Analysis On Influencing Factors Of HIV New Infection And Discussion On Intervention Models Of The Injection Drug Users In Xinjiang

Objective: The study is to understand incidence status of HIV in Xinjiang,to analyze its influencing factors among injecting drug users(IDUs),to establish a kinetic model based on methadone maintenance treatment and needle exchange intervention for HIV transmission among IDUs,and to explore HIV prevalence among IDUs affected by intervention measures.Methods: From June 2010 to March 2015,we recruited HIV–negative IDUs in 6 regions with high prevalence of HIV infection in Xinjiang for a prospective cohort study.The participants of the study were followed–up every 3 months and were surveyed with a questionnaire interview on drug behavior and HIV antibody test every 6 months.Results: Among a total of 1253 participants,67 HIV infections were identified during the 3 year′s follow–up of 2 416 person years by the end of March 2015 and the incidence rate of HIV infection was 2.77 per 100 person–years.Multivariate Cox proportional hazards regression model analysis revealed higher risk of HIV infection among Uygur IDUs(hazard ratio [HR]= 2.70,95% confidence interval [95% CI]: 1.44 –5.05),IDUs with primary school and lower education(HR = 2.07,95% CI: 1.14–3.76).In contrast to the IDUs having the drug less than one time per week,the IDUs having the drug 1–3,4–6,and ≥ 7 times per week had significantly increased HIV infection risk,with the HRs(95% CI)of 2.16(1.10–4.26),3.03(1.54–5.96),and 4.91(2.47–9.73),respectively.The IDUs sharing needles with others and knowing or not knowing the sharer′s HIV infection status had a significantly increased risk of HIV infection,with the HRs(95%CI)of 2.32(1.34–4.01)and 3.20(1.97–5.18)in comparison with the IDUs not sharing needles with others.In the past 6 months,people who accept sexual partners on the condition of sexual intercourse have a higher risk of infection(HR = 2.49,95%CI: 1.15–5.41).Establish a model of injection drug users based on needle exchange and methadone maintenance therapy,bring the relevant parameters into the basic reproduction number of the model,and get the change of the basic reproduction number under different intervention levels,and estimate the epidemic trend of AIDS among injection drug users.Conclusion: From June 2010 to March 2015,the new HIV infection rate of injection drug users in Xinjiang was 2.77/100 person–years(95%CI: 2.15–3.52),which was lower than that of the same population abroad,but higher than that of injection drug users in high HIV epidemic areas in China during the same period;ethnic origin,educational level,sharing needles or syringes in the past three months,frequency of heroin use in the past one month,and acceptance of partner money under the condition of sexual intercourse in the past six months are the influencing factors of new HIV infection among injection drug users;The two critical points of intervention model,that is,needle exchange coverage rate 57.5% and maintenance rate of Salone maintenance treatment 23.3%,are difficult to achieve,but the two intervention measures can be effectively combined to implement,and then effectively control the development of HIV epidemic among injection drug users in Xinjiang.