Abstract
BackgroundA methadone maintenance treatment (MMT) program to curb the dual epidemics of HIV/AIDS and drug use has been administered by China since 2004. Little is known regarding the geographic heterogeneity of HIV and hepatitis C virus (HCV) infections among MMT clients in the resource-constrained context of Chinese provinces, such as Guangxi. This study aimed to characterize the geographic distribution patterns and co-clustered epidemic factors of HIV, HCV and co-infections at the county level among drug users receiving MMT in Guangxi Zhuang Autonomous Region, located in the southwestern border area of China.MethodsBaseline data on drug users’ demographic, behavioral and biological characteristics in the MMT clinics of Guangxi Zhuang Autonomous Region during the period of March 2004 to December 2014 were obtained from national HIV databases. Residential addresses were entered into a geographical information system (GIS) program and analyzed for spatial clustering of HIV, HCV and co-infections among MMT clients at the county level using geographic autocorrelation analysis and geographic scan statistics.ResultsA total of 31,015 MMT clients were analyzed, and the prevalence of HIV, HCV and co-infections were 13.05%, 72.51% and 11.96% respectively. Both the geographic autocorrelation analysis and geographic scan statistics showed that HIV, HCV and co-infections in Guangxi Zhuang Autonomous Region exhibited significant geographic clustering at the county level, and the Moran’s I values were 0.33, 0.41 and 0.30, respectively (P < 0.05). The most significant high-risk overlapping clusters for these infections were restricted to within a 10.95 km2 radius of each of the 13 locations where P county was the cluster center. These infections also co-clustered with certain characteristics, such as being unmarried, having a primary level of education or below, having used drugs for more than 10 years, and receptive sharing of syringes with others. The high-risk clusters for these characteristics were more likely to reside in the areas surrounding P county.ConclusionsHIV, HCV and co-infections among MMT clients in Guangxi Zhuang Autonomous Region all presented substantial geographic heterogeneity at the county level with a number of overlapping significant clusters. The areas surrounding P county were effective in enrolling high-risk clients in their MMT programs which, in turn, might enable people who inject drugs to inject less, share fewer syringes, and receive referrals for HIV or HCV treatment in a timely manner.
Highlights
A methadone maintenance treatment (MMT) program to curb the dual epidemics of Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and drug use has been administered by China since 2004
The areas surrounding P county were effective in enrolling high-risk clients in their MMT programs which, in turn, might enable people who inject drugs to inject less, share fewer syringes, and receive referrals for HIV or hepatitis C virus (HCV) treatment in a timely manner
Of all MMT clients at baseline, 56.05% (17,383/31,015) had positive urine morphine testing results, 13.05% (4046/31,015) were infected with HIV, 72.51% (22,488/31,015) were infected with HCV, and 11.96% (3708/31,015) were HIV/HCV coinfected
Summary
A methadone maintenance treatment (MMT) program to curb the dual epidemics of HIV/AIDS and drug use has been administered by China since 2004. Methadone maintenance treatment (MMT) programs were first initiated in China as a small pilot project of only eight sites serving 1029 drug users in 2004. Since it has rapidly expanded into a nationwide program covering 738 clinics and serving some 344,254 heroin users by the end of 2011, which accounted for approximately 30% of registered IDUs in China [7, 8]. The MMT program in China is believed to have made impressive progress in HIV infection and drug use among PWID [7] as a result of offering various ancillary services, including testing for HIV, syphilis and HCV, psychosocial support, and referrals for the treatment of HIV, tuberculosis and sexually transmitted diseases
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