| Background: Globally human immunodeficiency virus(HIV)and various viral hepatitis viruses,such as Hepatitis A(HAV),Hepatitis B(HBV),Hepatitis C(HCV),have heavy disease burden,and substantial mortality,the prevention and control of these infectious diseases have become the global concerns.The distribution of the above infectious diseases is uneven,and most of them are concentrated in low income developing countries,including China.The men who have sex with men(MSM)population is a global core high-risk population for HIV and hepatitis A,B,and C.The prevalence of above infections diseases are significantly higher in MSM than that of general population.The antiviral treatment and other related interventions are effetive for the prevention and control of viral hepatitis infections.However,due to insufficient cognitive level,the effects of discrimination /stigma,and the limited number of testing institutions,the World Health Organization(WHO)estimates that less than 5% of the approximately 300 million people with HBV and HCV infection in the world Tested HBV/HCV.Approximately HBV and HCV infection caused about 1.4 million deaths worldwide each year.In contrast,79% of HIV-infected people worldwide know their HIV status through testing,and the global HIV detection rate of MSM in the past year is about 50%.Low testing rate may limit the implementation of effective treatment and prevention strategies to viral hepatitis.Although almost simultaneously,the WHO has set targets for eradicating HIV and viral hepatitis by 2030,the viral hepatitis testing rate is still significantly lower than the HIV testing rate.In 2016,WHO developed a guidelines of HIV self-testing to promote HIV test;that is,testers use HIV test kits to operate at home and self test their HIV status.But self-testing strategies are lacking application in promoting hepatitis virus testing.How to quickly identify scattered highrisk groups and provide them with convenient and feasible hepatitis virus detection strategies is a global unsolved technique problem.There is less reports on the coinfection status of various viral hepatitis in MSM population in China,especially the prevalence of viral hepatitis A(HAV)infection in China MSM.Whether the combined testing of HIV and viral hepatitis using self-testing strategies can be accepted by China MSM population is unclear,and whether the combined detection reagent based on selfdetection approach can promote HIV detection in the MSM population remains to be studied.In recent years,offline synthetic reagents for the combined detection of various viral hepatitis and HIV have been proposed in the world.Still,it is not clear what method can be used to quickly recruit high-risk MSM who have not tested HAV / HBV / HCV to participate in self-test study,and currently the study of aforementioned combined HIV/HBV/HCV hepatitis detection reagents in MSM is lacking.Relevant reports on its effect to promot viral hepatitis testing in the MSM population in also lacking.Objectives:The purpose of this study was to clarify the HIV prevalence of HIVrecruited MSM population-based on voluntary counseling and testing(VCT)clinic,and the relationships between viral hepatitis infection and HIV,and other related factors;We used the WeChat public account to recruit national MSM population to identify the prevalence of HAV/HBV/HCV infection and its correlated factors.Besides,we provide HIV and HAV/ HBV/ HCV joint test for MSM population regularly through Wechat public accout,to investigate the effect of self-test on the viral hepatits testing rate in MSM,and to understand the correlation of the HIV self-test behavior and the HAV \ HBV \ HCV self-test behavior in MSM subjects.Method:1).cross-sectional survey about the prevalence of viral hepatitis,genital tract human mycoplasma infection,and their association with HIV infection in MSM in Shenyang city During March 2018 to October 2018,we recruited MSM subjects at the Voluntary testing and counseling(VCT)of First Affiliated Hospital of China Medical University in Shenyang.After obtaining the written informed consent of the research subject to participate in the project,we conducted a participant self-filled questionnaire survey to collect the characteristics of the social background,partner seeking,sexual behavior,recreational drug use behavior,etc.During the study we collected rectal swabs and venous blood specimens.The blood samples were used to test for HIV with fourth-generation antigen-antibody detection reagents and Western blot(WB),we also used rapid detection reagents to test hepatitis C antibody(HCV-Ab),hepatitis B surface antigen(HBsAg),and type A Hepatitis IgM(HAV-Ig M).Besides,we performed the Treponema pallidum particle test(TPPA)and rapid plasma reagin test on the collected blood to determine the status of syphilis infection.And the collected rectal swabs samples were tested for 10 STD items,including Mg(Mycoplasma Genitalium),Mh(Mycoplasma Hominis),and Chlamydia trachomatis [CT],Neisseria gonorrhoeae [NG],and ureaplasma urealyticum by multiplex polymerase chain reaction(PCR)method.[Uu],Micrococcus [Up1,Up3,Up6,Up14])and herpes simplex virus type 2(HSV-2).Multivariate logistic regression was used to analyze the factors affecting HIV infection in MSM subjects;2).Investigation on the feasibility of recruiting MSM for HIV and HAV-HBV-HCV combined self-test based on new media of WeChat public account We used WeChat public account to recruit MSM participants to participate in the selft test project,and conduct Internetbased electronic questionnaire surveys to eligible MSM subjects.We firstly charged 50 RMB deposit to each MSM respondent who applied for the free HIV / syphilis/hepatitis A / hepatitis B / hepatitis C self-test kits.MSM study subjects will receive the test reagents according to the instructions and carry out self-inspection at home.Trained staffs answered questions and interpreted the participants self-tested results.Each participant was asked to take photos of their self-test results via their mobile phone and upload them to the named online test result collection system provided by the project.The project staff timely returned the 50 RMB deposit to each respondent,and will pay another 15 RMB to each participant for the compensation for their time to attend the survey.The investigator offered post-test consultation and referral services to the suspected positives based on the self-test results fed back by the MSM survey respondents.Multivariate logistic regression was used to analyze the relevant risk factors of patients with hepatitis;3).Stepped-wedged cluster randomized controlled trial to evaluate the effect of combined detection reagents on the promoton of HAV-HBV-HCV and HIV test in China MSM From August 2018 to December 2018,we advertised in the We Chat public accounts which were mainly subscribed by MSM,the advertisements linked the project recruitment announcement and participate in the QR code,and guide MSM who intend to participate in the joint HIV and HAV,HBV,and HCV self testing.After participants were screened qualified,subjects were randomly divided into four groups(A,B,C,and D).A 12-month step-by-step randomized controlled trial was conducted to the frour group MSM.The four groups of respondents provided free application service for HIV and HAV,HBV,HCV selftesting reagents from baseline survey,3,6,and 9 months survey,respectivley.The baseline survey and subsequent follow-up surveys of four groups of respondents completed an online questionnaire every three months to evaluate the self-reported HIV and HAV,HBV,and HCV test status of the MSM respondents and the actual test status.The generalized mixed linear model(GLMM)and generalized estimation equation(GEE)were used to evaluate the changes in the detection of HAV,HBV,and HCV in MSM respondents by the provision of combined self-test reagent.Spearman rank correlation coefficient was used to analyze the relationship between HIV and HAV,HBV,HCV of the survey subjects.Results: 1).cross-sectional survey about the prevalence of viral hepatitis,genital tract human mycoplasma infection,and their association with HIV infection in MSM in Shenyang city A total of 183 MSM respondents participated in the study.About 77.0% of the respondents were over 25 years old,76.5% had full-time employment,87.4% had a current marital status of unmarried,74.3% had an education level above middle school,and 56.3% had a mean month income of ≥300 USD.Totally 51.4% of the respondents have sought for male sexual partners through mibile social application software(APP)in the past year.Laboratory tests show that the prevalence of HIV and other STIs were HIV(19.7%),syphilis(12.0%),HAV(1.1%),HBV(3.3%),HCV(0.5%),Mg(15.3%),and Mh(7.1%).Besides,the prevalence of NG was 0.5%,CT was 4.4%,Uuu was 4.4%,and HSV-2 was 1.1%.Multivariate logistic regression results showed that HIV infection was independently associated with finding sexual partners through APP(adjusted odds ratio [aOR] = 2.6),Mg infection(aOR = 3.2),Mh infection(aOR = 4.1),and syphilis infection(aOR = 3.1);2).Investigation on the feasibility of recruiting MSM for HIV and HAV-HBV-HCV combined selftest based on new media of WeChat public account From October 2017 to August 2019,2103 qualified MSM from 29 provinces participated in the project and provided feedback on the test results.79.5% of the MSM survey respondents applied for participation directly after reading the project’s online recruitment advertisement information,and 20.6%(432 people)participated through the "second distribution" ways;the feedback rates of the various self-test indicators of the MSM survey respondents were: HIV(86.5% 1819/2103),syphilis(85.2%,1792/2103),Hepatitis B(85.0%,1789/2103),Hepatitis C(85.3%,1794/2103)and Hepatitis A test 57.6%(1043/1811).About 84.2%(1771/2103)reported HIV and hepatitis B and C test results at the same time;the number of positive test results and the positive rate of various test items among MSM respondents who reported self-test results were HIV(3.0% [54/1819],95% CI,[2.2 ～ 3.9]%),syphilis(4.2% [76/1792],95% CI,[3.4 ～ 5.3]%),HBV(3.0% [53/1789],95% CI,[2.2 ～ 3.9]%)and HCV(0.1% [2/1794],95% CI,[0.0 ～ 0.4]%),HAV(0.8% [8/1043],95% CI,[0.3 ～ 1.5]%);the rate of viral hepatitis infection(i.e.,the proportion of those infected with at least one of HAV,HBV,and HCV indicators)was 3.5%(63/1811),95% CI,(2.7-4.4)%.The distribution of positive rates of viral hepatitis detection among MSM survey subjects was uneven,with regions with higheast positive rates mainly distributed in the northeast,southern and southeastern China.Participants from Fujian(11.8%),Anhui(11.1%),and Jilin(9.5%)have the highest hepatitis seropositive rate,while the lowest seropositive rate was in western China(<1%).Multivariate logistic regression analysis showed that the sexual role with male partners was receptive role(vs.the insertive role)(OR = 2.3,95% CI = 1.1～4.8,P = 0.011),and the sexual role was oral sex(vs.the insertive role)(OR = 3.0,95% CI = 1.3～7.1,P = 0.019),self-tested HIV positive status(vs.HIV self-test negative)(OR = 2.2,95% CI = 1.0～4.7,P = 0.044)are independent risk factor for viral hepatitis infection in MSM subjects,while having previously been vaccinated against hepatitis A(OR = 0.2,95% CI = 0.1～0.3,P <0.001)and having been vaccinated against hepatitis B(OR = 0.06,95% CI = 0.03～0.12,P <0.001)were negatively associated with the viral hepatitis infection in MSM participants.The proportion of those who responded to the results of hepatitis A,B,and C was willing to recommend test strips to their sex partners or friends for testing,respectively,84.3%(879/1043),83.7%(1498/1789),and 83.7%(1501/1794).MSM respondents have a better experience with self-testing reagents,of which 88.1% thought that the “application-mail-test" of self-testing reagents is convenient / no difficulty,and 83.8% are willing to recommend the self-test reagents provided by this project to their sex partners or MSM friends(secondary distribution test);3).Stepped-wedged cluster randomized controlled trial to evaluate the effect of combined detection reagents on the promoton of HAV-HBV-HCV and HIV test in China MSM From August 2018 to December 2018,a total of 560 qualified MSM were recruited to participate in the project.The qualified MSM survey respondents were randomly divided into four groups(group A,group B,group C,and group D.The number of subjects in each group was 140 MSM.69.3%(388/560)of the respondents are between 21～30 years of age;83.2%(466/560)of the respondents have a college degree or above;49.1%(275/560)of the respondents have a monthly income of 2,000 yuan Below;57.9%(324/560)of the respondents are currently living in a nonresidential place.Besides,more than 70%(394/560)of the respondents had the same sexual orientation;465 MSM(83.0%)participated in at least one follow-up,and 394(70.4%)respondents completed all consecutive follow-up surveys for 12 months.During the 12-month follow-up,a total of 1556 self-test reagents were mailed to the survey participants and their partners or friends after application,and the feedback rate of the test reagents was 90.4%(1407/1556).The self-reported viral hepatitis in the past three months of the MSM survey respondents increased from 9.0% before the intervention to 82.2% during the intervention stage.Besided,before the intervention the confirmed HAV,HBV,and HCV testing rate were 5.3% and 12.1%,and 5.6%,respectively.While,the confirmed HAV,HBV,and HCV testing rate increased to 64%,73.8%,and 76.9% during the intervention stage,respectively.The analysis of GEE and GLMM showed that,the self-reported hepatitis detection rates and confirmed HAV,HBV,and HCV testing rates were all significantly higher in the intervention phase than those in the non-intervention phase(all P <0.001).Besides,Spearman rank correlation analysis showed that there was a significant correlation between HIV detection behavior,and HAV/HBV/HCV testing behaviors in MSM subjects(all P <0.001);Conclusions: 1).Finding sexual partners through social application software,MSM populations infected with Mg,Mh,and syphilis have significantly increased risk of HIV infection.Relevant healthy departments should use social software to promote and intervene in HIV testing of MSM populations.At the same time,they should pay attention to the previously neglected sexually transmitted diseases such as Mg and Mh in MSM populations.They should also encourage the detection and prevention of HIV infections and continue to monitor the status of various viral hepatitis pathogens in MSM;2).Through the WeChat new media,MSM can be quickly recruited to participate in the combined HIV and hepatitis test.The self-test mode of prepayment deposit-test-refund deposit is feasible attractive among the MSM respondents;3).MSM population has a high self-test feedback rate for viral hepatitis,and were able to accept the concept of "second transmission" test for viral hepatitis.4).The prevalence of HAV,HBV and HCV is high in China MSM population.Viral hepatitis infections are positive for HIV self-tests of MSM subpopulation with passive sexual roles,oral sex role,but vaccination to HBV and HAV can protect MSM from viral hepatatis infection;5).Providing HIV and HAV-HBV-HCV self-testing reagents through new media of WeChat public account can significantly improve the testing rate of HAVHBV-HCV in MSM population.The HAV-HBV-HCV self-testing behavior was positively associated with their HIV self-testing behavior,joint testing can help promote HAV-HBV-HCV testing rate in MSM population. |
