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During 2015–2019, a total of 3,771,942 HIV/AIDS patients were registered and under supervision, 659,676 of whom were newly diagnosed and 3,112,266 were previously documented (Table 1). Among them, 3,540,831 (93.9%) underwent TB screening using symptom query, including 618,197 (93.7%) among newly diagnosed patients and 2,922,634 (93.9%) among existing patients (χ2=35.89, p<0.01). In the past 5 years, the proportion of patients undergoing TB screening using symptom query decreased from 94.2% to 92.7% (z=–17.94, p<0.01) among newly diagnosed patients and increased from 93.1% to 93.9% (z=15.53, p<0.01) among existing patients. In total, 3,216,466 (85.3%) underwent TB screening using chest x-ray or sputum examination, including 572,544 (86.8%) among newly diagnosed patients and 2,643,922 (85.0%) among existing patients (χ2=1467.49, p<0.01). In the 5 years, the proportion undergoing chest x-ray or sputum examination increased from 82.9% to 89.0% (z=32.40, p<0.01) among newly diagnosed HIV/AIDS patients and increased from 79.0% to 87.8% (z=160.90, p<0.01) among existing patients. Among the HIV/AIDS patients underwent TB screening using any method, 28,694 (0.9%) were diagnosed as TB, including 11,514 (2.0%) among the newly diagnosed patients and 17,180 (0.6%) among existing patients (χ2=9863.31, p<0.01). From 2015 to 2019, TB detection rate among the newly diagnosed HIV/AIDS patients decreased from 2.1% to 1.9% (z=–2.69, p<0.01) and decreased from 0.9% to 0.6% (z=–17.88, p<0.01) among existing patients.
Category Year HIV-positive Symptom screening Chest or sputum testing TB-positive Newly diagnosed 2015 112,264 105,788 (94.2) 93,098 (82.9) 1,981 (2.1) 2016 120,428 113,706 (94.4) 103,073 (85.6) 1,972 (1.9) 2017 133,541 125,106 (93.7) 116,665 (87.4) 2,410 (2.1) 2018 145,122 136,144 (93.8) 127,725 (88.0) 2,706 (2.1) 2019 148,321 137,453 (92.7) 131,983 (89.0) 2,445 (1.9) Subtotal 659,676 618,197 (93.7) 572,544 (86.8) 11,514 (2.0) Follow-up 2015 440,307 409,899 (93.1) 347,645 (79.0) 3,078 (0.9) 2016 524,594 494,264 (94.2) 431,394 (82.2) 2,954 (0.7) 2017 625,097 585,167 (93.6) 521,625 (83.4) 3,192 (0.6) 2018 702,018 663,259 (94.5) 622,815 (88.7) 3,924 (0.6) 2019 820,250 770,045 (93.9) 720,443 (87.8) 4,032 (0.6) Subtotal 3,112,266 2,922,634 (93.9) 2,643,922 (85.0) 17,180 (0.6) Total HIV 2015 552,571 515,687 (93.3) 440,743 (79.8) 5,059 (1.1) 2016 645,022 607,970 (94.3) 534,467 (82.9) 4,926 (0.9) 2017 758,638 710,273 (93.6) 638,290 (84.1) 5,602 (0.9) 2018 847,140 799,403 (94.4) 750,540 (88.6) 6,630 (0.9) 2019 968,571 907,498 (93.7) 852,426 (88.0) 6,477 (0.8) Subtotal 3,771,942 3,540,831 (93.9) 3,216,466 (85.3) 28,694 (0.9) Table 1. TB screening among HIV-positive patients in China, 2015–2019 [n(%)].
Among the 31 PLADs, proportion of TB screening using symptom query ranged 40.7%–99.2%, with a median of 94.2%, and 28 (90.3%) of the PLADs achieved rates ≥90%. Regions with lower proportions of TB screening were mainly in central and western parts of the country (Figure 1A). Prevalence of TB among the HIV/AIDS patients ranged from 0.2%–5.2%, with a median of 0.7%, and 7 (22.6%) of the PLADs had TB prevalence among the HIV/AIDS patients over 1%, including Tibet (5.2%), Qinghai (4.2%), Guangxi (2.2%), Beijing (2.2%), Jiangxi (1.6%), Gansu (1.2%), and Guizhou (1.1%).
Figure 1.Geographical distribution of TB/HIV double screening and anti-TB treatment outcomes for TB/HIV patients in China, 2015–2019. (A) TB screening among HIV/AIDS patients. (B) HIV testing among TB patients. (C) Anti-TB treatment for TB/HIV patients.
From 2015 to 2019, a total of 3,865,549 TB patients were registered in mainland China, among whom 13,446 (0.3%) knew their HIV positive status at the time of diagnosis (Table 2). The proportion of knowing their HIV positive status increased from 0.3% to 0.5% (z=30.87, p<0.01) during the 5-year period. During the same period of time, in total, 2,126,518 (55.0%) TB patients underwent HIV testing, with the proportion increasing from 46.0% to 64.0% (z=252.40, p<0.01). Among TB patients that underwent HIV testing at diagnosis, the HIV positive rate was 0.3%, increasing from 0.2% (z=3.09, p<0.01). Overall, 19,023 (0.9%) of TB patients were found to be positive, including those previously who previously knew their status, with the number increasing over 70%, and the proportion increasing from 0.8% to 1.1% (z=16.29, p<0.01) in the 5-year period.
Year TB registered
individualKnown HIV-positive
statusUnderwent
HIV testingNewly detection
HIV-positive statusHIV-positive 2015 798,098 2,041 (0.3) 366,984 (46.0) 894 (2.4) 2,935 (0.8) 2016 771,841 2,081 (0.3) 394,099 (51.1) 1,013 (2.6) 3,094 (0.8) 2017 774,706 2,330 (0.3) 420,875 (54.3) 1,050 (2.5) 3,380 (0.8) 2018 790,182 3,196 (0.4) 477,255 (60.4) 1,372 (2.9) 4,568 (1.0) 2019 730,722 3,798 (0.5) 467,305 (64.0) 1,248 (2.7) 5,046 (1.1) Total 3,865,549 13,446 (0.3) 2,126,518 (55.0) 5,577 (2.6) 19,023 (0.9) Table 2. HIV screening among TB patients in China, 2015–2019 [n(%)].
Among the 31 PLADs, the proportion of HIV testing among TB patients ranged 8.9%–94.8%, with a median of 52.3% (Figure 1B). Among TB patients that underwent HIV screening, the overall HIV positive proportion ranged 0.1%–2.4%, with a median of 0.5%; 5 (16.1%) PLADs had proportions of HIV-positivity of ≥1%, including Sichuan (2.4%), Guangxi (2.4%), Fujian (1.8%), Chongqing (1.5%), and Yunnan (1.2%).
During 2014–2018, 30,849 TB/HIV patients were registered and enrolled in anti-TB treatment program, of whom 27,033 (87.6%) were successfully treated. For patients with different categories of TB (including resistance to various drugs), the success rates of anti-TB treatment were statistically different (χ2=510.96, p<0.01). Patients with smear negative pulmonary TB had the highest success rate (89.6%), and those with extra-pulmonary TB had the lowest success rate (69.1%). Death (5.4%), either from non-TB or TB, accounted for the highest proportion unsuccessfully treated patients, followed by other reasons (5.0% including response refusal), lost to follow-up (1.2%), and treatment failure (0.8%).
In the 31 PLADs, rates of anti-TB treatment success among TB/HIV patients ranged 53.3%–95.1% with a median of 86.4%; 10 (32.3%) PLADs achieved success rates of ≥90%, but 7 (22.6%) had rates of <80%.
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