Analysis of HIV-1 recent infections and hotspot areas in a bordering area in Yunnan Province, China.

BACKGROUND

Honghe Prefecture, located on the China-Vietnam border, has long suffered from HIV-1. To accurately assess the HIV-1 prevalence situation and promote precise prevention and treatment of AIDS, a recent infection surveillance was conducted to explore the at-risk subpopulations and hotspot areas of HIV-1 transmission in Honghe Prefecture.

METHODS

Combined with the recent infection testing algorithm, HIV-1 recency assay was used to differentiate recent HIV-1 infections among newly reported HIV-1 cases in Honghe Prefecture from 2021 to 2022. Factors associated with recent HIV-1 infection were analyzed by logistic regression. The hotspot areas of recent infections were analyzed by spatial scanning statistics.

RESULTS

Of the 2698 HIV-1-infected individuals enrolled in this study (no HIV-2 cases reported), 297 HIV-1 cases were classified as recent HIV-1 infection, and the proportion of recent infection was 11.0%. Females (AOR = 2.61, 95% CI: 1.98-3.43), young people (15-34 years old) (AOR = 1.71, 95% CI: 1.21-2.43), highly educated people (AOR = 2.04, 95% CI: 1.24-3.37), men who have sex with men (MSM) (AOR = 3.08, 95% CI: 1.74-5.46), and spouses/regular sexual partners of HIV-1-positive individuals (AOR = 1.96, 95% CI: 1.15-3.33) were more likely to be detected as recent infections. Among the subpopulations by sex, age and transmission route, heterosexually exposed women aged 15-34 years (OR = 1.85, 95% CI: 1.07-3.19) and 35-49 years (OR = 1.65, 95% CI: 1.05-2.58) and MSM aged 15-34 years (OR = 5.11, 95% CI: 2.73-9.59) had a higher proportion of recent infections. Among the subpopulations by mode of exposure and sex, men infected through homosexual contact (OR = 5.59, 95% CI: 3.30-9.47) and women infected through non-marital non-commercial heterosexual contact (OR = 2.10, 95% CI: 1.50-2.95) and positive spousal exposure (OR = 3.03, 95% CI: 1.96-4.69) had a higher proportion of recent infections. With regard to detection methods, women detected by provider-initiated HIV testing counseling (PITC) (OR = 2.03, 95% CI: 1.50-2.76) and spouse/sexual partner testing (OR = 4.10, 95% CI: 2.19-7.67) had a higher proportion of recent infections. A statistically significant spatial cluster of recent infections was found in one county, Yuanyang.

CONCLUSIONS

This study investigated the use of HIV-1 recency testing in combination with HIV-1 case report surveillance. Correlation factor analysis revealed the presence of distinct risk subpopulations. The spatial distribution of recent infections showed differences. These findings were important for assessing the transmission risk and developing the targeted measures for interventions.

CLINICAL TRIAL NUMBER

Not applicable.