Study On The Late Diagnosis Of HIV And Its Associated Factors In Zhejiang Province

Objective(1) To understand the status and epidemiologic characteristics of late HIV diagnosis in Zhejiang province.(2) To identify the factors associated with late HIV diagnosis by univariate and multivariate logistic regression analysis.(3) To identify the reasons for late HIV diagnosis and measures for detecting HIV infections earlier by qualitative research.(4) To explore the measures and strategies for detecting HIV infections earlier by combining quantitative and qualitative research results.Methods(1) Data of HIV cases was collected from 2010 to 2012 through case reporting System. Then a random sampling method was used to select the study individuals. All individuals who were newly diagnosed with HIV infection in 2012 and lived in Zhejiang province were eligible. The questionnaire included HIV related knowledge, HIV testing history, medical history, Social discrimination, etc.(2)Moreover, a qualitative method was used to collect the reasons for late HIV diagnosis and measures for detecting HIV infections earlier.(3)Quantitative data were entered using EpiData 3.1 software and analyzed using SPSS 19.0 software. Chi-square test were used for categorical variables. Multivariate logistic regression was used to identify factors independently associated with late HIV diagnosis.(4)Recording was transcribed into text firstly, and then a summary method was used to analyze the qualitative data.Results(1) In Zhejiang province,the proportion of HIV late diagnosis was around 30% from 2010 to 2012. Of the 1223 study individuals,385(31.5%) had a late HIV diagnosis. The characteristics of the late diagnosis cases were (41.8±13.6) years of age,79.2% were male, 60.3% had married,66.5% was junior middle school and below,76.6% had registered inside the province. The most common HIV transmission route was heterosexual transmission, accounted for 67.5%. The blood sample source was dominated by clinical patients, accounted for 59.2%.(2)The other epidemiologic characteristics of the late HIV diagnosis individuals were as follows:71.4% had heard of AIDS before diagnosis, and 55.6% of them knew the proper use of condoms might reduce the spread of AIDS.60.5% of the late diagnosis cases never thought to be infected with HIV.49.9% of them knew where to test HIV before diagnosis. Only 27.3% appeared AIDS related symptoms, and 21% had gone to hospital immediately. 75.3% were worried about discrimination of HIV positive.48.1% estimated the number of HIV infected in every 10,000 people was less than 1.67% had not heard of the "four free and one care" policy before diagnosis.(3) The risk factors of late HIV diagnosis were having HIV-related symptoms before HIV diagnosis(OR=2.809, P<0.001),40 years old and above(OR=2.882, P=0.029), married(OR=1.713, P=0.008), registered inside the province(OR=2.860, P=0.042). The protective factors of late HIV diagnosis were those blood sample source of VCT(OR=0.587, P=0.004) and special investigation (OR=0.248, P=0.002).Conclusion(1)The status of late HIV diagnosis is existent in Zhejiang province, but it’s below the national average level. Having HIV-related symptoms before HIV diagnosis,40 years old and above, married, registered inside the province are the independent risk factors of late HIV diagnosis, so much attention should be given to the HIV cases with this kind to prevent and intervene late HIV diagnosis. The blood sample source of VCT and special investigation were less likely to have late HIV diagnosis, suggesting that offering HIV testing for compulsory detoxification prisoners is beneficial for earlier HIV diagnosis.(2) The measures and strategies for detecting HIV infections earlier are suggested. First, improve the depth and extent of the HIV health education work among the general population, to improve the risk perception of HIV infection. Secondly expand the coverage of VCT and start PITC in hospitals, to let more people perform HIV testing. And then greater efforts need to be made to strengthen the investigation among high-risk groups, to let more high-risk groups to take HIV testing on their own initiative. Finally, it is need to promote notification of HIV-infected persons’spouse/sexual-partner and to strengthen HIV testing for them.