Key gaps in the HIV cascade of care among men who have sex with men and migrants diagnosed with HIV: findings from a surveillance study in Shanghai |
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| Authors: | Joshua Brian Mendelsohn Hua Cheng Liviana Calzavara Susan Wang Sandra Bullock Sharmistha Mishra Ann Burchell Mona Loutfy Alan Li Robert Hogg Sarah Jane Steele Rahim Moineddin Laiyi Kang |
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| Affiliation: | 1. Pace University, College of Health Professions, New York, United States;2. Shanghai Centers for Disease Control and Prevention, Shanghai, China;3. University of Toronto, Dalla Lana School of Public Health, Toronto, Canada;4. Li Ka Shing Knowledge Institute, St. Michael''s Hospital, Toronto, Canada;5. Division of Infectious Disease, St. Michael''s Hospital, Toronto, Canada;6. Department of Family and Community Medicine, St. Michael''s Hospital, Toronto, Canada;7. Department of Medicine, University of Toronto, Toronto, Canada;8. Women''s College Research Institute, Women''s College Hospital, Toronto, Canada;9. University of Toronto, Toronto, Canada;10. Maple Leaf Clinic, Toronto, Canada;11. Inspiract Consultants, Toronto, Canada;12. Regent Park Community Health Centre, Toronto, Canada;13. Ontario HIV Treatment Network, Toronto, Canada;14. Simon Fraser University, Faculty of Health Sciences, Victoria, Canada;15. BC Centre for Excellence in HIV/AIDS, Vancouver, Canada;p. Médecins Sans Frontières, Capetown, South Africa;q. Department of Family and Community Medicine, University of Toronto, Toronto, Canada;r. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada |
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| Abstract: | BackgroundThere is a growing HIV epidemic among key populations in China, including men who have sex with men (MSM), and rural-to-urban migrants. In Shanghai, new HIV infections among these groups are increasing. In June 2016, a test-and-treat policy was adopted; residents of Shanghai are now offered antiretroviral therapy (ART) immediately after diagnosis. We aimed to clarify the challenges of implementation and the potential impact of the test-and-treat policy by reviewing 10 years of surveillance data prior to the rollout of the test-and-treat programme.MethodsWe used pre-ART and ART surveillance databases from 2006 to 2016 to quantify annual proportions of individuals with newly diagnosed HIV linking to care (the percentage completing the first CD4 test), initiating ART (the percentage starting ART, of those linked to care), and viral suppression (the percentage with a viral load of <50 copies per mL, of those initiating ART).FindingsData were extracted for individuals diagnosed with HIV during the surveillance period (13?637 individuals), including 7267 MSM and 11?156 migrants. Overall, 89% were male, 53% of infections were reported as same-sex transmissions, 69% were under 39 years old, and 27% were married. Averaging across the surveillance period, 77%, 59%, and 26% of MSM, and 66%, 52%, and 27% of migrants were linked to care, had initiated ART, and were virally suppressed, respectively. Proportions virally suppressed did not include 70% of MSM and 68% of migrants with an unknown viral load in the year of HIV diagnosis.InterpretationIn the 10-year period preceding the new test-and-treat policy, gaps were apparent in the proportions of MSM and migrants with HIV who were receiving care, who had commenced ART, and who were virally suppressed. To increase the impact of the test-and-treat programme, the proportion of individuals with newly diagnosed HIV initiating ART in future should exceed the proportion identified here. Viral load tests should be routinely carried out within 1 year of ART initiation. A prospective cohort study has been established to help to explain these gaps by evaluating the test-and-treat programme and modelling its impact on future HIV transmission.FundingCanadian Institutes of Health Research. |
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| Keywords: | Correspondence to: Dr Joshua Mendelsohn College of Health Professions Pace University New York NY 11226 USA |
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