The Surveillance Of HIV Epidemic And Promotion Of HIV Test Among Men Who Have Sex With Men In China Based On HIV Self-Testing Strategy

Background:The HIV epidemic among Chinese MSM is severe and there is a high proportion of MSM who are unaware of their HIV status.Increasing the HIV screening of MSM can not only enable HIV-infected cases to understand their infections in time,but also receive anti-retroviral treatment to reduce the risk of secondary transmission and also help health workers make more effective prevention and control measures.HIV self-testing(HIVST)is a new type of HIV detection pathway.Because of its convenience,privacy,painlessness and ease of use,HIVST has gained high acceptance in MSM populations in China and abroad.It can effectively promote the participation of MSM who have never tested HIV.Compared with developed countries,China's HIVST research started late and the research content were limited.Most of them were NGO-led pilot projects to explore the feasibility of developing HIVST in China.In order to control the rapid spread of HIV epidemic in Chinese MSM population,it is not only necessary to understand the feasibility of HIVST,but also need to use HIVST as a means of investigation to conduct epidemiological investigations and long-term follow-up of MSM groups,especially hidden MSM groups in order to obtain the true and objective detection of HIV epidemic situation and sexual behavior characteristics of the target population.In addition to expanding the screening coverage of the HIV epidemic in the MSM group,more HIV suspected infected cases that have been screened for diagnosis and virus suppression can fundamentally exert the maximum efficacy of HIVST in controlling the HIV epidemic in the MSM population.Therefore,provide professional post-test counseling and guidance for HIV suspected infected cases,following-up with HIV diagnosis and referral treatment as much as possible have important public health implications.In addition,international research on HIVST is not limited to exploring the acceptance and feasibility of HIVST.Researchers hope to use the advantages of HIVST itself to change the HIV testing habits of high-risk groups of HIV infection,even dating habits and sexual habits.The current researches have found that HIV high risk groups can increase their HIV detection frequency through HIVST and timely detect early HIV infection.By giving the HIV self-test package to sexual partners,can effectively understand the HIV status of their partner to make informed friends.Similarly,exploring HIVST also has important public health significance for improving HIV testing habits and informed friends among Chinese MSM.Methods:This topic is mainly divided into three parts.The first part and the second part are based on the WeChat public number to recruit Chinese MSM population to participate in HIV self-test to explore the baseline investigation of HIV test behavior and HIV epidemic situation among Chinese MSM population and prospective cohort follow-up study.Use the WeChat public account to recruit MSM respondents and conduct an Internet-based electronic questionnaire survey on MSMs that meet the inclusion criteria.The five-in-one self-test kit for HIV,STD and hepatitis was mailed to the respondents who met the study inclusion criteria.The participants conduct self-testing after the test reagents were obtained,and the results were interpreted and uploaded to the online survey system by mobile phone photographing.According to the self-test results reported by the respondents,the suspected HIV-positive respondents were provided with the necessary post-test counseling assistance,and recommended to the local medical and health institutions for diagnosis and treatment.Individuals whose HIVST feedbacks were negative on baseline test were further screened for subjects who met the cohort follow-up requirements for a prospective cohort study based on HIVST.The follow-up procedure was consistent with the baseline survey.The third part is a randomized controlled trial based on self-testing strategies to promote HIV testing and informed dating among Chinese MSM.The MSM respondents were recruited using the WeChat public account,and a baseline survey of the Internet-based e-questionnaire was conducted on MSM meeting the inclusion criteria and randomly assigned to the intervention group and the control group.The intervention group can apply for 2 or up to4 self-test kits at a time according to their actual needs.After receiving the self-test kits,the respondents can use it for their own HIV testing,or they can give the self-test package to their sexual partners or gay friends.Each self-test package,whether it is used for self HIV testing or given to their sexual partners or gay friends,needs to scan the QR code feedback test result on the manual in the self-test package after use.The subjects in the control group could not apply for self-test packages and only received general HIV health knowledge.The intervention group and the control group need to conduct a follow-up survey in the third month after the start of the study.By comparing the HIV test behavior characteristics of the intervention group and the control group in the past 3months,the HIV and STDs test behaviors of the respondent's sexual partners,and the changes in sexual behavior between the respondents and their partners to evaluate the effect of self-testing intervention.Results:In the first part,a total of 1,702 MSMs were recruited to participate in cross-sectional surveys through the WeChat public account.The proportion of MSMs that had previously tested HIV was 74.2%(1263/1702).The main method of the previously tested MSM was to use HIVST kits,accounting for 57.2%(772/1263).MSM respondents have not participated in HIV testing for the past:mainly because they do not have the risk of HIV infection,accounting for 49.7%(218/439);followed by privacy concerns about exposure to personal information and sexual orientation,accounting for31.9%(140/439),and self-reported do not know which institutions provide free HIV testing accounted for 40.5%(178/439).At the baseline,the application for HIVST was1746 person-times,and the HIVST result feedback rate was 84.8%(1480/1746).The baseline HIVST positive rate was 3.3%(56/1693),the syphilis positive rate was 4.8%(80/1667),the HBV positive rate was 2.8%(47/1665),and the HCV positive rate was 0.2%(4/1674).Multivariate logistic regression analysis showed that recreational drugs use(vs.not used)were in the past six months(AOR=2.4,95%CI=1.4-4.1,P=0.002),anal bleeding during anal intercourse in the past six months(vs.no bleeding)(AOR=1.9,95%CI=1.1-3.3,P=0.017),previous diagnosis of sexually transmitted infections(vs.uninfected)(AOR=3.0,95%CI=1.6-5.4,P=0.001)and did not insist on the use of condoms during anal intercourse in the past six months(vs.insisted on use)(AOR=2.3,95%CI=1.3-4.1,P=0.003)is independent influencing factors of HIV infection.Through all of HIVST positive MSMs were advised to follow-up to local medical and health institutions for HIV diagnosis,it was confirmed that the proportion of HIVST positive MSM follow-up to local medical and health institutions for HIV diagnosis and positive test was 53.6%(30/56),and 46.4%(26/56)did not do further HIV diagnosis.The proportion of HIV diagnosised MSM follow-up on HIV treatment is confirmed to be 83.3%(25/30).If the follow-up is continued,the treatment rate may be higher.In the second part,a total of 448(30.3%)MSM participated in the prospective cohort of HIVST,with a cumulative follow-up of 201.7 person-years.During the follow-up period,the feedback rate of HIVST results was 92.0%(796/865),and the MSM of HIV and syphilis conversion were 8 and 5 respectively.The incidence of HIV and syphilis was 4.0(95%CI=1.7-7.7)/100 person-years and 2.5(95%CI=0.8-5.7)/100 person-years,respectively.Multivariate Cox proportional hazard model analysis showed that there was anal intercourse without condoms(vs.not occurred)with homosexual partners in the past six months(AHR=8.4,95%CI=1.0-69.3,P=0.048)and post-drinking sexual behavior in the past six months(vs.not occurring)(AHR=9.3,95%CI=2.1-41.6,P=0.003)were independent influencing factors for recent HIV infection in the study subjects.Self-reported was diagnosed with sexually transmitted diseases(AHR=24.0,95%CI=3.6-162.2,P<0.001)and HIV serological conversion(vs.not positive)(AHR=19.0,95%CI)=1.0-371.1,P=0.053)were independent influencing factors for recent infections of syphilis in the study.In the third part,a total of 328 respondents participated in a3-month randomized controlled trial based on HIVST,including 178 subjects in the intervention group and 150 in the control group.There were no statistically significant differences in social background characteristics,sexual behavior characteristics,and high-risk behavioral characteristics associated with HIV infection between the baseline intervention group and the control group.None of the subjects in the baseline intervention group and the control group had tested HIV in the past three months,and the condom use in the intervention group and the control group with fixed,accidental,and female partners were same,and there was no statistically significant difference between the acknowledgement of the fixed and accidental partners'HIV and STD infection status and test behaviors.After the three-month HIVST intervention,the HIV test rate of the control group in the past three months was 40.7%(61/150),and the intervention group was 100.0%(178/178),and the HIV test rate of the intervention group was statistically different from that of the control group(?~2=144.942,P<0.001).The median number of total HIV testing performed by the control group in the past three months after intervention was 1(IQR:1-1.5),and the total number of HIV testing performed by the intervention group was 2(IQR:1-2),and the frequency of HIV testing in the intervention group was statistically different from that in the control group(Mann-Whitney U test of two independent samples,P<0.001).In the recommended partner's HIV testing behavior,75.4%(107/142)of the intervention group recommended their fixed partners for HIV and STD testing.The recommended HIV testing rate was significantly higher than that of the control group(75.4%vs.46.7%,?~2=21.459,P<0.001);62.0%(88/142)of the intervention group's fixed sex partners have tested HIV or STD in the past three months,the detection rate was statistically different from that of the control group(62.0%vs.29.0%,?~2=26.632,P<0.001);After the intervention,76.1%(108/142)of the intervention group self-reported knew the HIV test results of their fixed partners,which had marginal statistical differences compared with the control group(76.1%vs.65.4%,?~2=3.386,P=0.066).Similarly,for the occasional partner of the intervention group,the effect of HIVST intervention consistent with the above-mentioned fixed partner was also found compared to the control group.During the study,through the HIVST results of the intervention group and its partners or gay friends feedback,a total of 6 people were positive for HIVST,the positive rate of HIVST was 2.7%;4 people were positive for syphilis,syphilis self-test positive rate was 1.8%.According to the follow-up data,5MSM respondents in the intervention group used the HIVST provided by the project found their fixed sexual partners with HIV or sexually transmitted infection(not known before),and 2 of them self-reported sexual behaviors with their partners with a higher frequency of condom use.Conclusions:As a new HIV testing method,HIVST greatly reduces the threshold for HIV testing.A new online recruitment method based on WeChat can attract a large number of hidden MSM groups who have never tested HIV before.Health workers can also use HIVST as a new epidemiological investigation to explore the HIV epidemic among Chinese MSM population,especially the hidden MSM group,and catch the recent HIV infection cases among this group through prospective cohort follow-up based on HIVST.The sexual characteristics and HIV epidemic data of Chinese MSM provided by HIVST could support the policy formulation and implementation of future HIV epidemics controlling targeting on this group.In addition,the popularity of HIVST among Chinese MSM population can also effectively promote HIV testing in this group and promote informed dating and healthier sexual behaviors to curb the rapid spread of HIV epidemics.While popularizing HIVST among Chinese MSM population,it is necessary to pay attention to the follow-up diagnosis of HIV-positive testers found by HIVST and the loss of personnel in the referral treatment,and establishing a complete post-test help and diagnosis service system is of great significance in controling the HIV epidemic among Chinese MSM population and achieving the three 90%AIDS prevention and control targets proposed by UNAIDS.