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BackgroundPre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play a crucial role in PrEP implementation, and their knowledge, attitudes, and career experience may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP in countries without PrEP-specific guidelines. ObjectiveWe aimed to determine the factors associated with clinicians being willing to prescribe PrEP in China. MethodsBetween May and June 2019, we conducted an online cross-sectional survey of clinicians in 31 provinces across the six administrative regions in China on the WeChat smartphone app platform. Multivariable logistic regression was used to determine factors associated with willingness to prescribe PrEP. ResultsOverall, 777 HIV clinicians completed the survey. Most of the respondents had heard of PrEP (563/777, 72.5%), 31.9% (248/777) thought that PrEP was extremely effective for reducing the risk of HIV infection, and 47.2% (367/777) thought that it was necessary to provide PrEP to high-risk groups. After adjusting for age, gender, ethnicity, and educational background of the clinicians, the following factors significantly increased the odds of the clinicians being willing to prescribe PrEP: having worked for more than 10 years, compared to 5 years or less (adjusted odds ratio [aOR] 2.82, 95% CI 1.96-4.05); having treated more than 100 patients living with HIV per month, compared to 50 patients or fewer (aOR 4.16, 95% CI 2.85-6.08); and having heard of PrEP (aOR 7.32, 95% CI 4.88-10.97). Clinicians were less likely to be willing to prescribe PrEP if they were concerned about poor adherence to PrEP (aOR 0.66, 95% CI 0.50-0.88), the lack of PrEP clinical guidelines (aOR 0.47, 95% CI 0.32-0.70), and the lack of drug indications for PrEP (aOR 0.49, 95% CI 0.32-0.76). ConclusionsAbout half of all clinicians surveyed were willing to prescribe PrEP, but most surveyed had a low understanding of PrEP. Lack of PrEP clinical guidelines, lack of drug indications, and less than 11 years of work experience were the main barriers to the surveyed clinicians’ willingness to prescribe PrEP. Development of PrEP clinical guidelines and drug indications, as well as increasing the availability of PrEP training, could help improve understanding of PrEP among clinicians and, thus, increase the number willing to prescribe PrEP.

BackgroundeHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM). ObjectiveThis study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China. MethodsWe performed a mobile phone–based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju—an online survey platform—was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform. ResultsIn total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference −2.5; 95% CI −5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87%, n=66/76 vs 70%, n=54/77 respectively; odds ratio 2.81, 95% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90%, n=77/86 vs 79%, n=65/82 respectively; odds ratio 2.20, 95% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US $131.60 on reducing 1 sexual partner and US $19.70 for a 1% increment in condom usage with casual partners. ConclusionsA comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic. Trial RegistrationChinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271

BackgroundNonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. The research and use of nPEP are mainly concentrated in the developed world, while little is known about the knowledge, attitudes, and practices of nPEP among HIV medical care providers in developing countries. ObjectiveWe aimed to assess the nPEP knowledge and prescribing practice among HIV medical care providers in mainland China. MethodsHIV medical care providers were recruited in China during May and June 2019 through an online survey regarding nPEP-related knowledge, attitudes, and clinical prescription experiences. Multivariable logistic regression was performed to identify factors associated with prescribing nPEP among HIV medical care providers. ResultsA total of 777 eligible participants participated in this study from 133 cities in 31 provinces in China. Of the participants, 60.2% (468/777) were unfamiliar with nPEP and only 53.3% (414/777) of participants ever prescribed nPEP. HIV care providers who worked in a specialized infectious disease hospital (vs general hospital, adjusted odds ratio [aOR] 2.49; 95% CI 1.85-3.37), had practiced for 6-10 years (vs 5 or fewer years, aOR 3.28; 95% CI 2.23-4.80), had practiced for 11 years or more (vs 5 or fewer years, aOR 3.75; 95% CI 2.59-5.45), and had previously prescribed occupational PEP (oPEP, aOR 4.90; 95% CI 3.29-7.29) had a significantly positive association with prescribing nPEP. However, unfamiliarity with nPEP (aOR 0.08; 95% CI 0.05-0.11), believing nPEP may promote HIV high-risk behavior (aOR 0.53; 95% CI 0.36-0.77) or result in HIV drug resistance (aOR 0.53; 95% CI 0.36-0.77) among key populations, and self-reported having no written oPEP guideline in place (aOR 0.53; 95% CI 0.35-0.79) were negatively associated with nPEP prescription behavior. ConclusionsHIV medical care providers have insufficient nPEP knowledge and an inadequate proportion of prescribing, which may impede the scale-up of nPEP services to curb HIV acquisition. The implementation of tailored nPEP training or retraining to HIV medical care providers would improve this situation.

BackgroundOver half of men who have sex with men (MSM) use geosocial networking (GSN) apps to encounter sex partners. GSN apps’ users have become a unique large subpopulation among MSM for interventions concerning HIV prevention and control. Pre-exposure prophylaxis (PrEP) is a promising measure for HIV prevention, especially for MSM, but its effectiveness largely depends on medication adherence. However, little is known about PrEP adherence among GSN apps’ users, which is critical to addressing the overall optimization of PrEP compliance outside of clinical trials in the context of large-scale implementation. ObjectiveThe objective of this study is to understand the correlation between GSN apps’ use and medication adherence among MSM receiving PrEP, with the aim to increase their awareness about PrEP use in order to increase adherence. MethodsThis study based on the China Real-world Oral intake of PrEP (CROPrEP) project, a multicenter, real-world study of Chinese MSM on daily and event-driven PrEP. Eligible participants completed a detailed computer-assisted self-interview on sociodemographic, GSN apps’ use, and sexual behavior. Then participants were followed up for 12 months and assessed for various characteristics (eg, PrEP delivery, adherence assessment, PrEP coverage of sexual activities, and regimens switch). A generalized estimation equation was used to analyze the predictors of medication adherence and regimen conversion among GSN apps’ users and nonusers. ResultsAt baseline, 756 of the 1023 eligible participants (73.90%) reported primarily using GSN apps to seek sexual partners, and GSN apps’ users are more likely to have high-risk behaviors such as multiple sex partners and condomless anal intercourse than other nonusers (all P

BackgroundDisclosure of HIV serostatus is important for the prevention of HIV infection among men who have sex with men (MSM). However, knowledge of sexual partners’ HIV status among MSM in China is low. As a complement to HIV testing services, HIV self-testing (HIVST) has considerable potential to promote serostatus disclosure. ObjectiveThe primary objective of our trial is to evaluate the effect of HIVST on improving serostatus disclosure to sexual partners. We hypothesize that MSM in an intervention condition will have a higher awareness of the HIV status of their sexual partners compared with MSM in the control condition. The secondary aims are to evaluate (i) changes in sexual behaviors after disclosure of HIV status by sexual partners, (ii) promotion of the frequency of HIV and syphilis testing on participants and their sexual partners, and (iii) factors that restrict the disclosure of HIV infection to sexual partners. We hypothesize that MSM in the intervention condition will exhibit safer sexual decision making and a higher rate of HIV testing uptake compared with MSM in the control condition. MethodsA stepped wedge randomized controlled trial will be conducted throughout China. Study recruitment of 800 MSM will be promoted through advertisements released on WeChat public accounts. Individuals who are born biologically male, aged ≥18 years, HIV negative, and who have not undergone HIV testing in the past 3 months will be recruited. Eligible men will be randomly divided (1:1:1:1) into four groups and randomized. The group cluster will initiate the intervention so that participants will be provided with 2-4 free finger prick–based HIVST kits until trial completion. The intervention period for participants in each of the four groups will be initiated at 3-month intervals. Men in both groups will be required to complete a baseline and four follow-up surveys every 3 months. The primary intervention outcome will evaluate the effect of the distribution of HIVST kits on improvement in the disclosure of sexual partners’ HIV status. The secondary outcomes will be changes in sexual behaviors after disclosure of HIV status from sexual partners, the promotion of the frequency of HIVST on participants and their sexual partners, and the factors that restrict disclosure of HIV status to sexual partners. ResultsSubject recruitment began in August 2018. The first round of follow-up surveys post intervention is complete, with three rounds remaining to be done. Data analysis was scheduled for April 2020 and the results will be disseminated through conferences and peer-reviewed publications. ConclusionsFew studies have evaluated interventions to increase knowledge of sexual partners’ HIV status among MSM. Our trial will provide information on the link between HIVST and HIV serostatus disclosure. The findings of this trial will facilitate the implementation of HIVST services to help control the spread of HIV among MSM in China. Trial RegistrationChinese Clinical Trial Registry ChiCTR1800019453; http://www.chictr.org.cn/showproj.aspx?proj=30158 International Registered Report Identifier (IRRID)DERR1-10.2196/17788

To study the anti-tumor effect of Cistanche deserticola in Balb/c mice, tumor-bearing nude mice subcutaneously inoculated with HepG2 liver cancer cells were administered with total glycosides (TG) of C. deserticola at different doses by gavage. The pathological changes in the liver and tumors, the proliferation capacity of splenic lymphocytes, and antioxidant indicators in the liver were detected. Metabolomics and 16S rDNA sequencing were used to analyze the changes in metabolites and microbial community composition in the intestinal contents of mice. Results showed that TG inhibited the growth of tumor in nude mice without affecting the normal growth and development of the mice and without any toxic side effects. As the dose of TG increased, the structure of hepatocytes in liver tissues became intact, the degree of pathological changes gradually reduced, the distribution of tumor cells became sparser, and the degree of vacuole deformation increased, which was accompanied by the occurrence of necrosis, indicating that TG could protect the liver and simultaneously inhibit the growth of tumor. TG alleviated liver lesions in mice, as evidenced by increased levels of catalase (CAT) and glutamic-pyruvic transaminase (GPT) and decreased levels of aspartate aminotransferase (GOT) and alkaline phosphatase (AKP). With increasing TG dose, the proliferative capacity of lymphocytes also increased, indicating that TG could exert an anti-liver cancer effect by improving immune function in mice. In addition, TG could inhibit the progression of liver cancer by regulating the levels of metabolites and improving the composition of the intestinal microbiota. Therefore, TG of C. deserticola has an anti-liver cancer effect by improving oxidative stress resistance, regulating immune capacity, improving the metabolic profile and regulating intestinal microbial balance.

In general, there are no long-term meteorological or hydrological data available for karst river basins. The lack of rainfall data is a great challenge that hinders the development of hydrological models. Quantitative precipitation estimates (QPEs) based on weather satellites offer a potential method by which rainfall data in karst areas could be obtained. Furthermore, coupling QPEs with a distributed hydrological model has the potential to improve the precision of flood predictions in large karst watersheds. Estimating precipitation from remotely sensed information using an artificial neural network-cloud classification system (PERSIANN-CCS) is a type of QPE technology based on satellites that has achieved broad research results worldwide. However, only a few studies on PERSIANN-CCS QPEs have occurred in large karst basins, and the accuracy is generally poor in terms of practical applications. This paper studied the feasibility of coupling a fully physically based distributed hydrological model, i.e., the Liuxihe model, with PERSIANN-CCS QPEs for predicting floods in a large river basin, i.e., the Liujiang karst river basin, which has a watershed area of 58 270 km-2, in southern China. The model structure and function require further refinement to suit the karst basins. For instance, the sub-basins in this paper are divided into many karst hydrology response units (KHRUs) to ensure that the model structure is adequately refined for karst areas. In addition, the convergence of the underground runoff calculation method within the original Liuxihe model is changed to suit the karst water-bearing media, and the Muskingum routing method is used in the model to calculate the underground runoff in this study. Additionally, the epikarst zone, as a distinctive structure of the KHRU, is carefully considered in the model. The result of the QPEs shows that compared with the observed precipitation measured by a rain gauge, the distribution of precipitation predicted by the PERSIANN-CCS QPEs was very similar. However, the quantity of precipitation predicted by the PERSIANN-CCS QPEs was smaller. A post-processing method is proposed to revise the products of the PERSIANN-CCS QPEs. The karst flood simulation results show that coupling the post-processed PERSIANN-CCS QPEs with the Liuxihe model has a better performance relative to the result based on the initial PERSIANN-CCS QPEs. Moreover, the performance of the coupled model largely improves with parameter re-optimization via the post-processed PERSIANN-CCS QPEs. The average values of the six evaluation indices change as follows: the Nash-Sutcliffe coefficient increases by 14 %, the correlation coefficient increases by 15 %, the process relative error decreases by 8 %, the peak flow relative error decreases by 18 %, the water balance coefficient increases by 8 %, and the peak flow time error displays a 5 h decrease. Among these parameters, the peak flow relative error shows the greatest improvement; thus, these parameters are of page1506 the greatest concern for flood prediction. The rational flood simulation results from the coupled model provide a great practical application prospect for flood prediction in large karst river basins.