Wuxi Center for Disease Control and Prevention, Wuxi 214023, Jiangsu, China.
Kirby Institute, UNSW, Sydney 2052, NSW, Australia.
Biomed Environ Sci. 2018 Jan;31(1):37-47. doi: 10.3967/bes2018.004.
We aimed to elucidate the rates of repeat HIV testing and incident HIV diagnosis, and baseline CD4+ T cell count among individuals attending HIV voluntary counseling and testing (VCT) clinics in Wuxi, China.
A repeat HIV testing within 12 months was recorded if individuals had their first test with negative results, during 2013-2014 and retested within 12 months. An incident HIV diagnosis was recorded if individuals had their first test with negative results, during 2013-2015 and had a subsequent positive result at any point by the end of 2015. Data on HIV testing and diagnosis among individuals attending 32 VCT clinics from 2013 to 2015 and HIV diagnosis from other clinical services in Wuxi, China, were retrieved. A multivariate logistic regression model was used to analyze factors associated with repeat HIV testing. Cox regression was used to evaluate factors associated with incident HIV diagnosis.
From 2013 to 2014, 11,504 individuals tested HIV negative at their first recorded test, with 655 (5.7%) retesting within 12 months. Higher repeat HIV testing within 12 months was associated with male gender [adjusted odds ratio (aOR) = 1.7, 95% confidence interval (CI): 1.4-2.2], risk behaviors [commercial heterosexual behaviors (aOR = 1.4, CI: 1.1-1.6), male-male sexual behaviors (aOR = 3.7, CI: 2.7-4.9)], injection drug use (aOR = 9.9, CI: 6.5-15.1), and having taken HIV tests previously (aOR = 2.0, CI: 1.6-2.4). From 2013 to 2015, 1,088 individuals tested negative on HIV test at their visit and at ⋝ 2 subsequent tests; of them 30 had incident HIV diagnosis. The overall rate of incident HIV diagnosis among all VCT individuals was 1.6 (95% CI: 1.1-2.1) per 100 person-years. Incident HIV diagnosis was associated with male gender [adjusted hazard ratio (aHR) = 8.5, 95% CI: 1.9-38.1], attending hospital-based VCT clinics (aHR = 7.8, 95% CI: 1.1-58.3), and male-male sexual behavior (aHR = 8.4, 95% CI: 1.5-46.7). Individuals diagnosed at VCT clinics had higher CD4+ T cell count compared with those diagnosed at other clinical services (median 407 vs. 326 copies/mm3, P = 0.003).
VCT individuals in Wuxi, China, had a low repeat HIV testing rate and high HIV incidence. VCT-clinic-based interventions aimed at increasing repeat HIV testing are needed to detect more cases at an earlier stage, especially among individuals at high risk for HIV infection such as men who have sex with men.
我们旨在阐明在中国无锡参加艾滋病自愿咨询检测（VCT）诊所的个体中重复 HIV 检测和新发 HIV 诊断的发生率以及基线 CD4+T 细胞计数。
如果个体在 2013-2014 年首次检测结果为阴性，且在 12 个月内再次检测，则记录重复 HIV 检测。如果个体在 2013-2015 年首次检测结果为阴性，且在 2015 年底之前任何时候后续检测结果呈阳性，则记录新发 HIV 诊断。检索了 2013 年至 2015 年期间在 32 个 VCT 诊所接受 HIV 检测和诊断以及在中国无锡其他临床服务机构接受 HIV 诊断的个体的 HIV 检测和诊断数据。使用多变量逻辑回归模型分析与重复 HIV 检测相关的因素。使用 Cox 回归评估与新发 HIV 诊断相关的因素。
2013 年至 2014 年，有 11504 名个体首次检测 HIV 呈阴性，其中 655 名（5.7%）在 12 个月内再次检测。12 个月内重复 HIV 检测率较高与男性（调整优势比[aOR]：1.7，95%置信区间[CI]：1.4-2.2）、风险行为（商业异性性行为[aOR]：1.4，CI：1.1-1.6；男男性行为[aOR]：3.7，CI：2.7-4.9）、注射吸毒（aOR：9.9，CI：6.5-15.1）和既往 HIV 检测史（aOR：2.0，CI：1.6-2.4）相关。2013 年至 2015 年，有 1088 名个体在就诊时以及随后的 ⋝2 次检测中 HIV 检测结果均为阴性；其中 30 人发生新发 HIV 诊断。所有 VCT 个体的新发 HIV 诊断总发生率为每 100 人年 1.6（95%CI：1.1-2.1）。新发 HIV 诊断与男性（aHR：8.5，95%CI：1.9-38.1）、在医院 VCT 诊所就诊（aHR：7.8，95%CI：1.1-58.3）和男男性行为（aHR：8.4，95%CI：1.5-46.7）相关。与在其他临床服务机构诊断的个体相比，在 VCT 诊所诊断的个体的 CD4+T 细胞计数更高（中位数 407 拷贝/mm3 与 326 拷贝/mm3，P=0.003）。
中国无锡的 VCT 个体重复 HIV 检测率较低，HIV 发病率较高。需要针对 VCT 诊所开展干预措施，以增加重复 HIV 检测，以便在更早阶段发现更多病例，尤其是在男男性行为等 HIV 感染高风险个体中。
