The Effect Of Community Based HIV Universal Testing And Enhanced Follow-up Management, And Epidemiological Analysis Of Older Adults With HIV

Part I Community based HIV universal testingObjective:This study used a large-scale human immunodeficiency virus (HIV) antibody screening in a field investigation among more than1million individuals to explore the universal HIV testing in general population, and to understand the HIV infection situation.Methods:We used a multi-stage stratified random cluster sampling method in a community-based investigation of30sample points within9counties in Zhejiang province. The HIV antibody was detected and demographic information was collected together with health exam plan (HEP).Results: Of1113030persons screened for HIV,310were positive (adjusted rate,3.45/10000;95%confidence interval [CI],3.41-3.48). The HIV infection rate was higher in men than that in women at all age group; those in the25-34and35-44age groups were highest (compared with the <15age group, the adjusted odds ratios were25.69and18.48, respectively). The HIV infection rate in the medium gross domestic product (GDP) counties (adjusted rate,5.28/10000;95%CI,4.53-6.04) was significantly higher than those in the high and low GDP counties among the male25-34and35-44age groups. Migrant HIV-positive individuals were10years younger, and with lower education than native HIV-positive individuals. Also they did not have fixed sexual partners.Conclusion: Adding HIV antibody testing to HEP in the general population can enlarge coverage of HIV testing and find potential people living with HIV. Focus could be placed on male migrants of25-44years old in HIV control strategies, especially in industrial activity districts. Part II The effect of community based enhanced follow-up managementObject: To establish the community based ART intervention measures, and through a comparative between the research group and the control group, evaluation patients compliance situation, follow-up index system and the treatment effect in different follow-up mode.Methods: Based on the current "CDC" follow-up mode, newly establish "community-CDC-hospital" follow-up mode. After12months intervention, we evaluation the compliance changes, follow-up index changes and treatment effect. Using SPSS18.0data analysis tools include descriptive statistics, chi-square test, Logistic regression and t-test.Results:165cases and84cases were enrolled into the enhanced follow-up group and routine follow-up group respectively, after12months intervention, compliance in enhanced follow-up group increased from83.03%to91.52%, compliance in routine follow-up increased from82.14%to83.33%, significant difference can be seen (X2=3.733, P=0.045). According to the annual assessment analysis of the key indicators of HAART population, compared to the routin follow-up group, completion of main indexes in the enhanced follow-up group adhere to treatment, the completion of the7times follow-up ratio, CD4detection ratio, the proportion of viral load testing of the routine follow-up group. At the same time, in enhanced group CD4+T cell raised from 347.59±137.46to424.74±172.38(t=-3.028, P=0.003), while in routine group also increased significantly (t=-2.327, P=0.022). Enhanced follow-up group activation system (CD8+CD38+) expression ratio of37.38±8.68was reduced to34.40±11.53, and had significant difference (t=1.987, P=0.048); enhanced follow-up IL7-CD127system (CD4+CD127+) increased from23.22±7.11to27.69±11.72, with significant difference between before and after (t=-3.237, P=0.001).Conclusion: Community based enhanced follow-up intervention measures are feasibility and validity, through standardized management, by improving the compliance and social support, therapeutic effect became better, promote immune reconstitution, in this way to reduce the death rate mortality. Part III Epidemiological Analysis of Older Adults with HIVObjective: The aims of this study were to systematically review epidemiological characteristics in older people living with HIV/AIDS (PLWHA) in low endemic areas of China, analyze the causes of death and mortality, and provide a basis for targeted prevention in these populations.Methods:Nine counties representative of the distribution and epidemiological factors of the HIV epidemic in Zhejiang Province were selected, and data from1115HIV-positive individuals, including196older people (≥50years), who were confirmed as PLWHA from January1st,2000to December31th,2012, were retrospectively analyzed.Results:The proportion of older PLWHA increased from0%in2000to22.45%in2012. Sexual transmission was the main route, accounting for82.65%of infectious in this group. Compared with the younger group (range from14to49years old), the older group had significantly lower CD4+cell counts (291.64vs.363.63; P<0.001) when first diagnosed, and more of this group presented in the AIDS state with opportunistic infections (51.02%vs.34.06%; P<0.001). In the older group,25(12.76%) patients died directly of AIDS and171(87.24%) were censored, and in the younger group50(5.44%) patients died directly of AIDS and869(94.56%) were censored. Estimated survival time since HIV diagnosis in the older group was11.54±0.49years (95%confidence interval [CI]10.59-12.50), while in the younger group it was13.85±0.46years (95%CI12.94-14.76), the log rank (Mantel-Cox) test gave a chi-square value of3.83, and there was significant difference between the groups (P<0.05).Conclusion:The number of older PLWHA increased steadily over the study period in low HIV endemic provinces of a developing country. Later discovery and preexisting disease perhaps contributed to a shorter estimated survival time for older PLWHA and higher mortality.