Wu Xinsheng, Wu Guohui, Ma Yanmin, Huang Xiaojie, Yang Yuecheng, Cai Yanshan, Luo Ganfeng, Ma Ping, Qiao Ying, Chen Yuanyi, Lin Yi-Fan, Gao Yanxiao, Zhan Yuewei, Song Wei, Wang Yingying, Wang Rugang, Yang Xuejuan, Sun Lijun, Wei Hongxia, Li Quanmin, Xin Xiaoli, Wang Lijing, Wang Xicheng, Xie Ronghui, Yang Lijuan, Meng Xiaojun, Zhao Jin, Li Linghua, Zhang Tong, Xu Junjie, Fu Gengfeng, Zou Huachun
School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China.
Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China.
Lancet Reg Health West Pac. 2022 Aug 10;29:100569. doi: 10.1016/j.lanwpc.2022.100569. eCollection 2022 Dec.
China implemented strict non-pharmaceutical interventions to contain COVID-19 at the early stage. We aimed to evaluate the impact of COVID-19 on HIV care continuum in China.
Aggregated data on HIV care continuum between 1 January 2017 and 31 December 2020 were collected from centers for disease control and prevention at different levels and major infectious disease hospitals in various regions in China. We used interrupted time series analysis to characterize temporal trend in weekly numbers of HIV post-exposure prophylaxis (PEP) prescriptions, HIV tests, HIV diagnoses, median time intervals between HIV diagnosis and antiretroviral therapy (ART) initiation (time intervals, days), ART initiations, mean CD4+ T cell counts at ART initiation (CD4 counts, cells/μL), ART collections, and missed visits for ART collection, before and after the implementation of massive NPIs (23 January to 7 April 2020). We used Poisson segmented regression models to estimate the immediate and long-term impact of NPIs on these outcomes.
A total of 16,780 PEP prescriptions, 1,101,686 HIV tests, 69,659 HIV diagnoses, 63,409 time intervals and ART initiations, 61,518 CD4 counts, 1,528,802 ART collections, and 6656 missed visits were recorded during the study period. The majority of outcomes occurred in males (55·3-87·4%), 21-50 year olds (51·7-90·5%), Southwestern China (38·2-82·0%) and heterosexual transmission (47·9-66·1%). NPIs was associated with 71·5% decrease in PEP prescriptions (IRR 0·285; 95% CI 0·192-0·423), 36·1% decrease in HIV tests (0·639, 0·497-0·822), 32·0% decrease in HIV diagnoses (0·680, 0·511-0·904), 59·3% increase in time intervals (1·593, 1·270-1·997) and 17·4% decrease in CD4 counts (0·826, 0·746-0·915) in the first week during NPIs. There was no marked change in the number of ART initiations, ART collections and missed visits during the NPIs. By the end of 2020, the number of HIV tests, HIV diagnoses, time intervals, ART initiations, and CD4 counts reached expected levels, but the number of PEP prescriptions (0·523, 0·394-0·696), ART collections (0·720, 0·595-0·872), and missed visits (0·137, 0·086-0·220) were still below expected levels. With the ease of restrictions, PEP prescriptions (slope change 1·024/week, 1·012-1·037), HIV tests (1·016/week, 1·008-1·026), and CD4 counts (1·005/week, 1·001-1·009) showed a significant increasing trend.
HIV care continuum in China was affected by the COVID-19 NPIs at various levels. Preparedness and efforts to maintain the HIV care continuum during public health emergencies should leverage collaborations between stakeholders.
Natural Science Foundation of China.
中国在早期实施了严格的非药物干预措施以遏制新冠病毒病。我们旨在评估新冠病毒病对中国艾滋病病毒（HIV）照护连续过程的影响。
收集了2017年1月1日至2020年12月31日期间中国不同级别疾病预防控制中心和各地区主要传染病医院的HIV照护连续过程的汇总数据。我们采用中断时间序列分析来描述在大规模非药物干预措施实施之前和期间（2020年1月23日至4月7日），每周HIV暴露后预防（PEP）处方数、HIV检测数、HIV诊断数、HIV诊断与抗逆转录病毒治疗（ART）开始之间的中位时间间隔（时间间隔，天）、ART开始数、ART开始时的平均CD4⁺T细胞计数（CD4计数，细胞/μL）、ART取药数以及ART取药漏访数的时间趋势。我们使用泊松分段回归模型来估计非药物干预措施对这些结果的即时和长期影响。
在研究期间，共记录了16,780份PEP处方、1,101,686次HIV检测、69,659例HIV诊断、63,409个时间间隔和ART开始数、61,518次CD4计数、1,528,802次ART取药以及6656次ART取药漏访。大多数结果发生在男性（55.3% - 87.4%）、21 - 50岁人群（51.7% - 90.5%）、中国西南部地区（38.2% - 82.0%）以及异性传播（47.9% - 66.1%）人群中。非药物干预措施实施的第一周，PEP处方数减少了71.5%（发病率比[IRR] 0.285；95%置信区间[CI] 0.192 - 0.423），HIV检测数减少了36.1%（0.639，0.497 - 0.822），HIV诊断数减少了32.0%（0.680，0.511 - 0.904），时间间隔增加了59.3%（1.593，1.270 - 1.997），CD4计数减少了17.4%（0.826，0.746 - 0.915）。在非药物干预措施实施期间，ART开始数、ART取药数和漏访数没有明显变化。到2020年底，HIV检测数、HIV诊断数、时间间隔、ART开始数和CD4计数达到了预期水平，但PEP处方数（0.523，0.394 - 0.696）、ART取药数（0.720，0.595 - 0.872）和漏访数（0.137，0.086 - 0.220）仍低于预期水平。随着限制的放宽，PEP处方数（斜率变化1.024/周，1.012 - 1.037）、HIV检测数（1.016/周，1.008 - 1.026）和CD4计数（1.005/周，1.001 - 1.009）呈现出显著的上升趋势。
中国的HIV照护连续过程在不同层面受到了新冠病毒病非药物干预措施的影响。在突发公共卫生事件期间，维持HIV照护连续过程的准备工作和努力应借助利益相关者之间的合作。
中国国家自然科学基金。
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