title: Screening acute HIV infections among Chinese men who have sex with men from voluntary counseling & testing centers.
abstract: BACKGROUND
  Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.
  
  
  RESULTS
  An open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5-7.9) and 7.1 (95% CI: 5.4-9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.
  
  
  CONCLUSIONS
  The HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.
authors.affiliation: Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Xiaoxu
authors.initials: X
authors.lastname: Han
authors.forename: Junjie
authors.initials: J
authors.lastname: Xu
authors.forename: Zhenxing
authors.initials: Z
authors.lastname: Chu
authors.forename: Di
authors.initials: D
authors.lastname: Dai
authors.forename: Chunming
authors.initials: C
authors.lastname: Lu
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Zhao
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.forename: Yangtao
authors.initials: Y
authors.lastname: Ji
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
mesh_terms: D000208:Acute Disease; D000328:Adult; D044466:Asian People; D002681:China; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003376:Counseling; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D006268:Health Facilities / Q000191:economics; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors