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Journal of sexually transmitted diseases 2013年第1期2013卷 674584页

作者： Eleanor Fleming Jared Oremo Katherine O'Connor Aloyce Odhiambo Tun Ye Simon Oswago Clement Zeh Robert Quick Mary L Kamb Centers for Disease Control and Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Office of the Director Office of Health Equity 1600 Clifton Road Mailstop E07 Atlanta GA 30333 USA Division of Applied Sciences Epidemic Intelligence Service Centers for Disease Control and Prevention Scientific Education and Professional Development Program Office Atlanta GA 30333 USA. Safe Water and AIDS Project Kisumu 40100 Kenya. Division of Applied Sciences Epidemic Intelligence Service Centers for Disease Control and Prevention Scientific Education and Professional Development Program Office Atlanta GA 30333 USA Division of Foodborne Waterborne and Environmental Diseases Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Atlanta GA 30333 USA. Centers for Disease Control and Prevention Center for Global Health Office of the Director Atlanta GA 30333 USA. Kenya Medical Research Institute (KEMRI) Kisian 40100 Kenya. Centers for Disease Control and Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Office of the Director Office of Health Equity 1600 Clifton Road Mailstop E07 Atlanta GA 30333 USA.

We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011-February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P < 0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P < 0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging.

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Expansion of China＇s free antiretroviral treatment program

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Chinese Medical Journal 2012年第19期125卷 3514-3521页

作者： ZHAO De-cai WEN Yi MA Ye ZHAO Yan ZHANG Yao WU Ya-song LIU Xia Elizabeth Au LIU Zhong-fu ZHANG Fu-jie Division of Treatment and Care National Center for AIDS/STD Control and Prevention Chinese Center for Diseases Control and Prevention Beijing 100050 China Beijing Ditan Hospital Affiliated to Capital Medical University Beijing 100015 China School of Medicine University of North Carolina Chapel Hill NC 27514 USA School of Medicine Tufts University Boston MA 02155 USA

Background In 2003, China＇s National Free Antiretroviral Treatment Program （NFATP） was initiated as a pilot, which covered only 100 HIV/aids patients. By 2011, the pilot had evolved into a nationwide program and had provided free treatment for over 150 000 patients. The objective of this study was to report and evaluate the progress of China＇s free antiretroviral treatment program. Methods The NFATP Database was systematically reviewed and a total of 150 692 HIV/aids patients were included in this study. Program progress indicators including the number of treated HIV/aids patients, follow-up visit rate, CD4 test rate, and viral load test rate were summarized and examined over a calendar year to evaluate the progress of NFATP quantitatively and qualitatively. Results By the end of 2011, a total of 150 692 HIV/aids patients had been treated through the NFATP and 122 613 of them were still on treatment. Of all patients, about 72% were enrolled during the past four years. The dominant transmission route was blood related in the early phase of the NFATP, but gradually changed to sexual contact. Besides quantitative improvements, progress indicators also demonstrated significant qualitative improvements that the program had made during the past 9 years. Conclusions Great achievement has been made by China＇s NFATP. China＇s experience indicates the importance of a comprehensive response to the success of its treatment program. However, to ensure the quality and sustainability of treatment in the long term, more attention and resources should be paid towards program management.

关键词： China human immunodeficiency virus antiretroviral therapy low-resource setting scale-up

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Trends in diseases reported on US death certificates that mentioned HIV infection, 1996-2006

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Journal of the International Association of Physicians in aids Care 2011年第1期10卷 5-11页

作者： Adih, William K. Selik, Richard M. Xiaohong Hu Division of HIV/AIDS Prevention-Surveillance and Epidemiology National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA United States

Objective: We examined trends during 1996-2006 in diseases reported on death certificates that mentioned HIV infection. Methods: We analyzed multiple-cause mortality data compiled from all US death certificates with any mention of HIV to determine the annual percentages of deaths with various diseases. Results: Deaths reported with HIV during 1996-2006 decreased from 35 340 to 13 750. Standardized percentages of death certificates reporting aids-defining opportunistic infections also decreased: pneumocytosis (6.3% to 5.1%), nontuberculous mycobacteriosis (5.5% to 1.8%), cytomegalovirus (5.7% to 1.2%). Non-Hodgkin's lymphoma rose from 4.8% in 1996 to 6.4% in 1997 and declined to 5.0% in 2001, while Kaposi's sarcoma declined from 3.7% in 1996 to 1.7% in 2001;these aids-defining cancers had stable percentages after 2001. All other cancers increased during 1996-2006 (2.7% to 7.3%). The percentage of deaths with diseases not specifically attributable to HIV increased: liver disease (5.8% to 13.0%), kidney disease (7.9% to 12.0%), and heart disease (4.9% to 10.2%). Conclusion: Among deaths reported with HIV, the percentages reported with HIV-attributable diseases decreased, while the percentages reported with other diseases increased. Consequently, these other life-threatening diseases need more attention in the management of HIV-infected persons. © The Author(s) 2011.

关键词： causes of death death certificates HIV infection mortality

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Epidemiology of HIV among asians and pacific islanders in the united states, 2001-2008

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Journal of the International Association of Physicians in aids Care 2011年第3期10卷 150-159页

作者： Adih, William K. Campsmith, Michael Williams, Cheryl L. Hardnett, Felicia P. Hughes, Denise Division of HIV/AIDS Prevention-Surveillance and Epidemiology National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA 30333 1600 Clifton Road United States Northrop Grumman Information Technology Atlanta GA United States

Background: Recent analyses have shown increases in combined annual HIV diagnosis rates for Asians and Pacific Islanders (API). Methods: Using surveillance data from 33 states and 4 dependent areas we investigated the epidemiology of HIV among API during 2001-2008. Results: HIV diagnoses for API during 2001-2008 were predominantly among persons age 30-39 years (40%) and males (78%). The primary risk factor for males was sexual contact with males (78%) and for females, heterosexual contact (86%). API were the only racial/ethnic groups with a statistically significant estimated annual percentage increase (4.4%) in HIV diagnoses over the time period. Thirty-seven percent of HIV diagnoses among API progressed to aids in <12 months, with significantly greater likelihood among those 30 years and older. Survival was lower among API with aids diagnosis after 49 years of age, and was higher among persons with aids whose primary risk factor for infection was heterosexual contact. Conclusions: In contrast to other racial/ethnic groups, API were the only groups to show a significant increase in HIV diagnoses. A clearer understanding of the reasons for this trend is needed, so that appropriate interventions can be selected and adapted to prevent increased HIV prevalence among API in the U.S. © The Author(s) 2011.

关键词： aids epidemiology HIV Pacific Islanders trends

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Innovative quality-assurance strategies for tuberculosis surveillance in the United States

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Tuberculosis research and treatment 2012年第1期2012卷 481230页

作者： Lilia Ponce Manangan Cheryl Tryon Elvin Magee Roque Miramontes Division of Tuberculosis Elimination National Center for HIV/AIDS Viral Hepatitis STD and Tuberculosis Prevention Centers for Disease Control and Prevention (CDC) Mailstop E-10 1600 Clifton Road Atlanta GA 30033 USA.

Introduction. The Centers for Disease control and prevention (CDC)'s National Tuberculosis Surveillance System (NTSS) is the national repository of tuberculosis (TB) data in the United States. Jurisdictions report to NTSS through the Report of Verified Case of Tuberculosis (RVCT) form that transitioned to a web-based system in 2009. Materials and Methods. To improve RVCT data quality, CDC conducted a quality assurance (QA) needs assessment to develop QA strategies. These include QA components (case detection, data accuracy, completeness, timeliness, data security, and confidentiality); sample tools such as National TB Indicators Project (NTIP) to identify TB case reporting discrepancies; comprehensive training course; resource guide and toolkit. Results and Discussion. During July-September 2011, 73 staff from 34 (57%) of 60 reporting jurisdictions participated in QA training. Participants stated usefulness of sharing jurisdictions' QA methods; 66 (93%) wrote that the QA tools will be effective for their activities. Several jurisdictions reported implementation of QA tools pertinent to their programs. Data showed >8% increase in NTSS and NTIP enrollment through Secure Access Management Services, which monitors system usage, from August 2011-February 2012. Conclusions. Despite challenges imposed by web-based surveillance systems, QA strategies can be developed with innovation and collaboration. These strategies can also be used by other disease programs to ensure high data quality.

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Engaging HIV-infected patients in antiretroviral therapy services： CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China

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Chinese Medical Journal 2011年第10期124卷 1488-1492页

作者： ZHANG Yao LU Lin LI Hui-qin LIU Wei TANG Zhi-rong FANG Hua Jennifer Y. Chen MA Ye ZHAO Yan Ray Y. Chen ZHANG Fu-jie Division of Treatment and Care National Center for AIDS/STD Control and Prevention Chinese Center for Diseases Control and Prevention Beijing 100050 China Yunnan Center for Diseases Control and Prevention Kunrning Yunnan 650022 China Yunnan AIDS Care Center Ktmming Yunnan 650118 China Division of HIV and Sexually Transmitted Disease Guangxi Center of Diseases Control and Prevention Nanning Guangxi 530012 China Outpatient Clinic Provincial Center of Diseases Control and Prevention Nanning Guangxi 530000 China Harvard Medical School Boston USA The Office of Global Research National Institute of Allergy and Infectious Diseases US National Institutes of Health Beijing 100600 China Beijing Ditan Hospital Affiliated to Capital Medical University Beijing 100015 China

Background The initiation and expansion of China＇s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in *** We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and *** Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV *** A total of 83 556 patients were included. Over the study period, 30 635 （37%） of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status,incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were *** Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005-2009. However, a sizable proportion of HIV positive patients still lack CD4testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link

关键词： human immunodeficiency virus CD4 cell count testing care linkage risk factors

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Reply to Hsue et al

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Clinical Infectious Diseases 2011年第1期53卷 96-97页

作者： Mondy, Kristin E. Gottdiener, John Brooks, John T. Washington University School of Medicine St Louis Missouri University of Texas Southwestern Austin Program Central Texas Veterans Healthcare System Austin Texas University of Maryland Baltimore Maryland Centers for Disease Control and Prevention National Center for HIV Hepatitis STD and TB Prevention Division of HIV/AIDS Prevention Atlanta Georgia

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The clinical significance of CD4 counts in asian and caucasian HIV-infected populations: Results from TAHOD and AHOD

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Journal of the International Association of Physicians in aids Care 2011年第3期10卷 160-170页

作者： Achhra, Amit C. Zhou, Jialun Choi, Jun Yong Hoy, Jennifer Zhang, Fujie Templeton, David J. Merati, Tuti Woolley, Ian Petoumenos, Kathy Amin, Janaki National Centre in HIV Epidemiology and Clinical Research Faculty of Medicine UNSW Sydney Australia Division of Infectious Diseases Department of Internal Medicine Yonsei University College of Medicine Seoul South Korea Infectious Diseases Unit Alfred Hospital Monash University Melbourne VIC Australia National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Yunnan China RPA Sexual Health Royal Prince Alfred Hospital Sydney Australia Faculty of Medicine Udayana University Sanglah Hospital Bali Indonesia Infectious Diseases Department Monash Medical Centre Monash University Clayton VIC Australia National Centre in HIV Epidemiology and Clinical Research University of New South Wales Sydney NSW 2052 Australia

The significance of interethnic variation in CD4 counts between Asian and Caucasian populations is not known. Patients on combination antiretroviral therapy from Treat Asia and Australian HIV Observational Databases (TAHOD, predominantly Asian, n = 3356;and AHOD, predominantly Caucasian, n = 2312, respectively) were followed for 23 144 person-years for aids/death and all-cause mortality endpoints. We calculated incidence-rates and used adjusted Cox regression to test for the interaction between cohort (TAHOD/AHOD) and time-updated CD4 count category (lagged by 3 months) for each of the endpoints. There were 382 aids/death events in TAHOD (rate: 4.06, 95%CI: 3.68-4.50) and 305 in AHOD (rate: 2.39, 95%CI: 2.13-2.67), per 100 person-years. At any given CD4 count category, the incidence-rates of endpoints were found to be similar between TAHOD and AHOD (in the adjusted models, P >.05 for the interaction term between cohort type and latest CD4 counts). At any given CD4 count, risk of aids or death was not found to vary by ethnicity, suggesting that the CD4 count thresholds for predicting outcomes defined in Caucasian populations may be equally valid in Asian populations. © The Author(s) 2011.

关键词： Asians Caucasian race CD4 counts cohort analysis ethnicity

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艾滋病早期诊治降低病死率和传播(英文)

艾滋病早期诊治降低病死率和传播(英文)

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中华医学会第五次全国艾滋病、病毒性丙型肝炎暨全国热带病学术会议

作者：张福杰 Marc Bufterys Dr Division of Treatment and Care National Centre for AIDS/STD Control and PreventionChina CDC27 Nanwei RoadBeijing 100027China Global AIDS Program US Centres for Disease Control and PreventionBeijingChina MD

Background Overall HIV mortality rates in China have not been *** this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. Methods We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and *** rates were calculated in terms of person-years,with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment,with risk factors for not receiving treatment identified by use of logistic regression.

关键词： HIV HAART 病毒性丙型肝炎病死率早期诊治

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Partner concurrency and the std/HIV epidemic

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Current Infectious Disease Reports 2010年第2期12卷 134-139页

作者： Aral, Sevgi O. Division of STD Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA 30333 1600 Clifton Road NE Mailstop E-02 United States

Conceptually and theoretically, it is easy to see how short gaps and concurrent partnerships fuel the spread of sexually transmitted infections (STI) and HIV in populations. The consequences of concurrency are bounded by the duration of the infectious period and by the relationships between concurrent partnerships and other dimensions of sexual behavior. Consequently, it is difficult to predict how concurrent partnerships or short gaps may be related to the spread of STI and HIV in a particular epidemiologic context in empirical reality. In recent years, analyses of sexual behavior data collected through nationally representative surveys revealed similar prevalences of concurrent sexual partnerships in Western populations. The association between concurrent sexual partnerships and STI/HIV risk is complicated. At the population level, recent findings suggest that the ecological association between polygyny and HIV prevalence is negative at the country level and at the sub-national level. To address the need for agreed-upon standard definitions and measures of concurrent sexual partnerships, which will facilitate comparisons across time and settings, the Joint United Nations Program on HIV/aids (UNaids) Reference Group on Estimates, Modelling, and Projections convened a meeting in April 2009. The recommendations developed at this meeting include suggestions for a definition, indicators, and measures of concurrency. © The Author(s) 2010.

关键词： aids Concurrency Cuncurrent Gap Multiple sex partners Partnerships Sexual networks Sexual structure std

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