Construction And Validation Of HIV Testing And Linkage To Care Models Among Men Who Have Sex With Men In China

BackgroundPromoting three "90-90-90" goals in 2020 for ending AIDS pandemic globalization were needed urgently moving forward.In China,large gaps still existed in the first two 90%goals which are diagnosed people living with HIV(PLWH)by HIV testing and link PLWH into care and treatment.Dramatically increasing HIV prevalence among men who have sex with men(MSM)was found in both China and other countries globally.PLWH among MSM know their HIV status by promoting regular HIV testing and linked to care after HIV diagnosis following the HIV continuum care system,were the indispensable prerequisites for the realization of virological inhibition in infected patients,and also the key strategies to achieve three UNAIDS 90%goals in both China and global wide.Researching to get under the skin why the gaps existed in MSM uptake HIV testing regularly and timely linkage to care after HIV diagnosis,by constructing theory-driven and integrated behavior models would provide an evidence-based and practical reference for policymakers and stakeholders to update regulations and policies,developing targeted and tailored strategies to achieve two 90%goals among MSM in China.Objectives1.HIV testing among men who have sex with men:structural equation model construction and validation2.Linkage to care after HIV diagnosis among men who have sex with men:structural equation model construction and validationMethods1.HIV testing model construction and validation were conducted by the cross-sectional survey.At first,based on the previous relevant studies and the theory of triadic influence,we proposed the hypothesis HIV testing model with 10 potential factors of regular HIV testing:intention,attitudes,social normative beliefs,self-efficacy,HIV risk perception,knowledge,social cohesion,comfort for seeking care,STD testing history,and disclosure homosexual orientation to family.Then,we did a cross-sectional survey among 351 MSM participants,we utilized the collected data to construct a fine-fitted HIV testing model among MSM by Structural equation modeling(SEM)via Mplus statistic software,the regular HIV testing behavior was the outcome of the HIV testing model.Finally,another 212 MSM participated in the survey to provide self-reported data for validation of the HIV testing model.Data was entered into Mplus and then utilized SEM to fit the HIV testing model which was constructed previously.The model fit indices were used to judge the fitness of the validation model.2.Linkage to care model construction was constructed by a cross-sectional survey.The first step was based on previous relevant studies and the framework of mechanism for HIV related stigma,we proposed the hypothesis linkage to care model with 9 potential factors:HIV related stigma,stigma from family,social support,mental health,attitudes toward linkage to care,negative coping,CD4+T cell count,HIV status disclosure to their sexual partner,and convenience for seeking care.Then we recruited 257 MSM newly diagnosed with HIV,we utilized Structural equation modeling via Mplus statistic software to construct a fine-fitted linkage to care model among MSM living with HIV.Validation of linkage to care model is a qualitative design study,we recruited 12 MSM newly diagnosed with HIV by purpose to conduct individual in-depth interviews.Interview data were analyzed by Colaizzi's method via Nvivo 11.0 software,themes,subthemes,and potential relationships between themes were extracted from interview documents.Then,comparing the difference among qualitative data results and the linkage to care model in the study.Results1.Total 11 direct paths,one indirect path,and 3 association paths were in the final HIV testing model.The loading of direct paths to regular HIV testing from intention,STD testing history,and disclosure of homosexual orientation to family were 0.177,0.420,-0.137,respectively.Self-efficacy,social normative beliefs,and attitudes were directly to intention,furthermore,within and between personal,social,and environmental streams paths were existed in the final model,all paths were static significantly(P<0.05).The model fit indices were ?2/df=1.403,CFI=0.926,TLI=0.918,RMSEA=0.034,SRMR=0.057.The proportion of regular HIV testing among 351 MSM was 63.82%.2.Results of HIV testing model validation illustrated that there were 3 paths differenced from the HIV testing model in the previous stage.The model fit indices were ?2/df=1.136,CFI=0.955,TLI=0.950,RMSEA=0.025,SRMR=0.064.3.Total 9 direct paths,one indirect path,and 4 association paths were in the final linkage to care model.The loading of direct paths to timely linkage to care from social support,HIV status disclosure to their sexual partner,convenience for seeking care,and CD4+T cell count were 0.206,0.222,0.148,-0.172,respectively.The loading of the indirect path from HIV-related stigma via social support to timely linkage to care was-0.057,all paths were static significantly(P<0.05).The model fit indices were ?2/df=1.160,CFI=0.967,TLI=0.959,RMSEA=0.025,SRMR=0.044.The proportion of timely linkage to care among 257 MSM newly diagnosed with HIV in model construction study was 63.42%.4.The interview data from 12 MSM newly diagnosed with HIV were utilized as linkage to care model validation.After Colaizzi's method of data analysis,a total of 10 themes,17 sub-themes were coded,9 relationships among themes were also identified,and 2 new themes differed from the linkage to care model constructed in previous were extracted from interview data.Conclusions1.The model of HIV testing among MSM constructed in the current study explained MSM's regular HIV testing behavior from individual,social,and environmental multi-aspects.However,there is still space to adapt the model within Chinese cultural background,health care system characteristics,and MSM's experience of health care.The role of social cohesion showed the significant impacts of social influence in promoting MSM's regular HIV testing,which implicated the potential appropriate social-level intervention conducted among Chinese MSM.2.The model of linkage to care conducted in the current study illustrated how HIV-related stigma as the original predictor,via social support,mental health,and other mechanism level factors to affect MSM's timely linkage to care after HIV diagnosis.However,deeper analysis is needed for the functions of MSM's expectations on HIV,their life and health care experience,and personalization influence MSM's in timely linkage to care.In the future,we should pay attention to the widespread and far-reaching impact of HIV related-stigma and Chinese family culture on MSM,and carry out early and targeted counseling services on HIV testing and linkage issues,to establish a correct understanding of HIV.Emphasize the power of peer and social communities,and promote the close connection between medical institutions and community-based organizations.3.The results show that social factors have the same important influence and practical significance in the decision-making and practice of MSM regular HIV testing and timely linkage to care after diagnosis.The decreasing effect of social support on HIV-related stigma suggests that the positive effect of social network can reduce the obstacles of PLWH delayed seeking treatment.It is suggested that in the future,we should further understand and pay attention to the culture of the homosexual circle and social influence of MSM in the early stage,establish cooperation with social organizations in the early stage,improve MSM's correct cognition of HIV infection risk,promote detection,and shorten the referral time of medical treatment after HIV diagnosed through social support and peer influence intervention.