HIV and Hepatitis C Virus Testing Delays at Methadone Clinics in Guangdong Province, China

In China, injection drug use is a major transmission route for HIV and hepatitis C virus (HCV) infection. Timely HIV and HCV testing among drug users is vital to earlier diagnosis, linkage to care, and retention. This study aimed to examine HIV and hepatitis C virus (HCV) testing delays at methadone clinics in Guangdong Province, China, and identify individual-level and clinic-level factors associated with delayed testing. Data from 13,270 individuals at 45 methadone clinics in Guangdong were abstracted from a national web-based surveillance database. A two-level binomial logit model was used to examine the association between individual- and clinic-level factors and delayed HIV and HCV testing, defined as receiving a test seven or more days after initial entry into the methadone system. Among 10,046 patients tested for HIV, 1882 (18.7%) had delayed testing; among 10,404 patients tested for HCV, 1542 (14.8%) had delayed testing. Among delayed testers, the median time to HCV testing was significantly longer than the median time to HIV testing (73 vs. 54 days, p<0.05). In the multivariate analysis, the likelihood of delayed HIV testing was higher among individuals with high school or greater education (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 1.02–1.72) and individuals enrolled at clinics with more patients (aOR 1.41, 95% CI 1.05–1.91, for each increase in 100). The likelihood of delayed HCV testing was higher among women (aOR 1.51, 95% CI 1.11–2.06) and employed individuals (aOR 1.21, 95% CI 1.02–1.43). Delayed testing for HIV and HCV is common among patients at methadone clinics in Guangdong, with many patients experiencing delays of two or more months. Structural interventions are needed to expedite testing once individuals enter the methadone maintenance program.

在中国，注射吸毒是人类免疫缺陷病毒（HIV）与丙型肝炎病毒（HCV）感染的主要传播途径。对吸毒人群及时开展HIV与HCV检测，对于实现早诊断、衔接诊疗与维持治疗至关重要。本研究旨在探究中国广东省美沙酮门诊（methadone clinics）中HIV与HCV检测延迟的现状，并识别与检测延迟相关的个体层面及门诊层面影响因素。本研究从全国网络监测数据库中提取了广东省45家美沙酮门诊共计13270名个体的数据。采用两水平二项Logit模型，分析个体及门诊层面因素与检测延迟的关联；检测延迟定义为初次进入美沙酮治疗系统后7天及以上才接受检测。在10046名接受HIV检测的患者中，1882名（18.7%）存在检测延迟；在10404名接受HCV检测的患者中，1542名（14.8%）存在检测延迟。在出现检测延迟的人群中，HCV检测的中位时间显著长于HIV检测（73天 vs. 54天，p<0.05）。多因素分析显示，高中及以上学历个体（调整后比值比[adjusted odds ratio，aOR]=1.32，95%置信区间[confidence interval，CI]=1.02~1.72）以及所在门诊接诊量每增加100名患者的个体（aOR=1.41，95%CI=1.05~1.91）出现HIV检测延迟的风险更高。女性（aOR=1.51，95%CI=1.11~2.06）与在职个体（aOR=1.21，95%CI=1.02~1.43）出现HCV检测延迟的风险更高。广东省美沙酮门诊患者中，HIV与HCV检测延迟现象较为普遍，诸多患者的检测延迟时长可达两个月及以上。需采取结构性干预措施，在患者进入美沙酮维持治疗项目后加快检测流程。