The Epidemic Character Of HIV/AIDS And Application Of The Spectrum/EPP Model In Dehong Prefecture,Yunnan Province

1. Epidemiological character analysis of HIV/AIDS between the year of1989～2012in Dehong Prefecture, Yunnan Province.Objective To determine the epidemiological characteristics and trends of HIV/AIDS in Dehong Prefecture from1989to2012, and to find out the population who need to be focused and weak link in the prevention and control of HIV/AIDS.Methods Retrospectively collected case finding, sentinel surveillance and testing data for various populations in Dehong prefecture, and downloaded HIV/AIDS case reporting data from ’the National HIV/AIDS prevention information system’between the period of1989～2012. Descriptive analysis of disease profile, population distribution, time distribution, geographical distribution and transmission route changes of HIV/AIDS, and percentage (%) was used to descriptive the disaggregated data, the Chi-square test or Fisher exact test statistical analysis was used to statistical analysis. Data analyses were performed using SPSS16.0software.Results A total of2219054HIV tests were performed during the period of1989and December31,2012. Among them,43323tests were positive, giving a proportion of1.95%. After excluding repeated tests and HIV positives from them, a total of20569HIV/AIDS cases were newly identified and reported during this period. The majority of newly reported HIV/AIDS cases were males14834(72.1%),5735(27.9%) were females.15366(74.7%) were20-39years old.8158(39.7%) were Han,5825(28.3%) were Dai,4132(20.1%) were Jingpo. The educational level of most HIV/AIDS was lower, only15656(95.4%) of them had received the education in secondary and below.17290(84.1%) were farmers and unemployed people. The reported HIV/AIDS cases showed an phenomenon of area un-balanced, Ruili(32.7%) accounted for the most of proportion of reported cases, followed by Luxi(23.9%), Yingjiang(20.5%), Longchuan(18.7%), Lianghe(4.0%) and Wanding(0.6%). The HIV/AIDS infection rate was statistically significant between different gender sociodemographic characteristics (P<0.0001).The HIV positive rate was the highest in drug users, it showed a downward trend after2004, from36.4%in2004down to11.6%in2012. For HIV/AIDS Voluntary Counseling and Testing (VCT) clinic attendees, the HIV positive rate showed a downward trend after2008, fell to8.0%in2012. For female sex workers the overall HIV positive rate showed a downward trend, from4.3%in2003to1.0%in2012. The ANC HIV positive rate showed a downward trend in volatility between2004and2012, until2012the HIV positive rate had been reduced to0.7%.The annual year reported number of HIV/AIDS had changed insignificantly during the period between1989and2003, and had decreased slowly from2004(2912) to2012(1341). The number of people living with HIV/AIDS and cumulative number of HIV/AIDS had increased significantly after2004, and the respective number was15307and20573in2012.3number of AIDS deaths were first reported in1990, and grew to153in2012. Of the newly reported HIV/AIDS each year, the proportion of female had shown a volatility growth trend. The proportion of newly reported HIV/AIDS through sexual contact (39.1%) was the first time more than through injection drug use(37.7%), showing a situation that sexual contact and drug use transmission was the main route of HIV transmission in Dehong Prefecture.Conclusions Males, adults, people with lower educational background and farmers are the main populations who are HIV infection in Dehong prefecture, this part of population should be strengthened surveillance, testing and intervention efforts. The HIV/AIDS epidemic in Dehong had showed a downward trend in recent years, the effect of AIDS prevention and control had been basically apparent. Three HIV transmission routines coexist in Dehong prefecture, sexual contact and drug use are the main route of HIV transmission. Injection drug users, female sex workers, clients of female sex workers, men who have sex with men and HIV single positive spouse and family should be the focused population in HIV/AIDS prevention and control. Continue to strengthen the HIV/AIDS prevention and control work, to further curb the spread of the HIV epidemic in Dehong prefecture. 2. Estimation and Projection on HIV/AIDS through application of Spectrum/EPP model in Dehong prefecture, Yunnan ProvinceObjective To estimate and project the HIV/AIDS epidemic in Dehong prefecture by using the Spectrum/EPP model, and to explore the effect of different HIV/AIDS prevention and control measures.Methods The whole population age between15～49in Dehong prefecture was divided into six sub-populations:injection drug users(IDU), female sex workers(FSW), client of female sex workers(Client), men who have sex with men(MSM), remaining male(RM) and remaining female(RF). According to the requirements of the Spectrum/EPP model, we collected the HIV/AIDS epidemic data needed in the model in Dehong prefecture, that data included the demographic, population size of each sub-population(low scenario, medium scenario, high scenario). HIV prevalence, program statistics included the distribution of antiretroviral therapy(ART) among adults and child, distribution of antiretroviral regimes for prevention of mother-to-child transmission(PMTCT) and so on. Apply the concentrated epidemic mode to estimate and project the HIV/AIDS epidemic in Dehong prefecture, at the same time, evaluate the influence of different prevention and control measures.Result Based on the implementation of the Spectrum/EPP model, there was similar HIV epidemic trend by respectively fitting the model with low, medium and high scenario of each sub-population size, showing that the model was stable. The model estimated that the first case of HIV infection was existed in1980, the HIV prevalence and incidence all showed a downward trend in recent years, the HIV prevalence was1.94%(1.59%～2.31%) and the HIV incidence was0.05%(0.03%～0.06%) in2012. The HIV epidemic was serious in Dehong prefecture. The number of living, new, cumulative HIV/AIDS and AIDS deaths were19351,460,68627and2242in2012respectively. The proportion of the actual reported living and cumulative HIV/AIDS cases accounted for the model estimated had rised significantly, which were14.9%and78.8%in2004, respectively.Males were the predominant population living with HIV/AIDS, with the estimated male to female ratio was10.6:1(17686/1665) in2012. People living with HIV/AIDS were concentrated in the15～49age group, accounted for the proportion of79.9%in2012. IDU’s HIV prevalence was the highest in the six sub-populations, showed a rapid downward trend in2005and subsequent years, but remained at a high level(>15%). MSM’s HIV prevalence had rised quickly, and would close to IDU’s HIV prevalence in2016. At the beginning of the HIV epidemic, injection drug use was the main route of HIV transmission, but the proportion of HFV infection by this route dropped to48.5%in2011, and predicted that the proportion of HIV infection through sex contact would rise to87.7%in2016.By comparison of the baseline ART and no ART, result showed that the avoided number of AIDS deaths were685and498in2012and2016, respectively. By adjusting the intervention efforts of adult ART, child ART and PMTCT, showing that ART had no significant impact on the number of people with HIV/AIDS and newly infected, while had significant impact on AIDS deaths. PMTCT could impact the number of newly and existing HIV/AIDS of child obviously. By comprehensive considered the impact of ART and PMTCT, we established four kinds of programs. Compared between programl and program2, program3and program4, showed that child’s HIV/AIDS epidemic level could be impacted significantly by improving the their ART and PMTCT efforts, but had little impact on the total HIV epidemic of Dehong prefecture. Compared between program1,2and program3,4, showed that improve the adult ART coverage could reduce the number of AIDS deaths significantly in Dehong prefecture.Conclusions The overall HIV epidemic had shown a downward trend in Dehong prefecture in recent years, and the effect of HIV/AIDS prevention and control measures had basically apparent. The HIV epidemic level was high in Dehong prefecture, and would be one of the most severely affected regions in China. The HIV/AIDS epidemic in men who have sex with men(MSM) was serious and had increasing significantly, the local should pay attention to control and prevention of HIV/AIDS spread in this population. ART and PMTCT all had positive effect on controlling the epidemic of HIV/AIDS, ART could reduce the number of AIDS deaths significantly, while PMTCT could control the epidemic of HIV/AIDS in children. The applicability of the Spectrum/EPP model in estimate and project the HIV/AIDS in Dehong prefecture was for further studies, needing consider the model assumptions, risk behaviors, population movement, MMT and other factors, making the fitting result closer to the real situation.