HIV testing programme data for surveillance purposes: a case study in Guangzhou,China

Background

Timely monitoring of the HIV epidemic among key populations is a formidable challenge. We aimed to compare data collected from an integrated HIV biobehavioural surveillance plus (IBBS+) system and general HIV testing programmes to evaluate whether data from HIV testing programmes are suitable for surveillance purposes.

Methods

The IBBS+ data were collected from HIV sentinel surveillance conducted from 2009 to 2013 between April and July of each year in Guangzhou, China, while HIV testing programme data were collected from the China-Gates HIV Program during the same years from September to December. We evaluated the demographic characteristics, condom use, HIV testing history, and the HIV positive rate among men who have sex with men (MSM) in these two datasets. We used the Armitage-trend test to evaluate the HIV positive rates and behaviours of the participants in the two datasets over the study period.

Findings

2224 MSM were included in the IBBS+ dataset and 5311 were included in the HIV testing programme dataset. Most participants in the two datasets were aged 20–29 years, had at least college-level educational attainment, and had never been married. However, sociodemographic characteristics varied slightly between the two datasets (for example, participants in the testing service sample were younger and more likely to be unmarried). The IBBS+ indicated that MSM HIV prevalence increased from 3·9% in 2009 to 11·4% in 2013 (p_trend<0·0001), while data from the HIV testing programme indicated that the MSM HIV positive rate during the same period increased from 6·2% to 8·9% (p_trend=0·041). Condom use at last anal intercourse remained consistent and comparable between the two datasets throughout the study period, ranging from 65·8% to 71·1% in IBBS+ (p_trend=0·170) and 64·7% to 70·4% in the HIV testing programme (p_trend=0·053).

Interpretation

Routinely collected data from HIV testing programmes seem to complement existing biological and behavioural surveillance systems for HIV in MSM in China. Resource-limited settings without IBBS can consider using HIV testing programmatic data to monitor trends in HIV prevalence and riskier behaviours of key populations.

Funding

National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).