Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 22, 2022
Open Peer Review Period: Apr 20, 2022 - May 4, 2022
Date Accepted: Nov 29, 2022
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
HIV epidemiology, care, and treatment outcomes among student and non-student youths living with HIV in southwest China between 1996 and 2019
ABSTRACT
Background:
Nearly one-third of HIV new infections occurred among youths in 2019 worldwide. Previous studies suggested that student-youths (SYLWH) and non-student-youths (NSYLWH) might differ in some risk factors, transmission route, HIV care, and disease outcomes.
Objective:
This study aimed to compare HIV epidemic, disease outcomes, and access to care among SYLWH and NSYLWH living with HIV aged 16 to 25 years in Guangxi, China.
Methods:
This historical cohort study extracted data of all HIV/AIDS cases aged 16 to 25 years in Guangxi, China during 1996-2019 from two national surveillance databases. We conducted analyses to assess possible differences in demographic and behavioral characteristics, HIV care, and disease outcomes between SYLWH and NSYLWH. Multivariate COX regression and logistic regression were used to assess differences in mortality and virologic failure between SYLWH and NSYLWH.
Results:
A total of 13,839 youths aged 16 to 25 years were infected with HIV during 1996-2019. Of them, 10,202 cases were infected through sexual contact, 54% were men, 8.5% were students and 91.5% were not students. SYLWH were mainly infected through homosexual contact (70.7% vs. 15.5%, P<.001), while NSYLWH were more likely to be infected through heterosexual contact (84.5% vs. 29.3%; P<.001). Moreover, NSYLWH had a lower CD4 count than student youths at HIV diagnosis (332 vs. 362 cells/μL, P<.001). Also, NSYLWH had delayed antiretroviral therapy (ART) initiation than SYLWH (93 days vs. 22 days; P<.001). Furthermore, the mortality rate was 0.4 and 1.0 deaths per 100 years for SYLWH and NSYLWH, respectively. NSYLWH’s mortality risk was 2.3 times compared toSYLWH(adjusted hazard ratio [AHR], 2.3; 95% confidence interval [CI], 1.2–4.2 P=.008).
Conclusions:
NSYLWH might face low CD4 count at an HIV diagnosis, delayed ART initiation, and increased likelihood of death. HIV prevention and interventions must target youths who dropped out from school early to encourage safe sex and HIV screening, remove barriers to HIV care, and promote early ART to further curb HIV epidemic among youths.
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