| BackgroundAcquired immune deficiency syndrome(AIDS)is a disease caused by infection of the body with the human immunodeficiency virus(HIV).The world’s first case of AIDS was reported in 1981,and since then cases have been identified in many countries and regions around the world.As the AIDS epidemic expands,so do its risks.The AIDS epidemic not only affects individuals’ health and quality of life,but can also cause social problems and hinder social development.By the end of 2021,approximately 38.4 million people worldwide were infected with HIV,and in 2021,approximately 1.5 million people became newly infected with HIV,and 650,000 people died from AIDS-related illnesses.The burden of AIDS-related diseases is still heavy,and the current situation of AIDS prevention and control is not optimistic.China attaches great importance to AIDS prevention and control work,and has successively issued a series of policies and regulations related to AIDS prevention and control,with a large amount of funds in AIDS prevention and control.The importance,future priorities and requirements of AIDS prevention and control are also clarified in the Outline of the Healthy China 2030 Plan and Health China Action(2019-2030).So far,although China has been effective in AIDS prevention and control,it is still far from the goal of ending the AIDS epidemic by 2030.The burden of AIDS-related diseases remains heavy,and prevention and control efforts continue to face serious challenges.As the capital city of Shandong province,Jinan has a large population and a large number of mobile people.With the economic development and strengthening of AIDS prevention and control in recent years,the number of AIDS surveillance sites and voluntary counseling testing sites in Jinan has been increasing,and the ability to detect people living with HIV/AIDS has been increasing.The reported incidence rate of people living with HIV/AIDS in Jinan from 1992 to 2011 was the highest in Shandong province.The mastery of epidemiological characteristics of people living with HIV/AIDS in Jinan will help to develop precise prevention and control measures for HIV/AIDS and further curb the AIDS epidemic.Early diagnosis of people living with HIV/AIDS is difficult in AIDS prevention and control.Although China has taken a series of measures to expand the scope of HIV testing,the reduction in the percentage of late diagnosis is still not significant.Late diagnosis can affect the time for cases to receive treatment,thus affecting the treatment effect,reducing the quality of patients’ survival,and increasing the risk of HIV transmission.Exploring the trend change in the proportion of late diagnosis of people living with HIV/AIDS and the factors associated with the late diagnosis can help identify cases early and provide a scientific basis for more precise prevention and control measures.Objectives1.To describe the basic characteristics of people living with HIV/AIDS in Jinan,analyze the trend changes of reporting rates and spatial clustering of the AIDS epidemic from 20102021,and provide a scientific basis for clarifying the key areas,rational allocation of resources,and timely adjustment of AIDS prevention and control measures.2.To describe the late diagnosis of people living with HIV/AIDS in Jinan from 2010-2021,explore the trend change in the rate of late diagnosis and clarify the factors associated with late diagnosis,to provide a basis for the adjustment of prevention and control measures and early diagnosis of cases in future work.MethodsThe reported data of people living with HIV/AIDS in this study were obtained from the HIV/AIDS Information System,and the information of ID card number and detailed address were omitted when exporting the information of reported cases,and the current address of reported case was determined based on the code of the current address.People living with HIV/AIDS with current address in Jinan at the time of reporting,final diagnosis,regional category of the local county or other counties in the city or other cities in Shandong province or other provinces,entry time from January 1,2010 to December 31,2021,and case type of clinical diagnosis or laboratory diagnosis were included.Information at the time of case reporting was obtained,mainly including date of birth,sex,date of entry,disease name,date of death,current address code,occupation,marital status,education level,route of infection,history of sexually transmitted diseases,sample source,and first CD4+T-lymphocyte counts.Among them,the age of reported cases was calculated based on the time interval between the date of entry and the date of birth.To describe the information related to people living with HIV/AIDS,the trend changes of reporting rates of all reported cases,people living with HIV,and people living with AIDS were analyzed separately using the Joinpoint regression model,and the spatial autocorrelation was used to analyze the spatial clustering of the number of reported cases.In addition,logistic regression model was used to analyze the factors associated with late diagnosis for reported cases that could be clearly judged based on the definition of late diagnosis.In this study,Excel 2019 and R 4.2.2 software were used for statistical description of information related to reported cases.Joinpoint Regression Program software(version 4.9.1.0)was used to analyze the trend changes in reporting rates.GeoDa 1.14 software was used for spatial autocorrelation analysis,and ArcGIS 10.7 software was used for mapping the reported cases’ spatial distribution maps and visualizing the results of spatial autocorrelation analysis.Results1.A total of 3392 people living with HIV/AIDS were reported in Jinan from 2010 to 2021,including 2523(74.38%)people living with HIV and 869(25.62%)people living with AIDS.Among people living with HIV/AIDS,41.92%were aged 20-29 years old,95.17%were male,45.43%were with household registration in Jinan,96.76%were with Han ethnic group,49.79%were college educated or above,57.25%were unmarried.For occupation,farmers/migrant workers,students,workers,personnel of public institutions and technicians,service workers,and housekeeping and unemployed individuals/retired personnel account for 12.12%,7.69%.7.87%,16.19%,25.09%and 19.96%,respectively.Other or unknown occupations accounted for 11.08%of all reported cases,and cases without a history of sexually transmitted diseases accounted for 84.05%of all reported cases.Of all reported cases,81.99%were infected by homosexual transmission,38.24%and 46.85%were from HIV testing and counseling and medical institutions,respectively,and 47.61%had the first CD4+T-lymphocyte counts of 200499 cells/ul.2.The average annual increase in the reported rate of people living with HIV/AIDS in Jinan from 2010 to 2021 was 14.13%(P<0.001),with an upward trend from 2010 to 2015(APC=33.06%,P=0.001),and a slower upward trend from 2015 to 2021,but the trend change was not statistically significant(APC=0.43%,P=0.862).The trend change in the reported rate of people living with HIV in Jinan from 2010 to 2021 was similar to the overall trend change in the reported rate of all cases,with an average annual increase of 15.08%(P<0.001)in the reported rate of people living with HIV in Jinan from 2010 to 2021,with a significant upward trend from 2010 to 2015(APC=34.94%,P=0.004),with no statistically significant upward trend from 2015 to 2021(APC=0.78%,P=0.807).The average annual rate of people living with AIDS in Jinan increased by 8.71%(P=0.006)from 2010 to 2021,with an upward trend of people living with AIDS from 2010 to 2017(APC=19.30%,P=0.001)and a non-statistically significant decreasing trend from 2017 to 2021(APC=-7.61%,P=0.209).3.The cumulative number of reported cases in different districts(counties)of Jinan varied widely,with more cumulative cases reported in Lixia District,Shizhong District,Tianqiao District,Licheng District,and Huaiyin District.The results of the global spatial autocorrelation analysis showed that the number of reported cases in Jinan from 2010 to 2021 was aggregated at the township(street)level.The results of the local autocorrelation analysis showed that the streets(towns)where the "high-high" clustering areas were located belonged to the districts under the jurisdiction of Lixia District,Licheng District,Tianqiao District,Shizhong District,and Huaiyin District.The range of "high-high" clustering areas does not change much in each year from 2010 to 2021.4.Excluding 30 cases of deaths in which the specific cause of death could not be determined,the total number of late diagnosis among the remaining 3362 cases was 866,with a late diagnosis rate of 25.76%.On this basis,reported cases that could not be classified according to the definition of late diagnosis were excluded,and 3281 reported cases were analyzed for late diagnosis and associated factors.The results showed that there was no statistically significant difference in the proportion of late diagnosis among HIV/AIDS in different years from 2010 to 2021(Z=0.635,P=0.525).The results of multivariable logistic regression analysis of late diagnosis showed that the likelihood of late diagnosis was higher for those aged 30-39 years(aOR=1.811,95%CI:1.060-3.203),40-49 years(aOR=2.616,95%CI:1.475-4.785),greater than or equal to 50 years(aOR=2.422,95%CI:1.342-4.499),with heterosexual transmission as the route of infection(aOR=1.655,95%CI:1.302-2.100),and with the sample source being reported cases from medical institutions(aOR=1.797,95%CI:1.4902.170);The likelihood of late diagnosis was lower for reported cases that were female(aOR=0.611,95%CI:0.402-0.919),whose occupation was a student(aOR=0.426,95%CI:0.245-0.722),service workers(aOR=0.654,95%CI:0.482-0.889),others/unknown(aOR=0.647,95%CI:0.456-0.915),whose household registration was in Shandong province but not in Jinan(aOR=0.788,95%CI:0.648-0.956),and whose sample source was a key population(aOR=0.601,95%CI:0.377-0.926).Conclusions1.Among people living with HIV/AIDS in Jinan,those aged 20-29 years accounted for a relatively high proportion.The majority of people living with HIV/AIDS in Jinan are male,Han ethnic group,unmarried,with a college education and above,and their main route of infection is homosexual transmission.2.The AIDS epidemic in Jinan is at a low epidemic level.The number of cases varies among different districts(counties),with more cumulative reported cases in Lixia District,Licheng District,Shizhong District,Tianqiao District and Huaiyin District.The trend change in the overall reporting rate of people living with HIV/AIDS from 2010-2021 is an increase followed by a fluctuating change.From 2010 to 2021,the "high-high" clustering area of people living with HIV/AIDS in Jinan has not changed much.In general,the streets(towns)where the number of reported cases gathered were located in the areas under the jurisdiction of Lixia District,Licheng District,Shizhong District,Tianqiao District and Huaiyin District,and these areas should be considered as key areas for AIDS prevention and control in the future.3.The proportion of late diagnosis of people living with HIV/AIDS in Jinan fluctuated from 2010 to 2021.The late diagnosis of reported cases was associated with gender,age,occupation,household registration,route of infection,and sample source.In the future,we should increase the publicity and intervention work for high-risk groups,raise the awareness of HIV testing among the population,develop corresponding intervention measures for factors associated with late diagnosis,reduce the proportion of late diagnosis of people living with HIV/AIDS,and promote early diagnosis of high-risk groups. |
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