HIV Detection and Delayed Diagnosis: A Time Series Analysis in China

Abstract

Background: Insufficient HIV detection and late presentation to antiretroviral therapy (ART) pose significant public health challenges. In China, universal access to HIV testing is available now. Under this background, we aim to analyze the trends of HIV detection and the prevalence of delayed HIV diagnosis (DHD) in order to provide evidence for HIV prevention and treatment in China. Methods: Data of HIV tests in Hangzhou city between 2007 and 2018 were collected from the Chinese National HIV/AIDS Comprehensive Response Information Management System (CRIMS). Descriptive statistics were used to describe the characteristics of HIV testing and detection and the prevalence of DHD among newly diagnosed HIV cases. Non-parametric tests were employed to examine the prevalence of DHD among newly diagnosed HIV cases. Moreover, logistic regression models were employed to explore the influencing factors of DHD. Results: Testing rates doubled from 14.1% in 2007–2010 to 28.2% in 2016–2018. The total positive rate of HIV tests was 5.3 per 10,000. Preoperative testing was the predominant pathway for HIV tests, accounting for 41.9%, followed by testing for health screening, maternal examination and other patients, accounting for 18.4%, 13.2% and 11.8%, respectively. Meanwhile, the predominant pathway for HIV case detection was also preoperative testing, accounting for 29.1%, followed by testing for other patients, testing at STD clinics and VCT, with the proportions of 18.8%, 15.8% and 13.6%, respectively. MSM (men who have sex with men) contact was the main transmission route, accounting for 55.3%, followed by heterosexual contact, accounting for 41.6%. Overall, DHD occurred in 29.0% of the newly diagnosed cases, and this rate had not improved over the years. A higher prevalence of DHD was found in those diagnosed through a pre-test for receiving blood/products [OR (95%CI): 5.42(2.95–9.97)], detection of other patients [OR (95%CI): 2.08(1.64–2.63)], preoperative testing [OR (95%CI): 1.83(1.44–2.32)] and spouse or sexual partner testing in positive person [OR (95%CI): 1.93(1.34–2.78)] compared with those diagnosed at a VCT clinic. Heterosexuals [OR (95%CI): 1.20(1.06–1.36)] had a higher risk of DHD than MSM. Diagnosis at a CDC [OR (95%CI): 0.68(0.55–0.83)] and community health centers [OR (95%CI): 0.54(0.39–0.75)] had a lower risk of DHD than in hospitals. Older age, males, being single/divorced or widowed and floating population were also associated with DHD. Conclusions: In China, DHD had not improved in the last 10 years, although HIV testing had been expanded. Therefore, it is important for continued efforts to promote early diagnosis of HIV to prevent transmission, morbidity and early mortality in HIV infection.

Behavioral verification and risk factors of HIV cross-population transmission in China: analysis of national surveillance data 1989–2022

“…This may stem from passive testing-detected individuals displaying inadequate HIV testing awareness and deficient HIV knowledge. In contrast, those identified through VCT exhibit more risk awareness and will voluntarily mitigate risky sexual behavior following the consultation [ 31 , 32 ]. Despite the gradually decreasing HRHB risk among MSM, the high potential for transmission persists, given the extensive population of bisexual individuals who function as a "bridge".…”

Spatiotemporal Pattern and Its Determinants for Newly Reported HIV/AIDS Among Older Adults in Eastern China From 2004 to 2021: Retrospective Analysis Study

“…The high number of chronically infected individuals in Hangzhou has hindered HIV/AIDS control. Sexual transmission has become a major mode of HIV transmission in Zhejiang Province; however, homosexuality remains highly stigmatized and discriminated against in China [ 29 ]. As a result, Chinese MSM tend to hide their identity and engage in sexual behavior in other areas.…”

Molecular transmission network analysis of newly diagnosed HIV-1 infections in Nanjing from 2019 to 2021

“…A study on partner testing of HIV-infected individuals in Zhejiang showed that nearly 80% of the partners who were successfully tested positive for HIV were newly diagnosed infections [33]. Furthermore, research has shown that HIV patients diagnosed through passive detection have a higher prevalence of delayed HIV diagnosis [34]. In comparison to those diagnosed at voluntary counseling and testing (VCT) clinics, the lower rate of access to HIV-1 molecular transmission networks among HIV-infected individuals diagnosed through VCT may be related to earlier detection of their own diagnosis and delayed detection of the sexual partner who caused their infection.…”

“…A total of 1,161 newly diagnosed HIV-positive individuals were included in our study from 2019 to 2021. Among them, 93.88% were male, and the median age was 29 years old (with an interquartile range [IQR] of [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. The majority of the participants (97.93%) belonged to the Han ethnicity, and 62.45% were unmarried.…”