Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
BMC Infect Dis. 2022 Mar 17;22(1):258. doi: 10.1186/s12879-022-07168-x.
HIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis.
We used data from the national statutory notification of newly diagnosed HIV infections between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a non-recent infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance.
Overall, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent infection (aPR: 1.16, 95% CI: 1.05-1.28) as well as AIDS (aPR: 1.41, 95% CI: 1.08-1.85) at the time of diagnosis compared to MSM in less deprived regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group.
An effect of socioeconomic deprivation on the timing of HIV diagnosis was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on those living in deprived regions in the countryside.
在晚期诊断出的艾滋病毒感染与健康状况显著恶化有关。在德国，晚期诊断出的艾滋病毒感染者比例一直居高不下。本研究探讨了区域社会经济贫困对艾滋病毒诊断时间的影响。
我们使用了 2011 年至 2018 年间全国法定新诊断艾滋病毒感染报告的数据，并通过 BED-Capture-ELISA 检测（BED-CEIA）和诊断医生进一步确定了诊断时间。区域社会经济贫困数据来源于德国社会经济贫困指数（GISD）。结局指标为基于 BED-CEIA 结果的近期感染或艾滋病阶段的感染。使用多变量泊松回归模型和聚类稳健误差方差分析社会经济贫困对诊断时间的影响。
总体而言，67.5%（n=10810）的人被诊断为近期感染，15.2%（n=2746）的人被诊断为艾滋病。与男男性行为者（MSM）相比，异性恋接触者的比例更高（近期感染 76.8%，艾滋病 14.9% vs. MSM 近期感染 61.7%，艾滋病 11.4%）。居住在农村贫困地区（<100 万居民）的 MSM 更有可能出现近期感染（调整后的比值比[aPR]：1.16，95%置信区间[CI]：1.05-1.28）和艾滋病（aPR：1.41，95% CI：1.08-1.85），而农村非贫困地区的 MSM 则没有差异。在城镇（10 万≤100 万居民）或大城市（≥100 万居民）的 MSM 中没有观察到差异，异性恋传播组也没有总体差异。
仅在农村地区的 MSM 中发现了社会经济贫困对艾滋病毒诊断时间的影响。我们建议，应加强艾滋病毒意识和定期艾滋病毒检测的宣传工作，无论社会经济背景如何，都应针对异性恋者进行，对于生活在农村贫困地区的 MSM 应重点开展。
