HIV prevalence in China: integration of surveillance data and a systematic review

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• 作者：Lei Zhang ; Eric P F Chow ; Jun Jing ; Xun Zhuang ; Xiaoshan Li ; Meiqi He ; Huamin Sun ; Xiaoyan Li ; Marelize Gorgens ; David Wilson ; Lan Wang ; Wei Guo ; Dongming Li ; Yan Cui ; Lu Wang ; Ning Wang ; Zunyou Wu ; David P Wilson
• 刊名：The Lancet Infectious Diseases
• 出版年：November, 2013
• 年：2013
• 卷：13
• 期：11
• 页码：955-963
• 全文大小：1502 K

文摘

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Summary

Background

Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period.

Methods

We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year.

Findings

Of 6850 articles identified by the search strategy, 821 studies (384鈥?83 drug users, 52鈥?56 injecting drug users, 186鈥?88 female sex workers, and 87鈥?34 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9路08% (95% CI 8路04-10路52) in injecting drug users and 0路36% (0路12-0路71) in female sex workers, whereas incidence in both populations stabilised at rates of 0路57 (0路43-0路72) and 0路02 (0路01-0路04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1路77% (1路26-2路57) in 2000, to 5路98% (4路43-8路18) in 2010, with a national incidence of 0路98 (0路70-1路25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations.

Interpretation

HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission.

Funding

The World Bank Group, the Australian Research Council, the University of New South Wales, and Chinese Center for Disease Control and Prevention.