Analysis Of Late Diagnosis Of HIV/AIDS And Its Influencing Factors In Chongqing

Background:Acquired Immune Deficiency Syndrome(AIDS)has become an important public health problem that seriously threatens public health in China.Late diagnosis(LD)has become an urgent problem in AIDS prevention and control due to its effects on a series of problems such as missed optimal treatment opportunities,increased risk of death,adverse disease control,and higher medical costs.Chongqing is one of the key cities of AIDS epidemic in China.It is important to understand the distribution and factors affecting late diagnosis,and to provide reference for promoting initiative detection and timely detection of infected persons.Objectives:To understand late diagnosis of HIV/AIDS and its relating factors of HIV/AIDS reported in Chongqing from 2012 to 2016.Investigation was done in 4 districts(counties)of Chongqing to analyse late diagnosis of HIV/AIDS,and then countermeasures and suggestions were provided to solve the late diagnosis of HIV/AIDS in Chongqing.Methods:1.Information of HIV/AIDS reported in Chongqing from 2012 to 2016 on the sociodemographic characteristics,infection routes,sample sources,and other sexually transmitted diseases history were collected.Trend chi-square,geographic information system,and univariate analysis and stratified analysis were used for description and preliminary analysis.2.An investigation was conducted on all HIV/AIDS,reported in Chongqing in 2016 that can be followed up in the four districts of Shapingba District,Yubei District,Jiangjin District and Hechuan.Standardized questionnaire was used to collect information such as present testing,previous testing,medical and health service,clinical characteristics,AIDS-related knowledge and cognition,behavioral characteristics,etc.Chi-square test and logistic regression were considered to analyze the factors affecting initiative detection and LD.Results:1.The proportion of late diagnosis in all cases reported in Chongqing between 2012 and 2016 showed a decreased trend(χtrend2=31.85,P<0.001)from 43.11%(1649/3825)to 38.15%(2695/7065).The proportion of LD varied in different areas,it showed higher proportion in Shapingba district,Yuzhong district,Jiangjin district.The proportion of LD were higher in men,older than 50 years old,married,junior high school education and below,preoperative detection,and those who had STDs history.2.Of the 1035 HIV/AIDS investigated,349 cases were late detection,and the proportion of LD was 33.72%.The risk of LD in the group tested was 1.52(95%CI:1.03～2.24)times higher than in initiatively tested.Compare with the control group,the risk of LD in those who had not been tested for STDs before(OR=2.10,95%CI:1.17～3.78)was at high risk of LD.People who had non-commercial hemosexual behavior and not always used condoms in the last six months before testing positive was at high risk of LD compared to who ever had non-commercial hemosexual behavior(OR=1.65,95%CI:1.14-2.41).Compare to people who have been found in VCT,those found in the other sample source(OR=0.28,95%CI:0.19～0.43)was at low risk.3.Of the 1035 HIV/AIDS investigated,23.96%(248/1035)initiatively tested for HIV.HIV/AIDS who were 50 years old below,testing at CDC,with high per-capita income,realization of infection,history of HIV testing and history of male homosexuality were more likely to testing initiatively when compared with 50 years old above,testing at other sources,with low per-capita income,absence of realization of infection,no history of HIV testing and history of hemosexuality,OR value were 2.61(1.60～4.26),2.01(1.33～3.02),13.48(8.69～20.89),2.62(1.38～4.97),3.50(1.97-6.21),1.60(1.04-2.46)respectively.Conclusion and recommendations:The proportion of HIV/AIDS late diagnosis in Chongqing from 2012 to 2016 has generally decreased,but is still higher than the national overall level,and HIV/AIDS testing is still under great pressure.Late diagnosis of HIV/AIDS in Chongqing is related to initiative detection,previous STD examination,characteristics of male homosexual non-commercial sexual behavior,sample sources,etc.It is suggested that the propaganda of initiatively testing should be strengthened,HIV screening in STDs clinics should be carried out,STDs history of patients should be inquired in other clinics,and related HIV testing services should be provided to those who had STDs to promote detection.