Group 8: G-RHEA 

                                                Date of Submission: August 23,

2019

Members:                                                                            0877L 7:30-10:30 F A313

GURTIZA, Jaymarck Andrei Activity 2

ARONZA, Jetrude Ann

DE GUZMAN, Alaine

MAURICIO, Camille

QUEDDENG, Claudine Ruiz

ACTIVITY 2: Observational Study Designs

HIV incidence among men who have sex with men in Beijing: a prospective cohort study

ABSTRACT

Is the topic of the study important and worth knowing?

It is very beneficial because the articles are fully dedicated on diseases such as cancer,
hypertension and even sexually transmitted diseases. The main reason would be to provide a
consistent flow of information for the targeted people. The advantages of such sections include
the full coverage of the up-to-date medical trends that address the disease or condition.

What is the purpose of the study? Is the focus on a difference or a relationship?

         Objective/s

- To assess the HIV incidence rate among men who have sex with men (MSM) in Beijing

- To identify sociodemographic and behavioral risk factors of HIV seroconversions among MSM
in Beijing

- The focus is on the relationship of HIV incidence and sociodemographic and behavioral risk
factors among MSM in Beijing
INTRODUCTION

What research has already been done on this topic and what outcomes were reported?

In China, homosexual transmission has now become a major mode of HIV transmission.
However, HIV incidence among Chinese men who have sex with men (MSM) remains poorly
understood. “It is estimated that 780,000 persons were living with HIV/AIDS (PLWHA) in China
by the end of 2011… Many cross-sectional studies have reported on HIV prevalence among
MSM in China. However, data on HIV incidence rates. Among this subpopulation remains
limited” (Li, D. et al, 2012).     

Past Data

“Among the only three MSM cohort studies which have been conducted thus far in
China, HIV incidence rates ranged between 2.6 and 5.4 cases per 100 person-years.
Unfortunately, two of these studies were characterized by small sample sizes, short-term follow-
up heavy loss to follow-up. The most recent cohort study was only able to recruit 218 eligible
MSM participants, 44% of whom were lost to follow-up.” (Li, D. et al, 2012).     

         Presented Data

Present cohort study was designed to follow-up a large number of MSM participants
over an extended time with minimal loss to follow-up. To better guide HIV prevention and
intervention programs among MSM in China

METHODS

Is the appropriate study design used?

         Design 

Prospective cohort design was used in conducting this research. As this study is to
determine risk factors that may correlate with the incidence of HIV in Beijing. The study design
is seen as appropriate to establish such factors and meet the objectives.

Does the study cover an adequate period of time? Is the follow up period long enough?

         Period of Time Conducted

Study participants were followed up for 1 year with follow up visits for 6 and 12 months.
The time period was sufficient for the research as it ensured a high cohort retention rate

Are the criteria for inclusion and exclusion of subjects clear?        

Criteria for Inclusion and Exclusion

The criteria for inclusion and exclusion of participants was clear as it presented a
specific criteria for participants at the time of baseline and follow up data collection. Such criteria
were presented as:
 INCLUSION CRITERIA EXCLUSION CRITERIA

>18 years old negative for HIV at baseline

conduction

Male could not provide contact

information

Had anal or oral sex with another male partner in the relocated from Beijing within the
past 6 months next year

provided written and informed consent refused to participate for follow-

ups

What other outcomes and risk factors are in the study? Are they clearly defined?

The presented variables were limited to sociodemographic measures and behavioral

measures as independent variables or risk factors that were associated with the results of the
seroincidence based on medical examination results portrayed as the outcomes or dependent
variables. They are clearly defined as variables to consider in the study.

What are the statistical methods outlined?

         Outline of Statistical Method

The study used questionnaire-based data and biological testing results as means of data
collection. The statistical method presented in the study was Cox regression model in univariate
and multiple regression analyzed. Statistical significance was defined as p value <0.05

RESULTS

Do the reported findings answer the research questions?

         HIV incidence rate among MSM in Beijing has increased dramatically. Epidemic in this
group is extremely serious that using multiple method recruitment and cohort follow up
approaches remain challenging. Effective intervention services are urgently needed. Many
epidemiological studies have found that HIV infection is strongly associated with syphilis and
HSV-2. International studies have shown that younger MSM are at higher risk of HIV infection,
minor geographic variations notwithstanding.  Results from this study are consistent with such
studies. MSM were severely marginalized and stigmatized. All MSM faced social pressure to
hide their sexual orientation and most of them eventually got married. Today, social
environment becomes less stigmatizing .Younger MSM are more active in homosexuality than
the older ones. Older MSM are more likely to get married and younger MSM are mostly social
media users thus exposes and engages to casual sex. The report sufficiently answered the
research questions based on the data presented and the discussion of data in which the
conclusion is based on.

Are the actual values reported so that the magnitude of the differences can be judged by the
leader?        

Baseline Characters of the Participants

Table 1 above shows the descriptive results on the characteristics of the participants.
Overall participants are 797 and the median age is 28 years old. It also shows the ethnicity,
education, monthly income, marital status in the past 3 months, sexual orientation, and partner
of sexual debut.
Cohort Retention and Contact Information 

Of the 797 participants, 448 were recruited by peer referral, 173 via internet and 158
recruited through outreach. Table 2 above shows, 96.5% were retained on the cohort at the 6-
month follow-up, and 86.8% were retained at the 12-month follow up. Participants were
contacted through cell phone call, short text message, QQ/MSN, peer contact, email and
landline telephone.

Incidence of HIV, Syphilis and HSV-2 and Factors Affecting HIV Seroconversions
  Table 3 above shows that among 797 who were seronegative for HIV at baseline, 48
HIV seroconversions were observed resulting in an incidence rate of 95%. Of 666 participants
who were seronegative for syphilis at baseline, 30 syphilis seroconversions were observed
resulting in an incidence rate of 95%. 760 participants who were seronegative for HSV-2 at
baseline, 46 HSV-2 seroconversions were observed resulting in an incidence rate of 95% as
well. Unvariate and multivariate Cox regression analyses indicated that younger age, less
education, having multiple male sex partners in the past 6 months, syphilis infection and HSV-2
infection were significantly associated with time to HIV seroconversion (table 3). The data
presented portrayed the dramatic increase of incidence based on the risk factors presented.

Are the graphs and tables and their legend easy to read and understand? 

Descriptive result tables help readers to get an in depth understanding of the variables
involved in the study. The graphs and tables were easy to read and locate specific data per
category in the cohort.

CONCLUSION

Are the research questions adequately discussed?

The research questions were adequately discussed and addressed in the results of the
study.

Are the conclusions of the study discussed in the context of other relevant research?

The conclusions of the study were discussed in the context of other researches through
gathering data from relevant researches. It also addressed the issue of low retention rate
presented by other researches.

Are shortcoming of the research addressed?

The limitations of the research were indicated and addressed. The limitations of the
research are as follows: the study subjects were recruited using non-random sampling methods
that could have led to selection bias.

REFERENCE

Li, D, Li S, Liu Y, et al. (2012). HIV incidence among men who have sex with men in Beijing: a
prospective cohort study. BMJ: e001829.doi:10.1136/ bmjopen-2012-001829