Factors Associated with High-Risk Behaviors among People Newly Diagnosed with HIV Through Heterosexual Contact Before & After Diagnosis in Some Areas in Henan Province

OBJECTIVE:

To understand the factors associated with high risk behaviors among people newly diagnosed to be infected with HIV through heterosexual contact before and after diagnoses in some areas in Henan province, and evaluate the risk of secondary transmission.

METHODS:

A face to face interview was conducted among people infected with HIV through heterosexual contact by using self-designed questionnaires during January-May in 2015.

RESULTS:

Among 361 HIV infected persons, the proportions of those with commercial heterosexual behaviors or sex with irregular sex partners decreased from 77.3%(279/361) and 28.5%(103/361) before diagnosis to 13.6% (49/361) and 2.5%(9/361) after diagnosis, the difference was significant (χ(2)=16.66,P<0.001;χ(2)= 4.80,P=0.03). The subjects surveyed always had more commercial heterosexual behaviors in Henan, Guangdong and Zhejiang provinces before and after diagnosis. After HIV infection confirmation, the condom use rates were 51.0%(25/49) for commercial heterosexual behaviors, 88.5% (184/208) for sex with regular partners and 88.9%(8/9) for sex with irregular partners, respectively. Multivariate logistic regression analysis indicated that risk behaviors associated with HIV transmission included commercial sexual behaviors, previous HIV detection and age of 35 years or older.

CONCLUSIONS:

Extramarital heterosexual behavior has posed serious challenge to the prevention and control of HIV spread. It is necessary to inform the HIV test results, improve the intervention and promote condom use in people with history of commercial sex and people aged ≥35 years.

Purchase full article [Article in Chinese] at:   http://goo.gl/jj3npC

By:  Fan PY1, Bai YJ2, Yang WJ1, Li N1, Sun DY1, Zhu Q1, Wang Z1.

• 1Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
• 2Zhoukou Prefecture Centre for Disease Control and Prevention, Zhoukou 466000, China.
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Mar 10;37(3):367-70. doi: 10.3760/cma.j.issn.0254-6450.2016.03.015. 

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Determinants of Multidrug-Resistant Tuberculosis in Henan Province in China

Background

Multi-drug resistance (MDR) has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. This study described the characteristics and risk factors associated with MDR-TB among 287 cases and 291 controls in Henan province, China.

Methods

A hospital-based case-control study was conducted between June 2012 and December 2013. The study subjects were selected using multistage probability sampling. Multivariate conditional logistic regression models were used to determine the risk factors associated with MDR-TB.

Results

The following risk factors for MDR-TB were identified: previous TB treatment (AOR = 4.51, 95 % CI: 3.55–5.56), male sex (AOR = 1.09, 95 % CI: 0.24–1.88), high school or lower education degree (AOR = 1.87, 95 % CI: 1.27–2.69), unemployment (AOR = 1.30, 95 % CI: 0.78–2.52), long distance of residence from the health facility (AOR = 6.66,95 % CI: 5.92–7.72), smoking (AOR = 2.07, 95 % CI: 1.66–3.19), poor knowledge regarding MDR-TB (AOR = 2.06, 95 % CI: 1.66–2.92), traveling by foot to reach the health facility (AOR = 1.85, 95 % CI: 1.12–3.09), estimated amount of time to reach the health facility was greater than 3 h (AOR = 1.42, 95 % CI: 0.51–2.35), social stigma (AOR = 1.17, 95 % CI: 0.27–2.03), having an opportunistic infection (AOR = 1.45, 95 % CI: 0.58–2.4), more than 3 TB foci in the lungs (AOR = 1.98, 95 % CI: 1.49–3.25), total time of first treatment was more than 8 months (AOR = 1.39, 95 % CI: 0.65–2.54), adverse effects of anti-TB medication (AOR = 2.39, 95 % CI: 1.40–3.26), and more than 3 prior episodes of anti-TB treatment (AOR = 1.83, 95 % CI: 1.26–2.80).

Conclusion

The identified risk factors should be given priority in TB control programs. Additionally, there is a compelling need for better management and control of MDR-TB, particularly through increasing laboratory capacity, regular screening, enhancing drug sensitivity testing, novel MDR-TB drug regimens, and adherence to medication.

Socio-demographic distribution of cases and controls, Henan province, 2013

Variables		Case (287)		Control (291)		Total (578)
		n	%	n	%	n	%
Sex
	Female	58	20.21	89	30.58	147	25.43
	Male	229	79.79	202	69.42	431	74.57
Age (years)
	≤29	39	13.59	29	9.96	68	11.76
	30–59	64	22.3	68	23.37	132	22.84
	≥60	184	64.11	194	66.67	378	65.4
Nationality
	Han Nationality	251	87.34	241	82.75	492	85.12
	Other Nationality	36	12.66	50	17.25	86	14.88
Religion
	Christian	20	7.12	15	5.32	35	6.05
	Muslim	7	2.42	9	2.96	16	2.77
	No religion	260	90.46	267	91.72	527	91.18
Occupation
	Unemployed	182	63.41	151	51.89	333	57.61
	Employed	105	36.59	140	48.11	245	42.39
Education degree
	High school or lower	211	73.52	157	53.95	368	63.67
	University or higher	76	26.48	134	46.05	210	36.33
Marital status
	Married	185	64.57	179	61.39	364	62.98
	Single	76	26.48	72	24.83	148	25.61
	Divorced	20	6.84	31	10.52	51	8.82
	Widowed	6	2.11	9	3.26	15	2.59
Monthly income of the Family (RMB)
	≤3000	231	80.44	228	78.35	459	79.41
	3000–5000	45	15.57	40	13.89	85	14.71
	≥5000	11	3.99	23	7.76	34	5.88
Patient residence
	Rural	197	68.49	175	60.18	372	64.36
	Urban	90	31.51	116	39.82	206	35.64
Family size
	≤3	142	49.32	156	53.74	298	51.56
	≥4	145	50.68	135	46.26	280	48.44

Full article at:   http://goo.gl/pkTWDC

By:  Zhang C1, Wang Y2, Shi G3, Han W4, Zhao H5, Zhang H6, Xi X7.

• 1Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College (http://www.xxmu.edu.cn/english/), No. 88 Jiankang Road, Weihui, 453100, Henan, China. 76406865@qq.com.
• 2Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. hope_liang@163.com.
• 3Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. lq13079587230@163.com.
• 4Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. renyong196847@163.com.
• 5Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. liangqing123@gmail.com.
• 6Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. 2236470894@qq.com.
• 7Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. xixiue@outlook.com. 
• BMC Public Health. 2016 Jan 16;16(1):42. doi: 10.1186/s12889-016-2711-z.

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Comparison of Characteristics & Mortality in Multidrug Resistant (MDR) & Non-MDR Tuberculosis Patients in China

We conducted a cohort study to compare the characteristics of MDR-TB with non-MDR-TB patients and to measure long term (9-year) mortality rate and determine factors associated with death in China.

We reviewed the medical records of 250 TB cases from a 2001 survey to compare 100 MDR-TB patients with 150 non-MDR-TB patients who were treated in 2001-2002. Baseline attributes extracted from the records were compared between the two cohorts and long-term mortality and risk factors were determined at nine-year follow-up in 2010.

Among the 234 patients successfully followed up, 63 (26.9%) were female and 171 (73.1 %) were male. MDR-TB patients had poorer socioeconomic status compared to non-MDRTB. Nine years after the diagnosis of TB, 69 or 29.5 % of the 234 patients had died (32 or 21.6 % of non-MDR-TBversus 37 or 43.0 % of MDR-TB) and the overall mortality rate was 39/1000 per year (PY) (27/1000 PY among non-MDR versus 63/1000 PY among MDR-TB). Factors associated with death included: MDR status (hazard ratio (HR): 1.86; CI: 1.09-3.13), limited education of primary school or lower (HR: 2.51; CI 1.34-4.70) and received TB treatment during the nine-year period (HR 1.82; 95 % CI 1.02-3.26).

MDR-TB was a strong predictor for poor long-term outcome. High quality diagnosis and treatment must be ensured. Greater reimbursement or free treatment may be needed to provide access for the poor and vulnerable populations, and to increase treatment compliance.

Below:  Geographical location of counties surveyed in Henan Province, 2001 and 2010

Below:  Survival analysis estimates of long-term survival based on drug resistance status

Full article at: http://goo.gl/sJPzuI

By: Yanni Sun^1*, David Harley¹, Hassan Vally² and Adrian Sleigh¹

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