药风险,但通过设立应急制度并提供多种取药途径,有效降低了缺药风险人群比例.

Background. We aimed to describe the epidemiological, virological, and serological features of coronavirus disease 2019 (COVID-19) cases in people living with human immunodeficiency virus (HIV; PLWH). Methods. This population-based cohort study identified all COVID-19 cases among all PLWH in Wuhan, China, by 16 April 2020. The epidemiological, virological, and serological features were analyzed based on the demographic data, temporal profile of nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the disease, and SARS-CoV-2-specific immunoglobin (Ig) M and G after recovery. Results. From 1 January to 16 April 2020, 35 of 6001 PLWH experienced COVID-19, with a cumulative incidence of COVID-19 of 0.58% (95% confidence interval [CI], .42-.81%). Among the COVID-19 cases, 15 (42.86) had severe illness, with 2 deaths. The incidence, case-severity, and case-fatality rates of COVID-19 in PLWH were comparable to those in the entire population in Wuhan. There were 197 PLWH who had discontinued combination antiretroviral therapy (cART), 4 of whom experienced COVID-19. Risk factors for COVID-19 were age >= 50 years old and cART discontinuation. The median duration of SARS-CoV-2 viral shedding among confirmed COVID-19 cases in PLWH was 30 days (interquartile range, 20-46). Cases with high HIV viral loads (>= 20 copies/mL) had lower IgM and IgG levels than those with low HIV viral loads (<20 copies/ml; median signal value divided by the cutoff value [S/CO] for IgM, 0.03 vs 0.11, respectively [P < .001]; median S/CO for IgG, 10.16 vs 17.04, respectively [P = .069]). Conclusions. Efforts are needed to maintain the persistent supply of antiretroviral treatment to elderly PLWH aged 50 years or above during the COVID-19 epidemic. The coinfection of HIV and SARS-CoV-2 might change the progression and prognosis of COVID-19 patients in PLWH.

目的 以知识-动机-行为技巧(IMB)理论为基础分析影响MSM检测行为的相关因素,为扩大检测策略提供参考依据.方法 采用自行设计的网络调查问卷收集武汉市MSM的人口学特征、性行为、检测信息、动机、技巧和检测行为等,采用非条件Logistic回归模型和结构方程模型分析该人群近6个月接受HIV检测的影响因素.结果 297名研究对象中,64.3％近6个月做过HIV检测,多因素分析结果显示HIV检测行为技巧得分高(OR=1.22,95％CI:1.06～1.41),性伴数≥2(OR=1.87,95％CI:1.03～3.41),性行为坚持使用安全套(OR=2.92,95％CI:1.19～7.20),性角色为插入方(OR=2.02,95％CI:1.06～3.86),做过性病检测(OR=3.62,95％ CI:2.02～6.48)与HIV检测呈正相关.IMB结构方程模型结果显示,行为技巧会直接影响HIV检测行为(路径系数=0.19,P=0.007),而检测知识和检测动机有间接影响.结论 个体行为因素和心理因素均会影响MSM的HIV检测行为,应将两者相结合,针对检测意愿较低的MSM开展针对性的干预措施.

Background: To describe the virologic and immunologic outcomes among people living with HIV (PLHIV) coinfected with SARS-CoV-2. Setting: Wuhan, China. Methods: Thirty-five coinfected patients were identified by matching the reported cases in National Notifiable Infectious Disease Report system for COVID-19 and HIV in Wuhan by time of April 19, 2020. Questionnaire-based survey and follow-up with blood sample collection were used to obtain characteristics before COVID-19 and after recovery. Nonparametric Mann-Whitney U test, chi(2), or Fisher exact test, Mcnemar test, and Wilcoxon test were conducted. Results: Twenty of the 35 coinfected patients were identified as asymptomatic/mild/moderate COVID-19 (nonsevere group) and 15 were identified as severe/critical (severe group). The severe and nonsevere group had no differences in demographics, HIV baseline status, the intervals between last tests and follow-up tests for CD4(+) cell count and HIV-1 viral load (all P > 0.05). Overall, there was a significantly increased number of coinfected patients with HIV-1 viral load >= 20 copies/mL after recovery (P = 0.008). The median viral load increased significantly after recovery in severe group (P = 0.034), whereas no significant change of HIV-1 viral load was observed in the nonsevere group. Limited change of CD4(+) cell count was found (all P > 0.05). Conclusion: The coinfection of SARS-CoV-2 may put PLHIV at greater risk for HIV-1 viral rebound especially for severe/critical COVID-19, whereas it had limited impacts on CD4(+) cell count. Whether continuous antiretroviral therapy against HIV infection would have significant impacts on CD4(+) cell count among PLHIV coinfected with SARS-CoV-2 needs further research.