High Prevalence of HIV, HCV and Tuberculosis and Associated Risk Behaviours among New Entrants of Methadone Maintenance Treatment Clinics in Guangdong Province, China

<div><p>Background</p><p>Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants.</p> <p>Method</p><p>A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants’ demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections.</p> <p>Results</p><p>Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G²=10.86, <i>p</i>=0.013) and higher proportion of having had sex in the past three months (G²=30.22, <i>p</i><0.001) than their male counterparts. Among injecting drug users, females also inject (χ²=16.15, <i>p</i>=0.001) and share syringes (χ²=13.24, <i>p</i>=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities.</p> <p>Conclusion</p><p>Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.</p> </div

Significant associated factors for TB infections among MMT entrants by multivariate regression analysis.

<p>The figure demonstrates the adjusted odds ratios (together with 95% confidence intervals) of factors that are significant associated with TB infections among MMT entrants. The top dashed line denotes the scale for the continuous variables, whereas the bottom solid line denotes that for categorical variables.</p

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

<div><p>Objectives</p><p>China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.</p><p>Methods</p><p>The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.</p><p>Results</p><p>After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001).</p><p>Conclusions</p><p>This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care.</p></div

Comparison of characteristics among migrants accessing primary care in four types of medical institutions.

<p>Note: THC = Township health center; RHS = Rural health station; CHC = Community health center; CHS = Community health station.</p><p>1RMB = 0.16USD.</p><p>Comparison of characteristics among migrants accessing primary care in four types of medical institutions.</p

Comparison of primary care assessment scores among migrants accessing primary care in four types of medical institutions.

<p>Note: THC = Township health center; RHS = Rural health station; CHC = Community health center; CHS = Community health station.</p><p>Only 60 migrants reported having an experience of referral, the total scores were calculated by summing the mean scores for 9 domains except the Coordination (Referrals) domain.</p><p>ANOVA carried out for unadjusted domain scores and ANCOVA carried out for adjusted domain scores, which were adjusted for age, gender, marital status, level of education, employment status, monthly household income per capita, permanent migration intention, migration with family, times of migration, years of residence in Guangzhou, self-rated health status, chronic disease status, present of health insurance and source of health payment.</p><p>Bonferroni t-test had P<0.008:</p><p>^a THC/RHS vs. CHC/CHS</p><p>^b THC/RHS vs. MH</p><p>^c THC/RHS vs. TH</p><p>^d CHC/CHS vs. MH</p><p>^e CHC/CHS vs. TH</p><p>^f MH vs.TH</p><p>Comparison of primary care assessment scores among migrants accessing primary care in four types of medical institutions.</p

Comparison of primary care assessment scores among migrants with different characteristics.

<p>Note: Only 60 migrants reported having an experience of referral, the total scores were calculated by summing the mean scores for 9 domains except the Coordination (Referrals) domain.</p><p>T-test was used to compare PACT domain scores and total scores by variables.</p><p>***P<0.001</p><p>**P <0.01</p><p>*P<0.05</p><p>1RMB = 0.16USD.</p><p>Comparison of primary care assessment scores among migrants with different characteristics.</p

Additional file 1: Figure S1a. of Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

Causal diagram of MMT clinics, participants and detoxification centers. Figure S1b. Causal diagram of HIV/HCV transmission. Figure S1c. HIV testing and treatment systems causal diagram. Figure S1d. Causal diagrams of HIV and HCV testing and treatment systems. Figure S2a. Stock and flow diagram of MMT clinics, participants and detoxification centers. Figure S2b. Stock and flow diagram of HIV and HCV testing and treatment systems. Figure S2c. Stock and flow diagram of HIV transmission system. Figure S2d. Stock and flow diagram of HCV transmission system. Table S1. Parameters of MMT dynamic model. Table S2. System dynamic equations of the MMT system dynamic model. Table S3. Effectiveness of health education, psychological counseling, contingency management, needle exchange program, condom promotion, ART and HCV treatment. (PDF 1349 kb

Social ecological framework for African migrant patients’ trust of Chinese physicians.

<p>Social ecological framework for African migrant patients’ trust of Chinese physicians.</p

Additional file 1: Figure S1a. of Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

Causal diagram of MMT clinics, participants and detoxification centers. Figure S1b. Causal diagram of HIV/HCV transmission. Figure S1c. HIV testing and treatment systems causal diagram. Figure S1d. Causal diagrams of HIV and HCV testing and treatment systems. Figure S2a. Stock and flow diagram of MMT clinics, participants and detoxification centers. Figure S2b. Stock and flow diagram of HIV and HCV testing and treatment systems. Figure S2c. Stock and flow diagram of HIV transmission system. Figure S2d. Stock and flow diagram of HCV transmission system. Table S1. Parameters of MMT dynamic model. Table S2. System dynamic equations of the MMT system dynamic model. Table S3. Effectiveness of health education, psychological counseling, contingency management, needle exchange program, condom promotion, ART and HCV treatment. (PDF 1349 kb

Geographical location, HIV prevalence and 12-month retention rates of study participants in 14 MMT clinics in Guangdong province in 2013.

<p>Geographical location, HIV prevalence and 12-month retention rates of study participants in 14 MMT clinics in Guangdong province in 2013.</p