title: Trends in late HIV diagnosis among men who have sex with men in Jiangsu province, China: Results from four consecutive community-based surveys, 2011-2014.
abstract: OBJECTIVE
  To examine trends in HIV testing, late HIV diagnosis and associated factors among men who have sex with men (MSM) in Jiangsu province, China.
  
  
  METHODS
  Four consecutive community-based cross-sectional surveys were conducted among MSM from 2011 to 2014 in eight cities in the province. Participants were recruited from MSM venues and via the internet. HIV bio-behavioral surveys were conducted to collect demographic and behavioral data and measure HIV infection. HIV-infected participants with CD4 counts less than 350 cells/uL were defined as having a late HIV diagnosis. Chi-square trend tests were used to compare temporal changes over the years and multivariable logistic regression analyses were used to identify factors associated with late diagnosis.
  
  
  RESULTS
  A total of 2,441, 2,677, 2,591 and 2,610 participants were enrolled in 2011, 2012, 2013 and 2014, respectively. Testing for HIV in the last 12 months decreased over the time period, from 59.9% to 52.5% (p<0.001). Late HIV diagnosis remained high and steady, ranging from 33.3% to 44.2% over the years with no significant change over time (p = 0.418). MSM who were older than 24 years (aOR = 1.748, p = 0.020 for 25-39 years old; aOR = 3.148, p<0.001 for 40 years old or older), were recruited via internet (aOR = 1.596, p = 0.024), and did not have an HIV test in the past 12 months (aOR = 3.385, p<0.001) were more likely to be late diagnosed.
  
  
  CONCLUSIONS
  Our study showed a plateau in HIV testing among MSM in China, in parallel to high levels of late diagnosis. Emerging and innovative strategies such as HIV self-testing and reaching more MSM by internet, both highly acceptable to MSM in China, may reduce late diagnosis.
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Haiyang
authors.initials: H
authors.lastname: Hu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Hongjing
authors.initials: H
authors.lastname: Yan
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Jinshui
authors.initials: J
authors.lastname: Xu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Qiu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Ling-En
authors.initials: LE
authors.lastname: Shi
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Gengfeng
authors.initials: G
authors.lastname: Fu
authors.affiliation: Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Xiping
authors.initials: X
authors.lastname: Huan
authors.affiliation: Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, California, United States of America.|San Francisco Department of Public Health, San Francisco, California, United States of America.
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.affiliation: Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, California, United States of America.
authors.forename: Chongyi
authors.initials: C
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000639:trends*; D003710:Demography; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult