OBJECTIVETo study HIV, HBV and HCV infections in intravenous drug users.

METHODS2025 blood samples from intravenous drug users were collected from Sichuan, Hunan, Guangxi and Xinjiang regions, and tested for anti-HIV, anti-HCV, HBsAg using enzyme-linked immuno-sobent assays (ELISAs).

RESULTSThe positive rates of anti-HIV,anti-HCV and HBsAg were14.7%-30.4%, 60.7%-85.5% and 6.6%-22.4% in the intravenous drug users, respectively. The co-infection rates of HIV/HBV, HIV/HCV, HCV/HBV and HIV/HCV/HBV were 0%-0.4%, 11.6%-27.2%, 2.3%-14.3% and 1.6%-4.8% respectively in this population.

CONCLUSIONThe infection rates of HIV, HBV and HCV were higher in the intravenous drug users than that in general populations in the same regions, and HIV/HCV co-infection appeared most frequent in this population.

China ; epidemiology ; HIV Infections ; epidemiology ; Hepatitis B ; epidemiology ; Hepatitis C ; epidemiology ; Humans ; Prevalence ; Substance Abuse, Intravenous

OBJECTIVETo estimate the number of drug users in Hongjiang, Hunan and to develop strategy for drug reduction in the future.

METHODSTwo capture-recapture methods were used to estimate the numbers of drug addicts. Random stratified sampling survey was used to verify the optimum allocation. The first capture-recapture method (CR1) referred to the number from optimum allocation random stratified sampling survey conducted in the communities and the number from local Public Security Bureau list being the second capture. The second capture-recapture method (CR2) referred to the collection of records in the detoxification unit with an interval of 4 months. The estimated number was calculated under Seber's adjustment formula. Face to face interview was carried out during the optimum allocation random stratified sampling survey process.

RESULTSOf 1388 interviewed in the communities, 24 (1.73%) were identified as drug addicts under the optimum allocation random stratified sampling survey. When the figure 1.73% was applied to the total population (72,709) in Hongjiang, the result yielded an estimation of 1258 drug addicts. The estimated numbers of CR1 and CR2 were 904 and 1069 respectively. However, the number was 1.3 to 1.6 fold higher than the reported number (687) by local Public Security Bureau.

CONCLUSIONThe capture-recapture method seemed a better method in estimating the number of drug addicts.

China ; epidemiology ; Female ; Humans ; Incidence ; Male ; Needle Sharing ; Population Surveillance ; methods ; Substance Abuse, Intravenous ; epidemiology

Adult ; Blood Donors ; China ; epidemiology ; Female ; Herpesviridae Infections ; epidemiology ; transmission ; Herpesvirus 8, Human ; Humans ; Male ; Sarcoma, Kaposi ; epidemiology ; virology ; Substance Abuse, Intravenous ; virology

OBJECTIVETo understand the HIV epidemic and its correlation among the community-based drug users in Dongguan, Guangdong province.

METHODSIn 2008, 13 drug users were identified as seeds in Dongguan. Respondent driven sampling was applied to recruit community-based drug users. A structured questionnaire was used for a face to face interview. Intravenous blood samples were collected for the measurement of HIV, HCV and syphilis antibodies. RDS analysis tool (RDSAT) was applied for adjusting the estimates and bivariate analysis.

RESULTSA total of 303 drug users were recruited within 15 weeks and 300 blood samples were collected. After RDSAT adjustment, the prevalence rates of HIV, HCV and syphilis were 14.7% (95%CI: 6.1% - 25.4%), 63.2% (95%CI: 55.7% - 71.7%), and 4.7% (95%CI: 1.8% - 8.2%) respectively. The HIV prevalence rates among those who were HCV seropositive, migration, younger than 26 years at their first drug use, and ever shared needles or syringes were 22.9% (95%CI: 10.8% - 37.0%), 26.9% (95% CI: 11.4% - 44.9%), 19.9% (95%CI: 8.3% - 35.7%), and 29.1% (95%CI: 12.3% - 45.1%) respectively. The proportions of the drug users who were enrolled at methadone maintenance treatment (MMT) of local residency, migration were 20.9% (95%CI: 4.1% - 44.6%), 2.3% (95%CI: 0.0% - 7.0%) respectively.

CONCLUSIONThe HIV epidemic among the community-based drug users in Dongguan is serious. Drug users who are HCV seropositive, migration, younger than 26 years at their first drug use, and ever shared needles or syringes are more likely to be HIV seropositive.

Adolescent ; Adult ; China ; epidemiology ; Drug Users ; Female ; HIV Infections ; epidemiology ; Homosexuality, Male ; Humans ; Male ; Middle Aged ; Prevalence ; Risk-Taking ; Substance Abuse, Intravenous ; epidemiology ; Unsafe Sex ; Young Adult

Adult ; China ; epidemiology ; Circoviridae Infections ; epidemiology ; virology ; DNA, Viral ; analysis ; Female ; Genotype ; Hepatitis, Viral, Human ; virology ; Humans ; Male ; Substance Abuse, Intravenous ; virology ; Torque teno virus ; genetics ; isolation & purification

OBJECTIVETo investigate prevalence of human immunodeficiency virus (HIV) infection and risk factors for its transmission among injection drug users (IDUs) in Liangshan Yizu Autonomous Prefecture of Sichuan Province, China.

METHODSA community-based survey was conducted to investigate demographic characteristics, pattern and frequency of sharing injection equipment, and sexual behaviors in IDUs. Blood samples were also collected from them to detect for antibodies against HIV and syphilis.

RESULTSA total of 379 subjects were recruited with informed consent for study through community outreach and peer recruiting methods. Their prevalence of HIV infection was 11.3% (43/379). Ethnicity, frequency of sharing syringes and cotton swab during the past three months and syphilis infection associated with HIV infection by univariate analysis using chi-square test. Multivariate logistic regression analysis showed odds ratio of frequency of sharing syringes for HIV infection during the past three months was 2.28 (95% CI 1.18 - 4.43), and that for syphilis infection 3.10 (95% CI 1.48 - 6.48).

CONCLUSIONFrequency of sharing syringes during the past three months associated with syphilis and HIV infection.

Adolescent ; Adult ; China ; epidemiology ; Disease Transmission, Infectious ; Female ; HIV Infections ; epidemiology ; transmission ; Humans ; Logistic Models ; Male ; Needle Sharing ; adverse effects ; Prevalence ; Sexual Behavior ; Substance Abuse, Intravenous ; virology

INTRODUCTION: Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. METHODS: All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. RESULTS: 351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. CONCLUSION PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.
Antiviral Agents/therapeutic use* ; Halfway Houses ; Hepacivirus/genetics* ; Hepatitis C/epidemiology* ; Humans ; Pilot Projects ; Point-of-Care Systems ; RNA ; Referral and Consultation ; Substance Abuse, Intravenous/epidemiology*

Objective: To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT). Methods: A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region. The questionnaires information included demographic characteristics, HIV and HCV infection status, history of drug abuse, urine test for morphine, high risk sex behaviors, needle sharing, dropped out etc. Methods of χ(2) test one-way, multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection. Results: The study subjects included 750 participants, 18.31% (127/691) of patients were co-infected with HIV and HCV. The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84% (81/226) and 19.88% (64/322) respectively, which were higher than those who have never shared needles or dropped out (9.89%, 46/465 and 17.07%, 63/369). Logistic regression analysis results showed that after adjusted for confounding factors, patients who shared needles (OR=4.50, 95%CI: 2.72-7.43) and dropped out of treatment (OR=1.71, 95%CI: 1.04-2.80) were more likely to be infected with HIV/HCV. Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21, AP=0.44, SI=1.95). Conclusions: Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection. Health education, psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.
China/epidemiology* ; Coinfection/epidemiology* ; Female ; HIV Infections/epidemiology* ; Hepatitis C/diagnosis* ; Humans ; Logistic Models ; Male ; Methadone/therapeutic use* ; Morphine ; Needle Sharing ; Opiate Substitution Treatment ; Prevalence ; Risk Factors ; Sexual Behavior ; Substance Abuse, Intravenous/drug therapy* ; Substance-Related Disorders

OBJECTIVETo study the mortality among injecting drug users (IDUs) from an IDUs cohort in Liangshan of Sichuan province.

METHODSIn November 2002, 376 injecting drug users were recruited and followed up for 1 year as part of a prospective cohort study. Socio-demographics and risk behaviors on drug use were recorded. After one year, the mortality rate was estimated and risk factors for mortality were analyzed using Cox regression.

RESULTSOut of the original cohort of 376 participants, there were 28 reported and confirmed deaths during the one year follow-up period. The mortality rate of the cohort was 77.32 per 1000 person-years (95% CI: 48.68 - 105.95) with the standardized mortality ratio (SMR) as 47.62 (95% CI: 31.63 - 68.71). Out of the 28 deaths, 64.3% (18/28) caused by overdoses of drug. No variables were found to be associated with death of all causes, but being un-married and >or= 9 year history of injecting drugs were found to be associated with overdose-related mortality in the final model of Cox regression. The hazard ratios were 4.51 (95% CI: 1.03 - 19.67) and 2.77 (95% CI: 1.10 - 7.00) respectively.

CONCLUSIONOverdose served the most frequent cause of deaths in Liangshan of Sichuan province. Future studies should be conducted to focus on mortality and risk factors associated with mortality among IDUs to provide targeted interventions in reducing unnatural mortality.

Adult ; Cause of Death ; China ; epidemiology ; Cohort Studies ; Female ; Heroin Dependence ; mortality ; Humans ; Male ; Prospective Studies ; Risk Factors ; Substance Abuse, Intravenous ; mortality

OBJECTIVETo understand epidemiologic characteristics and changes in epidemic trend of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) in different areas and populations of Yunnan Province.

METHODSSeroepidemiological studies were conducted in injection drug users (IDUs), women sex workers, whoring goers, patients with sexually transmitted disease (STD), patients with tuberculosis, pregnant women and blood donors with sentinel surveillance, ad hoc investigations, regular case-finding and data collection during 1989 to 2003 in Yunnan Province.

RESULTSRelatively high prevalence of HIV/AIDS was firstly found in IDUs from border areas of the province in 1989. By December of 2003, totally 14 905 cases with HIV infection were reported in 121 counties of 16 prefectures in Yunnan Province. Prevalence of HIV infection ranged from 21.2% to 27.8% in IDUs, over 40% in IDUs from six areas, and 1.23% to 6.67% and 0.3% to 1.8% in underground prostitutes and whoring goers, respectively. Prevalence of HIV infection was 2.1% to 2.7%, 10.8% in specific areas, in male patients with STD, and was 0.14% to 0.25% in pregnant women during 1993 to 2002 and increased to 0.37% in 2003. Prevalence of HIV infection ranged 1.5% to 1.6% in patients with tuberculosis and 0.01% in blood donors during 1999 to 2000 and increased to 0.07% in 2003.

CONCLUSIONSEpidemic of HIV infection began in late 1980s in Yunnan, then spread from border areas to inland through IDUs, maintaining a higher prevalence in them to date. Sexual transmission of HIV/AIDS showed an increasing trend in them, with a low prevalence in general population, but appeared a wide spread in local areas.

Acquired Immunodeficiency Syndrome ; epidemiology ; Adult ; China ; epidemiology ; Female ; HIV Infections ; epidemiology ; HIV Seroprevalence ; HIV-1 ; Humans ; Male ; Prevalence ; Risk-Taking ; Sentinel Surveillance ; Sexually Transmitted Diseases ; epidemiology ; Substance Abuse, Intravenous ; complications ; epidemiology ; Surveys and Questionnaires