Guangzhou, China
Guangzhou, China

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McLaughlin M.M.,Sun Yat Sen University | Simonson L.,Sun Yat Sen University | Zou X.,Sun Yat Sen University | Ling L.,Sun Yat Sen University | Tucker J.D.,UNC Project China
PLoS ONE | Year: 2015

Background: Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. Methods / Principal Findings: We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. Conclusions: These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions. © 2015 McLaughlin et al.


McLaughlin M.M.,UNC Project China | Chow E.P.F.,University of New South Wales | Wang C.,Guangdong Provincial Center for and Skin Diseases Control | Yang L.-G.,Guangdong Provincial Center for and Skin Diseases Control | And 6 more authors.
PLoS ONE | Year: 2013

Background:Female sex workers have been the target of numerous sexually transmitted infection (STI) prevention strategies in China, but their male clients have attracted considerably less public health attention and resources. We sought to systematically assess the prevalence of HIV, syphilis, gonorrhea, and chlamydia among heterosexual male clients of female sex workers in China.Methods/Principal Findings:Original research manuscripts were identified by searching Chinese and English language databases, and 37 studies analyzing 26,552 male clients were included in the review. Client STI prevalence across studies was heterogeneous. Pooled prevalence estimates and 95% confidence intervals were 0.68% (0.36-1.28%) for HIV, 2.91% (2.17-3.89%) for syphilis, 2.16% (1.46-3.17%) for gonorrhea, and 8.01% (4.94-12.72%) for chlamydia.Conclusions/Significance:The pooled prevalence estimates of HIV, syphilis, gonorrhea, and chlamydia among clients in this review exceed the prevalences previously reported among population-representative samples and low-risk groups in China. However, heterogeneity across studies and sampling limitations prevent definitive conclusions about how the prevalence of STIs in this population compares to the general population. These findings suggest a need for greater attention to clients' sexual risk and disease prevalence in China's STI research agenda in order to inform effective prevention policies. © 2013 McLaughlin et al.


Zhang Y.,Guangdong Provincial Centers for Dermatology and Control | Zhang Y.,Social Entrepreneurship for Sexual Health SESH Program | Kim J.A.,Social Entrepreneurship for Sexual Health SESH Program | Liu F.,Guangdong Provincial Centers for Dermatology and Control | And 9 more authors.
Sexually Transmitted Diseases | Year: 2015

Sexual health campaigns are often designed top-down by public health experts, failing to engage key populations. Using the power of crowdsourcing to shape a "bottom-up" approach, this note describes 2 creative contributory contests to enhance sexual health campaigns. We provide guidance for designing creative contributory contests to improve HIVand other sexually transmitted disease testing. © 2015 American Sexually Transmitted Diseases Association All rights reserved.


McLaughlin M.M.,UNC Project China | McLaughlin M.M.,Sun Yat Sen University | Lee M.C.,University of North Carolina at Chapel Hill | Bulterys M.,Centers for Disease Control and Prevention | And 3 more authors.
Global Public Health | Year: 2014

Global health has become an increasingly prominent component of foreign policy in the last decade. The term health diplomacy has been used to describe this growing interface between foreign policy and global health, and it encompasses both the concept of using health to further foreign policy objectives as well as the idea that diplomatic tools can be helpful for attaining public health goals. The Chinese presence in Africa has grown in the last 15 years, generating increased interest in Sino-African relations. While much has been written in recent years about the Chinese presence in Africa, the growing numbers of Africans in China have attracted considerably less attention. Many are small-scale traders and might be expected to face many of the health challenges common among foreign migrants, but their health needs have been largely unrecognised. In this paper, we consider how a health diplomacy approach could be applied to African migrants in China, and the potential advantages and limitations of this strategy. We identify areas of overlap between public health, trade and foreign policy goals that can be emphasised to generate support for improved services for African migrants in China and to engage partners from a diversity of sectors. © 2014 © 2014 Taylor & Francis.


Chu C.E.,University of California at San Francisco | Wu F.,Sun Yat Sen University | He X.,Guangzhou Eighth Peoples Hospital | Ma Q.,UNC Project China | And 5 more authors.
AIDS Research and Human Retroviruses | Year: 2015

Our objective was to explore the social meaning of HIV and perceptions of an HIV cure among people who inject drugs (PWID) in Guangzhou, China, which speaks to ethical and resource challenges to development in this field. We conducted a qualitative research study using in-depth interviews. We analyzed interview transcripts from 29 PWID, eight physicians, and three social workers from an outpatient HIV clinic and two methadone maintenance treatment centers. The social meaning of HIV infection and perceptions of an HIV cure reflected patients' relationships with society, health systems, and physicians. First, HIV infection decreased perceived social worth and disrupted peer relationships. The possibility of being cured renewed patient hope for regaining physical well-being and achieving social mobility. However, the existence of a cure may not alter the HIV-related stigma due to its association with stigmatized behaviors and marginalized groups. Second, although stigma was a significant barrier to engagement in health care, hope for a cure may outweigh fears of stigma and enhance linkage to HIV testing and treatment as well as methadone services. A cure may exacerbate perceived health disparities if inaccessible to key affected populations such as PWID. The social implications of an HIV cure among this key affected population may inform the design and implementation of cure clinical trials. Careful management of patient expectations, focusing research on key affected populations, expanding HIV testing and treatment systems, improving access to harm reduction programs, and ensuring post-trial access are important considerations for HIV cure research. © Mary Ann Liebert, Inc. 2015.


Zhang L.,University of New South Wales | Chow E.P.F.,University of New South Wales | Zhuang X.,University of New South Wales | Zhuang X.,Nantong University | And 7 more authors.
PLoS ONE | Year: 2013

Background:Methadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.Method:Chinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.Results:A total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.Conclusion:MMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness. © 2013 Zhang et al.


Tucker J.D.,UNC Project China | Tucker J.D.,University of North Carolina at Chapel Hill | Tucker J.D.,London School of Hygiene and Tropical Medicine | Bien C.H.,UNC Project China | And 5 more authors.
AIDS | Year: 2014

Objective: The objective of this review was to examine different monitoring strategies (clinical, immunologic (CD4+ T cell count measurement) and virologic (viral load measurement)) to inform revision of the 2013WHOguidelines for antiretroviral therapy (ART) in low and middle-income countries. Design: A systematic review. Methods: We searched 10 databases, reference lists of included research studies and contacted experts in an attempt to identify all relevant studies regardless of language or publication status. We included both randomized controlled trials (RCTs) and observational studies. We selected studies that examined routine clinical monitoring (CM), immunologic monitoring (IM) or virologic monitoring (VM). CM involved clinical evaluation and basic laboratory blood testing without CD4+ T cell count or viral load. Two authors independently assessed study eligibility, extracted data and graded methodological quality. Results: A total of six studies were identified, including five RCTs and one observational study. Two RCTs among adults found an increased risk of AIDS-defining illness and mortality in CM compared to CM +IM. Two studies compared CM+IM to CM+IM +VM, with one finding a mortality advantage in the CM +IM+VM group. Duration of viremia and time to switching to a second-line regimen were longer in CM+IM compared to CM +IM+VM. Only one trial was conducted in children, and showed no difference in mortality comparing CM and CM+IM. No studies specifically studied pregnant women. Conclusion: CM+IM was shown to be beneficial in terms of a combined mortality and morbidity endpoint compared to CM alone. VM was associated with shorter duration of viremia and higher rates of switching, but an impact on mortality was not consistently shown. Pooled outcome estimates were possible with comparison of only CM to CM+IM. Further HIV research on different VL monitoring strategies is required. These data support the recommendation in the 2013WHOART guidelines for the use of VM to confirm and diagnose ART failure, and for the use of IM+CM whenVM is not available. © 2014 Wolters Kluwer Health.


PubMed | University of California at San Francisco, UNC Project China, Case Western Reserve University and Guangdong Provincial Dermatology Hospital
Type: | Journal: Lancet (London, England) | Year: 2016

HIV self-testing holds great promise for reaching high-risk key populations who do not access facility-based services, but it has rarely been evaluated outside of structured research settings. HIV self-testing is a process by which a person takes and interprets a test. We aimed to characterise implementation of unsupervised HIV self-testing among men who have sex with men (MSM) in China.We undertook a nationwide online survey of MSM in November, 2015, in China. Men were invited to participate by clicking through banner adverts on social network sites. Eligible men were at least 16 years of age, had ever had anal sex with a man, and had had sex without use of a condom in the past 3 months. Among MSM who ever self-tested for HIV, we assessed benefits (eg, first-time HIV test, increased testing frequency, confirmatory testing) and adverse outcomes, (eg, coercion, violence, suicidality). First-time HIV test was defined by what an individual reported was their first ever test for HIV (a self-test or a facility test). Among MSM who reported ever testing for HIV, we identified correlates of HIV self-testing as first-time HIV test with use of multivariable logistic regression. The institutional review boards of the Guangdong Provincial Center for Skin Diseases and STI Control, the University of North Carolina at Chapel Hill, and the University of California San Francisco approved this study.Of 1610 eligible men, 1189 (739%) completed the survey. 287% (341/1189) reported ever self-testing for HIV. The HIV prevalence among self-testers was 70% (24/341) and among non-self-testers was 49% (15/306). Among self-testers, 587% (200/341) reported HIV self-testing as a first-time HIV test and 226% (77/341) had increased testing frequency. 775% (31/40) of those with a positive HIV self-test received confirmatory facility-based testing. Minimal adverse outcomes were noted. Multivariable analysis showed that self-testing as first-time HIV test was associated with younger age (odds ratio 095, 95% CI 091-099), not telling health-care providers about having sex with men (222, 156-317), not using the internet to meet sex partners (253, 145-443), and having group sex (176, 103-298).HIV self-testing increases first-time HIV testing and testing frequency among those with previous testing. This tool could be useful to scale up HIV testing among high-risk men in China and other settings.National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01), UNC Center for AIDS Research (NIAID 5P30AI050410-13), UCSF Center for AIDS Research (NIAID P30 AI027763), NIMH (R00MH093201), Fulbright-Fogarty Fellowship (FIC R25TW0093), and SESH Global.


PubMed | University of California at San Francisco, Columbia University and the New York State Psychiatric Institute, Indiana University, UNC Project China and 2 more.
Type: Journal Article | Journal: International journal for equity in health | Year: 2016

Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China.In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes.Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals.Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.


PubMed | Guangzhou Eighth Peoples Hospital, UNC Project China, Sun Yat Sen University and University of North Carolina at Chapel Hill
Type: Journal Article | Journal: Asian Pacific journal of tropical disease | Year: 2016

There are over 100 clinical trials worldwide focused on developing an HIV cure. Research participants will assume substantial individual risks while receiving little or no individual benefit. Physicians will have important dual roles of leading HIV cure research studies and guiding patient expectations. Many low and middle-income nations have started HIV cure trials, including China. The goal of this study was to better understand physician attitudes, behaviors, and perceptions of HIV cure research within the context of China. We conducted a quantitative and qualitative evidence review of published literature on physician perceptions of HIV cure in China. Quantitative survey data revealed that physicians rarely believed HIV was curable, but this perception may be more common compared to other countries. Qualitative data showed that inconsistent terminology used among physicians may contribute to the perception of HIV as curable. The belief that HIV is curable among some physicians in China may be related to the influence of traditional Chinese medicine beliefs. Rather than seeking elimination of pathogens, traditional Chinese medicine aims to achieve harmony between organs and a vital life force. In this context, HIV infection can be seen as a temporary state of imbalance rather than an irreversible change. There is a wide range of physician perceptions about HIV cure in China. Conflicting information about HIV cure from physicians and other sources could thwart the progress of HIV cure research. Enhancing patient-physician communication about ongoing HIV cure research trials will be important for developing an HIV cure.

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