Evaluating the time of HIV infection, diagnosis and treatment delays based on HIV notification data in Northwest China, 2008–19
Rui Zhao
A # , Hailan Zhang B # , Xin Zhao B , Tianyi Zhuang B , Christopher K. Fairley A C D , Jason J. Ong A C E , Shiyi He A , Lu Bai A , Jane Hocking A F , Lei Zhang A C D G * , Xiaoli Wei B * and Guihua Zhuang A *
+ Author Affiliations
- Author Affiliations
A China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi, P. R. China.
B Xi’an Center for Disease Control and Prevention, Xi’an 710054, Shaanxi, P. R. China.
C Melbourne Sexual Health Centre, Melbourne, Vic., Australia.
D Central Clinical School, Alfred Hospital, Monash University, Melbourne, Vic., Australia.
E Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
F Sexual Health Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Vic., Australia.
G Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, P. R. China.
# These authors contributed equally to this paper
Handling Editor: Ligang Yang
Sexual Health 19(6) 556-565 https://doi.org/10.1071/SH22046
Submitted: 17 March 2022 Accepted: 29 August 2022 Published: 29 September 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Timely diagnosis and treatment are crucial for reducing HIV transmission; therefore, estimating the time from HIV infection to antiretroviral therapy (ART) initiation becomes particularly important for people living with HIV.
Methods: We used a well-characterised CD4 depletion model to estimate the time from HIV infection to initiation of ART and the rate of delayed HIV diagnosis (infection to diagnosis >1 year) and treatment initiation (diagnosis to treatment >1 year), based on HIV notification data for adults (aged ≥18 years) in Xi’an city, China, during 2008–19.
Results: Overall, 7402 reported HIV diagnoses were included. We estimated more than two-thirds of HIV infections remained undiagnosed (66.1%, 9489/14 345). The estimated proportion of HIV diagnoses that were delayed (>1 year) was 80.3% (5941/7402) during 2008–19, and it increased from 72.7% (32/44) in 2008 to 83.5% (908/1088) in 2019. In contrast, the proportion of cases with delayed treatment (>1 year) was 13.1% (971/7402) during 2008–19, and it reduced from 75.0% (33/44) in 2008 to 1.5% (16/1088) in 2019. The estimated median time from HIV infection to diagnosis increased from 5.05 (IQR, 0.27–8.15) years to 5.81 (IQR, 2.31–10.28) years, whereas the time from diagnosis to ART initiation reduced from 3.06 (IQR, 1.01–5.20) years in 2008 to 0.07 (IQR, 0.04–0.12) year in 2019.
Conclusions: Early treatment after diagnosis has significantly improved, but timely diagnosis of HIV infections may still require further improvement. The estimated proportion of undiagnosed HIV cases remains high in 2019 in Xi’an city and is likely to impede effective control.
Keywords: CD4, China, delay, diagnosis, HIV, infection, mathematic model, treatment.
References
[1] Assefa Y, Gilks CF. Ending the epidemic of HIV/AIDS by 2030: will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries? Int J Infect Dis 2020; 100 273–7.| Ending the epidemic of HIV/AIDS by 2030: will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries?Crossref | GoogleScholarGoogle Scholar |
[2] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.
| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[3] Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS 2012; 26 893–6.
| HIV transmission rates from persons living with HIV who are aware and unaware of their infection.Crossref | GoogleScholarGoogle Scholar |
[4] Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 373 795–807.
[5] Zhang X, Wang N, Vermund SH, Zou H, Li X, Zhang F, et al. Interventions to improve the HIV continuum of care in China. Curr HIV/AIDS Rep 2019; 16 448–57.
| Interventions to improve the HIV continuum of care in China.Crossref | GoogleScholarGoogle Scholar |
[6] Sun X, Lu F, Wu Z, Poundstone K, Zeng G, Xu P, et al. Evolution of information-driven HIV/AIDS policies in China. Int J Epidemiol 2010; 39 ii4–13.
| Evolution of information-driven HIV/AIDS policies in China.Crossref | GoogleScholarGoogle Scholar |
[7] World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2nd edn. Geneva: World Health Organization; 2016.
[8] General Office of National Health and Family Planning Commission PC. Notice of the General Office of the National Health and Family Planning Commission on adjusting the standard of free antiviral treatment for HIV/AIDS. 2016. Available at http://www.gov.cn/xinwen/2016-06/15/content_5082505.htm
[9] Zhang F, Ma Y. Progress and challenges in China’s free ART programme. Lancet HIV 2019; 6 e8–9.
| Progress and challenges in China’s free ART programme.Crossref | GoogleScholarGoogle Scholar |
[10] National Center for AIDS/STD Control and Prevention China CDC. National HIV/syphilis /HCV sentinel surveillance report in 2018. Beijing: National Center for AIDS/STD Control and Prevention China CDC; 2019.
[11] UNAIDS. UNAIDS data 2020. 2020. Available at https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf
[12] UNAIDS. UNAIDS data 2019. 2019. Available at https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf
[13] Nash D, Robertson M. How to evolve the response to the global HIV epidemic with new metrics and targets based on pre-treatment CD4 counts. Curr HIV/AIDS Rep 2019; 16 304–13.
| How to evolve the response to the global HIV epidemic with new metrics and targets based on pre-treatment CD4 counts.Crossref | GoogleScholarGoogle Scholar |
[14] Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching D4+ cell count thresholds <200, <350, and <500 cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis 2011; 53 817–25.
| Time from human immunodeficiency virus seroconversion to reaching D4+ cell count thresholds <200, <350, and <500 cells/mm3: assessment of need following changes in treatment guidelines.Crossref | GoogleScholarGoogle Scholar |
[15] Touloumi G, Pantazis N, Pillay D, Paraskevis D, Chaix M-L, Bucher HC, et al. Impact of HIV-1 subtype on CD4 count at HIV seroconversion, rate of decline, and viral load set point in European seroconverter cohorts. Clin Infect Dis 2013; 56 888–97.
| Impact of HIV-1 subtype on CD4 count at HIV seroconversion, rate of decline, and viral load set point in European seroconverter cohorts.Crossref | GoogleScholarGoogle Scholar |
[16] Fauci AS, Pantaleo G, Stanley S, Weissman D. Immunopathogenic mechanisms of HIV infection. Ann Intern Med 1996; 124 654–63.
| Immunopathogenic mechanisms of HIV infection.Crossref | GoogleScholarGoogle Scholar |
[17] CASCADE Collaboration Changes in the uptake of antiretroviral therapy and survival in people with known duration of HIV infection in Europe: results from CASCADE. HIV Med 2000; 1 224–31.
| Changes in the uptake of antiretroviral therapy and survival in people with known duration of HIV infection in Europe: results from CASCADE.Crossref | GoogleScholarGoogle Scholar |
[18] Song R, Hall HI, Green TA, Szwarcwald CL, Pantazis N. Using CD4 data to estimate HIV incidence, prevalence, and percent of undiagnosed infections in the United States. J Acquir Immune Defic Syndr 2017; 74 3–9.
| Using CD4 data to estimate HIV incidence, prevalence, and percent of undiagnosed infections in the United States.Crossref | GoogleScholarGoogle Scholar |
[19] Lima VD, Wang L, Sereda P, McLinden T, Barrios R, Montaner JSG. Estimation of time of HIV seroconversion using a modified CD4 depletion model. PLoS ONE 2021; 16 e0246135
| Estimation of time of HIV seroconversion using a modified CD4 depletion model.Crossref | GoogleScholarGoogle Scholar |
[20] Nacher M, Adenis A, Huber F, Hallet E, Abboud P, Mosnier E, et al. Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: strategic information to reduce the proportion of undiagnosed infections. PLoS ONE 2018; 13 e0199267
| Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: strategic information to reduce the proportion of undiagnosed infections.Crossref | GoogleScholarGoogle Scholar |
[21] Robertson MM, Braunstein SL, Hoover DR, Li S, Nash D. Estimates of the time from seroconversion to antiretroviral therapy initiation among people newly diagnosed with human immunodeficiency virus from 2006 to 2015, New York City. Clin Infect Dis 2019; 71 e308–15.
| Estimates of the time from seroconversion to antiretroviral therapy initiation among people newly diagnosed with human immunodeficiency virus from 2006 to 2015, New York City.Crossref | GoogleScholarGoogle Scholar |
[22] Song R, Green TA. An improved approach to accounting for reporting delay in case surveillance systems. JP J Biostat 2012; 7 1–14.
[23] Li AH, Jiang Z, Duan S, Zhao Y, Wu ZY. Estimation of HIV diagnosis rate with CD4(+) T-lymphocyte level and infected-time model in Dehong Prefecture, Yunnan Province. Zhonghua yu fang yi xue za zhi [Chin J Prev Med] 2018; 52 833–6.
[24] Zun-You WU. HIV/AIDS prevention strategy with Chinese characteristics. Chin J Dis Control Prev 2019; 23 885–9.
[25] Ong JJ, Peng MH, Wong WW, Lo Y-R, Kidd MR, Roland M, et al. Opportunities and barriers for providing HIV testing through community health centers in mainland China: a nationwide cross-sectional survey. BMC Infect Dis 2019; 19 1054
| Opportunities and barriers for providing HIV testing through community health centers in mainland China: a nationwide cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[26] Zhang C, Li X, Heilemann MV, Chen X, Wang H, Koniak-Griffin D. Facilitators and barriers of HIV self-testing among Chinese men who have sex with men: a qualitative study. J Assoc Nurses AIDS Care 2021; 32 599–609.
| Facilitators and barriers of HIV self-testing among Chinese men who have sex with men: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[27] Yang Y, Wang J, Lin F, Zhang T, Yu F, Zhao Y, et al. Stigma against HIV/AIDS among female sex workers and general migrant women in eastern China. BMC Women’s Health 2015; 15 2
| Stigma against HIV/AIDS among female sex workers and general migrant women in eastern China.Crossref | GoogleScholarGoogle Scholar |
[28] Dailey AF, Hoots BE, Hall HI, Song R, Hayes D, Fulton P, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays — United States. MMWR Morb Mortal Wkly Rep 2017; 66 1300–6.
| Vital signs: human immunodeficiency virus testing and diagnosis delays — United States.Crossref | GoogleScholarGoogle Scholar |
[29] Zhang L, Zou X, Xu Y, Medland N, Deng L, Liu Y, et al. The decade-long Chinese methadone maintenance therapy yields large population and economic benefits for drug users in reducing harm, HIV and HCV disease burden. Front Public Health 2019; 7 327
| The decade-long Chinese methadone maintenance therapy yields large population and economic benefits for drug users in reducing harm, HIV and HCV disease burden.Crossref | GoogleScholarGoogle Scholar |
[30] Yin W, Hao Y, Sun X, Gong X, Li F, Li J, et al. Scaling up the national methadone maintenance treatment program in China: achievements and challenges. Int J Epidemiol 2010; 39 ii29–37.
| Scaling up the national methadone maintenance treatment program in China: achievements and challenges.Crossref | GoogleScholarGoogle Scholar |
[31] Zunyou W. HIV/AIDS prevention strategy with Chinese characteristics. Chin J Dis Control Prev 2019; 23 885–9.
[32] Zhang F, Dou Z, Ma Y, Zhang Y, Zhao Y, Zhao D, et al. Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study. Lancet Infect Dis 2011; 11 516–24.
| Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study.Crossref | GoogleScholarGoogle Scholar |
[33] Jia Z, Mao Y, Zhang F, Ruan Y, Ma Y, Li J, et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study. Lancet 2013; 382 1195–203.
| Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study.Crossref | GoogleScholarGoogle Scholar |
[34] Zhao Y, Wu Z, McGoogan JM, Shi CX, Li A, Dou Z, et al. Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: a nationwide, retrospective cohort study. Clin Infect Dis 2018; 66 727–34.
| Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: a nationwide, retrospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[35] Degenhardt L, Mathers BM, Wirtz AL, Wolfe D, Kamarulzaman A, Carrieri MP, et al. What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries. Int J Drug Policy 2014; 25 53–60.
| What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries.Crossref | GoogleScholarGoogle Scholar |
[36] Petersen Z, Myers B, van Hout M-C, Plüddemann A, Parry C. Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries. Harm Reduct J 2013; 10 13
| Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries.Crossref | GoogleScholarGoogle Scholar |
[37] Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet 2010; 376 355–66.
| Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward.Crossref | GoogleScholarGoogle Scholar |
[38] Montaner JSG, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 2006; 368 531–6.
| The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic.Crossref | GoogleScholarGoogle Scholar |
[39] Zang X, Tang H, Min JE, Gu D, Montaner JSG, Wu Z, et al. Cost-effectiveness of the ‘One4All’ HIV linkage intervention in Guangxi Zhuang Autonomous Region, China. PLoS ONE 2016; 11 e0167308
| Cost-effectiveness of the ‘One4All’ HIV linkage intervention in Guangxi Zhuang Autonomous Region, China.Crossref | GoogleScholarGoogle Scholar |
[40] Brazier E, Maruri F, Duda SN, Tymejczyk O, Wester CW, Somi G, et al. Implementation of “Treat-all” at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey. J Int AIDS Soc 2019; 22 e25331
| Implementation of “Treat-all” at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey.Crossref | GoogleScholarGoogle Scholar |
