Abstract
IntroductionHIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China.MethodsSerial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality.ResultsThe crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable.ConclusionsSerial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.
Highlights
HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain
Almost all sites with drug users (DUs) HIV prevalence higher than 5% were in the provinces of Guangxi, Sichuan, Yunnan and Xinjiang
We found that the men who have sex with men (MSM) population, especially MSM living in large cities, experienced the highest HIV prevalence and incidence from 2010 to 2014 among all key affected populations (KAPs)
Summary
HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China. Conclusions: Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic. Since the 1990s, laboratory-based incidence assays have been developed and introduced into cross-sectional surveys [2Á5], and improvements in methods and algorithms have yielded more reliable estimates of new HIV infections [6,7]. Conducting representative sampling and complicated algorithmic approaches to estimate HIV incidence at a national level is prohibitive for countries with highly concentrated HIV epidemics, such as China [8,9]. The application of these models is limited by the difficulty of defining subpopulations and sub-epidemics in countries with concentrated epidemics and a lack of valid parameter estimates for many resource-limited subnational areas
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