HIV And HCV Prevalence Among Entrants To Methadone Maintenance Treatment Clinics In China:a Meta-analysis

Background:Methadone maintenance treatment (MMT) was implemented in China since2004. It was initiated in8pilot clinics and subsequently expanded to738clinics by the end of2011. There have been numerous independent studies documenting the prevalence of HIV or HCV among MMT clients at baseline of their treatment and large variations were commonly observed. This study aims to investigate the geographical and the temporal patterns of HIV and HCV epidemics of MMT patients in China through a systematic review and meta-analysis.Methods:We conducted a systematic review of published peer-reviewed research articles by searching the following databases: PubMed, ChineseScientific Journals Fulltext Database (CQVTP), China National Knowledge Infrastructure (CNKI) and Wanfang Data from2004-2011. Keywords used in the database search included ("Methadone" OR "Methadone Maintenance Treatment" OR "Methadone Maintenance Therapy" OR "Methadone Maintenance") AND ("HIV" OR "AIDS"OR "HCV" OR "hepatitis C virus" OR "co-infection") AND ("China" OR "China Mainland"). Studies were eligible for inclusion should report HIV or HCV prevalence estimates among clients in MMT at baseline of treatment in China, HIV and HCV infection must be diagnosed from laboratory serologic testing and study design such as study site, time period and sample size must be reported. Then taking an analysis for the studies which were eligible for inclusion with the prevalence of HIV, HCV and HIV-HCV con-infection, the geographical distribution and the time distribution.Results:Ninety eligible articles were selected in this review (2in English and88in Chinese), covered19provinces. The median sample size was300and the interquartile range was175-512(sample range38-8662). Nationally, pooled prevalence of HIV-HCV and HIV-HCV co-infection among MMT clients was6.0%(95%CI:4.7%-7.7%),60.1%(95%CI:52.8%-67.0%) and4.6%(95%CI:2.9%-7.2%), respectively. Prevalence in High Transmission Areas for HIV Infection (HTAs) were consistently higher than those in Low Transmission Areas for HIV Infection (LTAs)(HIV:17.5%(95%CI:14.0%-21.6%) vs.2.4%(95%CI:1.6%-3.5%); HCV:70.2%(95%CI:62.6%-76.8%) vs.55.5%(95%CI:46.4%-64.2%); HIV-HCV co-infection:8.0%(95%CI:4.8%-12.9%) vs.2.5%(95%CI:1.4%-4.4%)). Study location is the major contributor of heterogeneities of both HTV and HCV prevalence among drug users in MMT. No significant temporal trend was found in pooled prevalence estimates (HIV:p=0.282-, HCV:p=0.891; HIV-HCV co-infection: p=0.484).Conclusions:The MMT programme in China had a rapid development, but the scale of the programme should be enlarged and more HIV-positive drug users should be recruited in MMT, which can reduce the transmission of HIV. The high prevalence of HCV indicated that it should enhance more intervention for HCV.