title: Estimating HIV incidence among key affected populations in China from serial cross-sectional surveys in 2010-2014.
abstract: BACKGROUND
  HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China.
  
  
  METHODS
  Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality.
  
  
  RESULTS
  The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable.
  
  
  CONCLUSIONS
  Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Dongmin
authors.initials: D
authors.lastname: Li
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Liyan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Cynthia X
authors.initials: CX
authors.lastname: Shi
authors.affiliation: Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Brookmeyer
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ge
authors.affiliation: Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zhengwei
authors.initials: Z
authors.lastname: Ding
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; wuzy@263.netwuzunyou@chinaaids.cn.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
mesh_terms: D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D060386:Sex Workers; D013997:Time Factors
keywords: HIV; cross-sectional survey; incidence; key affected populations; mortality; prevalence