| BackgroundLiuzhou is a city with the highest prevalence of HIV infection in Guangxi Zhuang Autonomous Region which has the second-largest number of people living with HIV in China. There were more than ten thoudsands HIV patents in Liuzhou since the first AIDS case has been found in 1996. From 2007, the mainly patients were infected through heterosexual transmission, partly of those infected by spouse. Thus, HIV-discordant couples are important population for prevention. However, there were no available data on HIV transmission among HIV-discordant couples in this region. Research on the prevention of HIV transmission which occurs within discordant couples is at a critical juncture. Therefore, this study was designed to fill in the information gap. Objectives 1. To evaluate the incidence and risk factors for HIV seroconversion of HIV-negative partners among HIV-discordant couples in Liuzhou. 2. To explore the epidemiological characteristics in AIDS knowledge, risk behavior, spouse disclosure, medicine adherenece and other aspects of HIV--discordant couples in Liuzhou, and provide evidence for HIV prevention. 3. To explore willingness to use early antiviral therapy(ART) and pre-exposure prophylaxis(Pr EP) and potential predicting factors among HIV serodiscordant couples. Methods 1. HIV-serodiscordant couples were retrospectively identified through the HIV epidemiology, follow-up and treatment databases administered by Liuzhou Center for Diseases Control and Prevention(CDC) from January 1, 1996 to June 30, 2013, which kept the patients’ demographic characteristics, sexual behavior, laboratory index, parters’ HIV test, medical history and follow-up records. Cox proportional-hazards model was used to examine risk factors related to HIV seroconversion of negative partners. 2. Cross-sectional survey was conducted among serodiscordant couples in Liuzhou city, Luzhai, and Liujiang rural county. Participants were recruited from the people’s hospital, clinics of voluntary counseling and testing, center of community health service and health clinics in towns and townships. HIV-discordant couples were included after HIV test for partner of HIV index. The goal of this study was to explore the epidemiological characteristics in AIDS knowledge, risk behavior, spouse disclosure, medicine adherenece and other aspects of HIV-discordant couples, and to provide evidence for HIV prevention. Univariate analysis was assessed using the chi square test or Fisher’s exact test. Independent predictors were identified by the multivariable logistic analysis. 3. To explore willingness to use early antiviral therapy(ART) and pre-exposure prophylaxis(Pr EP) and potential predicting factors among HIV serodiscordant couples. Cross-sectional survey about serodiscordant couples was conducted in Liuzhou city. Univariate analysis was assessed using the chi square test or Fisher’s exact test. Independent predictors associated with willingness to use Pr EP were identified by the multivariable logistic analysis.Results 1. 1854 eligible HIV-serodiscordant couples were retrospectively identified through the HIV epidemiology and follow-up database from January 1, 1996 to June 30, 2013. 125 HIV seroconversion occurred over 4963.5 person-years, resulting in an overall HIV incidence of 2.52/100 person-years. Men with HIV-positive wives(a HR=1.698,95%CI:1.105-2.608,P=0.016), no children(a HR=2.214,95%CI:1.425-3.439,P<0.001), HIV-positive partners who did not receive ART before their HIV-negative partners’ seroconversion(a HR=2.004, 95%CI:1.274-3.153, P=0.003) and patients reported intermittent condom use(a HR=7.088,95%CI: 4.138-12.139,P<0.001) were associated with increased risk of HIV seroconversion. HIV-positive partners with the last CD4 counts of 350 cells/ul or more were significantly protected against HIV seroconversion compared with those CD4 counts of less than 200 cells/ul(a HR:0.467,95%CI: 0.274-0.794;P=0.005). 2. 438 HIV-serodiscordant couples were enrolled, the majority patients reported male(74.9%), 30~50 years of age(54.3%). 85.8% and 78.1% of patients and partners knew HIV knowledge. 65.5% of couples remained sex behaviors after HIV infection, with 23.0% had intermittent condom use. Regression analysis indicated that age, ethnicity, education and HIV knowledge were the variables significantly predictive of condom use. In the study, 91.6% of patients have revealed their illness to spouse, 73.1% of which told by themselves. Sex, ethnicity and HIV knowledge were factors associated with spouse disclosure.Of the patients who have received ART, 27.0% have poor medicine adherence. More than 85% of couples have recived HIV intervention services, publicity materials and free condom distribution were the most common way. Couples hoped to obtain the knowledge of AIDS by television and medical staff. 3. 326 HIV-serodiscordant couples were enrolled, the majority patients reported male(67.8%). 83.7% of the couples said that their matrimony relationship did not change after patients revealed their illness to spouse. More than half of patients and spouses considered that the local AIDS epidemic is very serious. 60.9% of HIV indexes who have not received ART expressed willingness towards early ART. However, 7.7% and 7.4% of patients and HIV-negative partners had heard of Pr EP. 181(55.5%) of HIV-negative partners expressed willingness to use Pr EP.No drugs unless sick and potential side effects were the two main barriers to Pr EP acceptability. Independent predictors of unwillingness to adopt Pr EP included longer time couples lived together(OR=0.615,95% CI:0.436-0.869,P=0.006), having not received AIDS education(OR=0.426,95% CI:0.227-0.801,P=0.008), continual condom use(OR=0.365,95% CI:0.193-0.692,P=0.002) and having not supportted by partners(OR=0.274,95% CI:0.150-0.449,P<0.00). ConclusionsHIV-negative partners remain high risk of HIV infection in Liuzhou city. Female, having not received ART, low CD4+ T cells, no children, intermittion condom use were factors of HIV transmission. Early ART was important to HIV prevetion. Promotion of condom use and comprehensive package of HIV prevention services were needed to female patiens and couples who have no children, especially.Age, ethnicity, HIV knowledge, education and spouse disclosure were the variables significantly predictive of condom use, so it should strengthen edutcaion in these groups of populaion. 27.0% of patients who started with ART have poor medicine adherence, and period of infection was the variable associated with it. Drug supervision was needed on people who have long period of infection.Though HIV-discordant couples had low level of awareness to Pr EP, more than half of people interested in Pr EP appeared to be potential participants for further study. Pr EP and early ART in combination with other comprehensive strategies can provide opportunities for HIV prevention. No drugs unless sick, considering no danger of infection and potential side effects were the main barriers to Pr EP acceptability. |
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