Repeat HIV Testing and Incident Rates among Individuals Attending Voluntary Counseling and Testing Clinics in Wuxi, China： A Retrospective Study

Objective We aimed to elucidate the rates of repeat HIV testing and incident HIV diagnosis, and baseline CD4^＋ T cell count among individuals attending HIV voluntary counseling and testing （VCT） clinics in Wuxi, China. Methods A repeat HIV testing within 12 months was recorded if individuals had their first test with negative results, during 2013-2014 and retested within 12 months. An incident HIV diagnosis was recorded if individuals had their first test with negative results, during 2013-2015 and had a subsequent positive result at any point by the end of 2015. Data on HIV testing and diagnosis among individuals attending 32 VCT clinics from 2013 to 2015 and HIV diagnosis from other clinical services in Wuxi, China, were retrieved. A multivariate logistic regression model was used to analyze factors associated with repeat HIV testing. Cox regression was used to evaluate factors associated with incident HIV diagnosis. Results From 2013 to 2014, 11,504 individuals tested HIV negative at their first recorded test, with 655 （5.7%） retesting within 12 months. Higher repeat HIV testing within 12 months was associated with male gender [adjusted odds ratio （a OR） = 1.7, 95% confidence interval （CI）： 1.4-2.2], risk behaviors [commercial heterosexual behaviors （a OR = 1.4, CI： 1.1-1.6）, male-male sexual behaviors （a OR = 3.7, CI： 2.7-4.9）], injection drug use （a OR = 9.9, CI： 6.5-15.1）, and having taken HIV tests previously （a OR = 2.0, CI： 1.6-2.4）. From 2013 to 2015, 1,088 individuals tested negative on HIV test at their visit and at ≥ 2 subsequent tests; of them 30 had incident HIV diagnosis. The overall rate of incident HIV diagnosis among all VCT individuals was 1.6 （95% CI： 1.1-2.1） per 100 person-years. Incident HIV diagnosis was associated with male gender [adjusted hazard ratio （a HR） = 8.5, 95% CI： 1.9-38.1], attending hospital-based VCT clinics （a HR = 7.8, 95% CI： 1.1-58.3）, and male-male sexual behavior （a HR = 8.4, 95% CI： 1.5-46.7）. Individuals diagnosed at VCT clinics had higher CD4＋ T cell count compared with those diagnosed at other clinical services （median 407 vs. 326 copies/mm3, P = 0.003）. Conclusion VCT individuals in Wuxi, China, had a low repeat HIV testing rate and high HIV incidence. VCT-clinic-based interventions aimed at increasing repeat HIV testing are needed to detect more cases at an earlier stage, especially among individuals at high risk for HIV infection such as men who have sex with men.

Anal cancer screening in women with a history of human papillomavirusrelated lower genital tract cancers:a pilot study

Objectives Women diagnosed with a history of lower genital tract cancer(LGTC)and precancer are at increased risk of anal cancer.Screening for anal cancer in a manner analogous to cervical cancer may detect precursor anal high-grade squamous intraepithelial lesions(HSILs)and prevent progression to cancer.Methods In a pilot study of anal cancer screening,women with previous LGTC and aged≥18 years in Sydney,Australia underwent a digital anorectal examination,anal swab for human papillomavirus(HPV)and p16/Ki67 testing and completeda questionnaire.Participants with positive HPV and/or p16/Ki67 results were referred for a high-resolution anoscopy(HRA)and evaluation of their HSILs.Results Of 52 participants,46 agreed to screening and 6 provided demographic information only.Median age was 46.5 years(IQR:36.059.0).Anal high-risk HPV(HRHPV)was detected in only seven(15.2%)participants(three HPV16).Eight(17.4%)had positive p16/Ki67 dual staining,with invalid results for 25(54.4%).0f 10 women referred for HRA,9 attended and 3 had HSILs,representing 6.5%of the screened population.Questionnaires were completed by 41 participants(89.1%).The majority reported that being screenedwas reassuring(97.5%)and was positive for their health(95.1%).Conclusion This pilot study demonstrated a lower-than-expected prevalence of anal HRHPV.Screening with HRHPV and p16/Ki67 staining identified anal HSILs in 6.5%of screenedwomen.Despitesomediscomfort,screeningwas viewed as beneficial by almost all participants.The utility of p16/Ki67dual staining was low,suggesting it may not be a suitable anal cancer screening methodology.

中国3个城市MSM人群无偿献血行为状况及影响因素分析

目的 了解我国3个城市中MSM人群偿献血行为状况及其影响因素。方法 2017年1－8月在广州、深圳和锡市通过同志社会组织辅助招募MSM研究对象。纳入的研究对象需同时满足的标准：≥18岁男性；与男性发生过肛交或者口交；最近6个月有≥2个同性性伴，或与同性临时性伴发生过保护肛交，或有性传播疾病患病史。通过问卷调查收集研究对象的人口社会学特征、性行为特征和既往献血行为状况等信息，并采集血样检测HIV。结果 共招募研究对象603人，其中广州市302人，深圳市152人，锡市149人，年龄（27.9±7.8）岁。曾经献过血的比例为29.2%（176/603），其中3个城市的献血比例分别为广州市33.1%（100/302）、深圳市27.6%（42/152）和锡市22.8%（34/149），差异统计学意义（χ2=6.421，P=0.093）。多因素logistic回归分析结果显示，最近12个月HIV检测≥2次（比检测1次者，aOR=1.49，95% CI：1.08～2.19）、曾使用过同性恋交友软件（比不使用者，aOR=2.13，95% CI：1.12～4.44）的MSM有更高的比例曾经献过血。结论 献血行为在感染HIV的高危MSM人群中较普遍，应该加强对该人群的献血健康教育工作，以保障临床用血安全。