Identifying the ongoing and local HIV acquisition among newly diagnosed sexually transmitted HIV/AIDS in China: Innovative approach for HIV epidemic surveillance practice (Preprint)

BACKGROUND Population migration makes it complex and difficult to identify local hotspot of HIV transmission, and compromise the HIV prevention and control efforts. OBJECTIVE Based on individual-based epidemiological investigation and clinical indicators, we developed logical algorithmic approaches for narrowing the scope of time and location of HIV acquisition, and characterizing the ongoing and local HIV acquisition in eastern China. METHODS We recruited newly diagnosed sexually transmitted HIV individuals in Zhejiang province between January 2017 and December 2019. We describe and compare the percentage of HIV acquisition within one year of HIV diagnosis, and HIV acquisition within Zhejiang province among participants within different sociodemographic and transmission route categories. RESULTS We enrolled 7775 participants in total. Among them, 84.8% (6594) were males and 15.2% (1181) were females. Over half of the participants (52.4%, 4063) have been living in Zhejiang province ever since, and 47.6% (3683) of them moved in from other provinces. Through the logical algorithmic approaches, among participants with an inferred time or location of HIV acquisition, 20.1% (1503/7482, 95%CI: 19.2%~21.0%) were infected with HIV within one year prior to HIV diagnosis, and 76.8% (5074/6603, 95%CI: 75.3%~78.4%) were infected with HIV in Zhejiang province. Among participants who moved in from other provinces to Zhejiang, 54.7% (1600/2927) were inferred to be infected with HIV in Zhejiang province. Compared with the corresponding group, participants who were males, had a negative HIV test history, and were infected through homosexual behavior have a higher proportion of infected HIV within one year of HIV diagnosis and within Zhejiang province. Homosexual transmission accounted for 73.4% of study participants who were inferred to be infected with HIV within one year prior to HIV diagnoses in Zhejiang province. CONCLUSIONS Our study found differences in the time and location of HIV infection between different mobility status and transmission routes subgroups. The practice of identifying recent and local HIV infections demonstrates the importance of coordinating more efforts on epidemiological surveillance, especially in areas with higher degree of population mobility. To detect the hotspot of upsurge HIV infection and have a comprehensive understanding of the HIV epidemic in a certain area.