Yuhua Ruan

Beijing Centers for Disease Control and Prevention, Peping, Beijing, China

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Publications (119)388.4 Total impact

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    ABSTRACT: The HIV epidemic among men who have sex with men (MSM) has been increasing at an alarming rate in most areas of China in recent years. Many Chinese MSM still lack sufficient access to HIV prevention services, despite ongoing scale-up of comprehensive HIV testing and intervention services. The purpose of this study was to investigate utilization of HIV testing and prevention services, and related factors that influence the MSM people to access HIV test or other services to prevent HIV among MSM in Beijing, China.Three successive cross-sectional surveys of MSM were conducted in Beijing from September 2009 to January 2010, September 2010 to January 2011, and September 2011 to January 2012. Demographic and behavioral data were collected and analyzed. Blood samples were tested for HIV and syphilis. Three models were established to analyze factors associated with HIV testing and preventive services.Of the 1312 participants, prevalence of HIV and syphilis was 7.9% and 15.4%, respectively. Sixty-nine percent ever had an HIV test, 56.2%, 78.7%, and 46.1% received HIV test, free condom/lubricants, and sexually transmitted infection services in the past 12 months (P12M), respectively. MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The most reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have an HIV test. The two main reasons for not seeking HIV test was not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).Given a high prevalence of HIV, syphilis, and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services.
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    ABSTRACT: Injection opioid use plays a significant role in the transmission of HIV infection in many communities and several regions of the world. Access to evidence-based treatments for opioid use disorders is extremely limited. HPTN 058 was a randomized controlled trial designed to compare the impact of two medication assisted treatment (MAT) strategies on HIV incidence or death among opioid dependent people who inject drugs (PWID). HIV-negative opiate dependent PWID were recruited from four communities in Thailand and China with historically high prevalence of HIV among PWID. 1251 participants were randomly assigned to either; 1) a one year intervention consisting of two opportunities for a 15 day detoxification with buprenorphine/naloxone (BUP/NX) combined with up to 21 sessions of behavioral drug and risk counseling (Short Term Medication Assisted Treatment: ST-MAT) or, 2) thrice weekly dosing for 48 weeks with BUP/NX and up to 21 counseling sessions (Long Term Medication Assisted Treatment: LT-MAT) followed by dose tapering. All participants were followed for 52 weeks after treatment completion to assess durability of impact. While the study was stopped early due to lower than expected occurrence of the primary endpoints, sufficient data were available to assess the impact of the interventions on drug use and injection related risk behavior. At weeks 26, 22% of ST-MAT participants had negative urinalyses for opioids compared to 57% in the LT-MAT (p<0.001). Differences disappeared in the year following treatment: at week 78, 35% in ST-MAT and 32% in the LT-MAT had negative urinalyses. Injection related risk behaviors were significantly reduced in both groups following randomization. Participants receiving BUP/NX three times weekly were more likely to reduce opioid injection while on active treatment. Both treatment strategies were considered safe and associated with reductions in injection related risk behavior. These data support the use of thrice weekly BUP/NX as a way to reduce exposure to HIV risk. Continued access to BUP/NX may be required to sustain reductions in opioid use.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2015; 68(5). DOI:10.1097/QAI.0000000000000510 · 4.39 Impact Factor
  • 01/2015; 81(1):134. DOI:10.1016/j.aogh.2015.02.808
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    ABSTRACT: Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. "Insertive" men engaged in less UAI (39 %) than "receptive" (53 %) or "versatile" (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.
    Archives of Sexual Behavior 12/2014; 44(2). DOI:10.1007/s10508-014-0396-x · 3.53 Impact Factor
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    ABSTRACT: We report here two different unique HIV-1 recombinant viruses from two HIV-positive men who have sex with men (MSM) in Beijing, China. Phylogenetic analysis of near full-length genomes (NFLG) shows that both unique recombinant forms (URFs) are themselves comprised of gene regions from two circulating recombinant forms CRF01_AE and CRF07_BC, both common in China. The parental CRF01_AE region of the recombinants clustered together with a previously described cluster 4 lineage of CRF01_AE. The CRF07_BC regions of both the recombinants clustered within the CRF07_BC radiation, but are distinct from other CRF07_BC reference sequences. The two recombinant forms have two breakpoints in common. The emergence of the two URFs indicates the ongoing generation of recombinant viruses involving CRF01_AE and CRF07_BC, and may provide insights into our understanding of the dynamics and complexity of the HIV-1 epidemic in China.
    AIDS Research and Human Retroviruses 12/2014; DOI:10.1089/AID.2014.0307 · 2.46 Impact Factor
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    ABSTRACT: Objectives: We evaluated an In-house assay for HIV-1 drug resistance genotyping by using DBS samples in China. Methods: The amplification sensitivity was assessed using 79 DBS specimens with plasma viral load ranging from 1,000 to 6,000 copies/ml. Precision was assessed using 5 DBS specimens with 5 replicates tested in one test run. Reproducibility was evaluated using other 5 DBS specimens with 5 replicates genotyped in 5 test runs. Nucleotide sequence identity and the degree of concordance in detecting drug resistance mutations were assessed within and between test runs. In addition, nucleotide sequence and drug resistance mutations were compared between 64 matched plasma and DBS specimens. Results: The amplification rate of DBS specimens with plasma viral load of 1,000-6,000 copies/ml was 96.2% (76/79). The nucleotide sequence identity was 99.7±0.34% and 99.6±0.25% within and between test runs, respectively. Moreover, there was a near perfect agreement of detecting drug resistance mutations intra- and inter- test runs with kappa value of 0.972 and 0.963, respectively. Between 64 pairs of plasma and DBS specimens, the nucleotide identity was excellent with 99.5±0.34%. As compared to the results of plasma specimens, the sensitivity and specificity for detecting drug resistance mutations in DBS specimens were 99.4 % (95% CI, 97.4-99.8%) and 99.8% (95% CI, 99.7-99.9%), respectively. Totally 15 discordant drug resistance mutations were found. Among them, 53.3 % (8/15) were caused by mixture base. Conclusions: The In-house HIVDR genotyping assay could be used for testing DBS samples with viral load above 1,000copies/ml in China and had a low intra- and inter- assay variability. DBS is an excellent alternative to plasma for HIV-1 drug resistance genotyping at population levels in China.
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    ABSTRACT: The high and climbing human immunodeficiency virus (HIV) rates among Chinese men who have sex with men (MSM) bring huge pressure and challenge to acquired immune deficiency syndrome response work in China. This study examined HIV-testing behavior and describes the characteristics of recently tested MSM in Chongqing to address targeting HIV prevention interventions.Two consecutive cross-sectional surveys were conducted among Chongqing MSM using respondent-driven sampling in 2009 and 2010. Information was collected regarding details on demographic characteristics, sexual practices with male and female partners, and HIV-testing experiences. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with recent HIV testing.The final sample size included in our analyses was 992. The overall HIV prevalence was 13.4%, and HIV prevalence increased significantly from 11.6% in 2009 to 15.4% in 2010 (P = 0.08). The overall rate of HIV testing in the past 12 months was 44.6%, and the self-reported rates decreased significantly from 47.8% in 2009 to 41.1% in 2010 (P = 0.03). Factors independently associated with recent HIV testing included living in Chongqing >1 year (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI] 1.1-2.9), the age of most recent male partner ≤25 (AOR 1.5, 95% CI 1.1-2.1), not having unprotected insertive anal sex with most recent male partner in the past 6 months (AOR 1.5, 95% CI 1.1-2.0), disclosing HIV status to most recent male partner (AOR 2.8, 95% CI 2.0-3.8), and holding lower level of HIV-related stigma (AOR 1.1 per scale point, 95% CI 1.0-1.1).The extremely high HIV prevalence and low annual testing level put MSM at high risk of HIV infection and transmission, and it is a priority to promote regular HIV testing among this group in order to control the spread of HIV in Chongqing, China.
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    ABSTRACT: BACKGROUND The rapid growth of religious affiliations and ethnic minority populations in China has important implications for MSM sexual health and HIV risk. This qualitative study aims to elucidate HIV-relevant implications of ethnocultural affiliations among MSM in Beijing, China. METHODS Data were collected in 2013 by in-depth, semi-structured, face-to-face interviews with MSM residing in Beijing, China. Forty-one interviews were conducted with MSM from eleven ethnic groups, and included Buddhist, Christian, Muslim, and non-religious men. Verbatim Chinese interview transcripts were coded, verified, and analyzed thematically. RESULTS Muslim and Christian MSM discussed experiencing heightened mental distress and internalized homonegativity due to beliefs that homosexual sex contradicts the doctrines of their religion. Some religious respondents perceived HIV infection as supernatural retribution for an immoral lifestyle. Respondents discussed how religious beliefs informed decisions regarding sexual concurrency and anal/oral sex. Many Muslims were not circumcised and did not associate male circumcision with Muslim identity. Christians, Muslims, and ethnic Zhuang discussed avoiding sex with their religious or ethnic peers because it was perceived to be socially awkward. Ethnic Uyghur and Hui MSM discussed being adversely stereotyped because of ethnicity, while other respondents described Uyghur and Hui men as less than socially desirable. Christian respondents discussed how involvement with an LGBT Christian organization helped them mitigate and cope with mental stress as a Christian MSM. Numerous respondents discussed episodes of forced sex and unprotected anal intercourse. CONCLUSION Religious and ethnic identity pose important implications for understanding HIV risk among MSM in China and requires additional research.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objective: To explore HIV virological failure and drug resistance among injecting drug users (IDUs) receiving first-line antiretroviral treatment (ART) in China. Design: A series of cross-sectional surveys from 2003 to 2012 from the Chinese National HIV Drug Resistance (HIVDR) Surveillance and Monitoring Network. Setting: China. Participants: Data were analysed by the Chinese National (HIVDR) Surveillance and Monitoring Network from 2003 to 2012. Demographic, ART and laboratory data (CD4+ cell count, viral load and drug resistance) were included. Factors associated with virological failure were identified by logistic regression analysis. Results: 929 of the 8556 individuals in the Chinese HIVDR database were IDUs receiving first-line ART. For these 929 IDUs, the median duration of treatment was 14 months (IQR 6.0-17.8). 193 of the 929 IDUs (20.8%) experienced virological failure (HIV viral load >= 1000 copies/mL). The prevalence of HIVDR among patients with virological failure was 38.9% (68/175). The proportion of patients with drug resistance to non-nucleoside reverse transcriptase inhibitor (NNRTIs), nucleoside reverse transcriptase inhibitor (NRTIs) and protease inhibitors (PIs) was 52.9%, 76.5% and 4.4%, respectively. Factors independently associated with virological failure include: ethnic minorities, junior high school education or less, farmers, self-reported missing doses in the past month, CD4 cell count at survey from 200 to 349 cells/mm(3) or from 0 to 199 cells/mm(3), and residence of Guangxi and Yunnan provinces. Conclusions: The proportion of virological failure was high among IDUs receiving first-line ART in China. However, better treatment outcomes were observed in Guangxi and Yunnan, which indicates the importance of ART education and adherence to intervention, especially for patients who are farmers, minorities or have a poor educational background.
    BMJ Open 10/2014; 4(10):e005886. DOI:10.1136/bmjopen-2014-005886 · 2.06 Impact Factor
  • AIDS Research and Human Retroviruses 10/2014; 30 Suppl 1:A152. DOI:10.1089/aid.2014.5310.abstract · 2.46 Impact Factor
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    AIDS Research and Human Retroviruses 10/2014; 30 Suppl 1:A197-8. DOI:10.1089/aid.2014.5426a.abstract · 2.46 Impact Factor
  • AIDS Research and Human Retroviruses 10/2014; 30 Suppl 1:A227. DOI:10.1089/aid.2014.5498.abstract · 2.46 Impact Factor
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    ABSTRACT: Prevention intervention trials have been conducted to reduce risk of sexual transmission among people living with HIV/AIDS (PLWHA), but the findings were inconsistent. We performed a systematic review and meta-analysis to evaluate overall efficacy of prevention interventions on unprotected vaginal or anal intercourse (UVAI) among PLWHA from randomized clinical trials (RCTs).
    PLoS ONE 09/2014; 9(9):e107652. DOI:10.1371/journal.pone.0107652 · 3.53 Impact Factor
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    ABSTRACT: Background: Buprenorphine/naloxone (BUP/NX), an effective treatment for opioid dependence, has been implicated in hepatic toxicity. However, as persons taking BUP/NX have multiple hepatic risk factors, comparative data are needed to quantify the risk of hepatoxicity with BUP/NX. Methods: We compared rates of alanine aminotransferase (ALT) elevation >= grade 3 (ALT >= 5.1 times the upper limit of normal) and graded bilirubin elevations in HIV-negative opioid injectors randomized to long-term (52 weeks) or short-term (18 days) medication assisted treatment (LT-MAT and ST-MAT, respectively) with BUP/NX in a multisite trial conducted in China and Thailand. ALT and bilirubin were measured at baseline, 12, 26, 40 and 52 weeks, times temporally remote from BUP/NX exposure in the ST-MAT participants. Results: Among1036 subjects with at least one laboratory follow-up measurement, 76 (7%) participants experienced ALT elevation >= grade 3. In an intent-to-treat analysis, the risk of ALT events was similar in participants randomized to LT-MAT compared with ST-MAT (adjusted hazard ratio 1.25,95% confidence interval 0.79 to 1.98). This finding was supported by an as-treated analysis, in which actual exposure to BUP/NX was considered. Hepatitis C seroconversion during follow-up was strongly associated with ALT events. Bilirubin elevations >= grade 2 occurred in 2% of subjects, with no significant difference between arms. Conclusions: Over 52-week follow-up, the risk of hepatotoxicity was similar in opioid injectors receiving brief and prolonged treatment with BUP/NX. These data suggest that most hepatotoxic events observed during treatment with BUP/NX are due to other factors.
    Drug and Alcohol Dependence 06/2014; 142. DOI:10.1016/j.drugalcdep.2014.06.013 · 3.28 Impact Factor
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    ABSTRACT: Background: Compensatory mutations have been observed to emerge with drug resistance (DR) mutations, but their effects on virological response to treatment have not been fully examined. In this study, we characterized the emergence and depletion dynamics of a compensatory mutation K43E that correlated with primary nucleoside reverse transcriptase inhibitor (NRTI) drug resistance mutations in Chinese HIV patients on antiretroviral treatment. Method: Single Genome Amplification (SGA) was used to obtain the HIV-1 pol gene quasispecies in three patients over 6 years of Antiretroviral Therapy (ART) treatment. SGA sequences were analyzed by Markov Chain Monte Carlo (MCMC) phylogenetic trees with molecular clock to identify and track compensatory mutation K43E correlated with primary DR mutation M41L. We evaluated the relationship between potential compensatory mutation and DR mutations through Ka/Ks ratio, Jaccard similarity coefficient, and compared these with concurrent viral load data. Conclusion: We determined that a known compensatory mutation, K43E, frequently co-occurs with the drug resistance mutation M41L and may offer a significant advantage in the long-term survival of such drug resistant strains.
    Current HIV Research 06/2014; 12(1). DOI:10.2174/1570162X12666140617154400 · 2.14 Impact Factor
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    ABSTRACT: Objectives: To assess HIV incidence and its associated risk factors among young men who have sex with men (YMSM) in urban areas, China. Design: The study used a prospective cohort study design and standard diagnostic tests. Methods: A twelve-month prospective cohort study was conducted among YMSM (18-25 years old) in 8 large cities in China. The participants were recruited via snowball sampling. A total of 1102 HIV-negative YMSM completed baseline assessment, 878 YMSM participants completed 6-month follow-up, and 902 completed 12-month follow-up. HIV was screened by an enzyme-linked immunosorbent assay and confirmed with Western Blot. Syphilis was screened via rapid plasma reagent and confirmed by treponema pallidum particle agglutination assay. Results: 78 HIV seroconversions were identified within 1168.4 person-year observations yielding an incidence rate of 6.7 per 100 person-years. HIV seroconversion was associated with non-student status (RR = 2.61, 90% CI = 1.3-5.26), low HIV transmission knowledge (RR = 8.87, 90% CI = 2.16-36.43), and syphilis infection (RR = 5.04, 90% CI = 2.57-9.90). Conclusions: Incidence of HIV among YMSM is high in urban areas of China. Interventions measures are required to contain the HIV epidemic within this population.
    PLoS ONE 05/2014; 9(5):e97527. DOI:10.1371/journal.pone.0097527 · 3.53 Impact Factor
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    ABSTRACT: Objectives. To figure out the most current prevalence of HIV and syphilis in MSM in China. Methods. A meta-analysis was conducted on the studies searched through PubMed, CNKI, and Wanfang published between 1 January 2009 and 11 April 2013. Results. Eighty-four eligible studies, either in Chinese or in English, were included in this review. The pooled prevalence of HIV and syphilis infection in MSM in China was 6.5% and 11.2%, respectively. The subgroup analyses indicated that the prevalence of HIV infection was higher in the economically less developed cities than that in the developed cities (7.5% versus 6.1%, P < 0.05). In contrast, the prevalence of syphilis infection was lower in less developed cities than in developed cities (8.6% versus 15.1%). Studies with a sample size smaller than 500 had a lower prevalence of HIV and syphilis infection than those with a sample size greater than 500 (5.9% versus 7.2% for HIV; 11.0% versus 11.5% for syphilis, respectively). Conclusions. HIV and syphilis infection are prevalent in MSM in China. The different prevalence of HIV and syphilis infection between developing and developed cities underscores the need to target prevention strategies based on economic conditions.
    BioMed Research International 04/2014; 2014:620431. DOI:10.1155/2014/620431 · 2.71 Impact Factor
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    ABSTRACT: Objective. To evaluate HIV risk perception and its associated factors among Chinese MSM. Methods. A cross-sectional study was conducted among MSM with an HIV negative or unknown status in Beijing, China, between 2011 and 2012. A questionnaire interview was conducted and a blood sample was collected for HIV and syphilis testing. Results. Of 887 MSM who reported they were HIV negative or did not know their HIV status before recruitment, only 7.3% reported a high risk of HIV infection, 28.0% medium risk, 52.2% low risk, and 12.5% no risk. In multivariate logistic regression models using those who reported a medium self-perceived risk as a reference group, self-reported high risk of HIV perception was associated with minority ethnicity (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.03-8.19), self-reported history of sexually transmitted diseases (OR: 2.27; 95% CI: 1.25-4.10), and HIV testing times since the last HIV testing (OR: 0.47; 95% CI: 0.26-0.84); low self-perceived risk of HIV infection was related to full-time employment (OR: 1.58; 95% CI: 1.15-2.18) and illicit drug use (OR: 0.28; 95% CI: 0.10-0.75). Conclusions. The HIV/AIDS epidemic is rapidly rising among Beijing MSM, but more than half MSM did not perceive this risk.
    03/2014; 2014:232451. DOI:10.1155/2014/232451
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    ABSTRACT: Objective. This is the first study in China to examine the use of nitrite inhalants and its correlates among men who have sex with men (MSM) in Beijing, China. Methods. A cross-sectional survey was conducted in 2012. Structured interviews collected data on demographics, sexual and drug use behaviors, and the use of HIV services. Blood specimens were collected and tested for HIV and syphilis. Results. A total of 400 MSM eligible for the study were between 19 and 63 years of age and overall HIV prevalence was 6.0% (9.0% among nitrite inhalant users and 3.3% among nonusers). Nearly half (47.3%) of them reported ever using nitrite inhalants and 42.3% admitted using nitrite inhalants in the past year. Multivariable logistic analysis revealed that ever using nitrite inhalants in the past was independently associated with being aged ≤25 years, having higher education attainment, seeking sex via Internet, having casual partners in the past three months, and being HIV positive. Conclusion. The use of nitrite inhalants was alarmingly prevalent among MSM in Beijing. The independent association of the nitrite inhalant use with more casual sex partners and HIV infection underscored the need for intervention and prevention of nitrite inhalant use.
    03/2014; 2014:365261. DOI:10.1155/2014/365261
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    ABSTRACT: We determined the prevalence and incidence of HBV and HCV infection in people who inject drugs (PWIDs) at high risk for HIV in China and Thailand and determined the association of HBV and HCV incidence with urine opiate test results and with short-term versus long-term buprenorphine-naloxone (B-N) treatment use in a randomized clinical trial (HPTN 058). 13.8% of 1049 PWIDs in China and 13.9% of 201 PWIDs in Thailand were HBsAg positive at baseline. Among HBsAg negative participants, the HBsAg incidence rate was 2.7/100 person years in China and 0/100 person years in Thailand. 81.9% of 1049 PWIDs in China and 59.7% of 201 in Thailand were HCV antibody positive at baseline. The HCV confirmed seroincidence rate among HCV antibody negative PWIDs was 22/100 person years in China and 4.6/100 person years in Thailand. Incident HBsAg was not significantly different in the short-term versus long-term B-N arm in China or Thailand. Participants with positive opiate results in at least 75% of their urines during the time period were at increased risk of incident HBsAg (HR = 5.22; 95% CI, 1.08 to 25.22; P = 0.04) in China, but not incident HCV conversion in China or Thailand.
    Hepatitis research and treatment 03/2014; 2014:296958. DOI:10.1155/2014/296958

Publication Stats

1k Citations
388.40 Total Impact Points

Institutions

  • 2012–2014
    • Beijing Centers for Disease Control and Prevention
      Peping, Beijing, China
  • 2004–2014
    • Chinese Center For Disease Control And Prevention
      • National Center for AIDS/STD Control and Prevention
      Peping, Beijing, China
  • 2013
    • Guangxi Medical University
      • School of Public Health
      Yung-ning, Guangxi Zhuangzu Zizhiqu, China
  • 2009
    • National Centre For Aids And STD Control
      Kantipura, Central Region, Nepal
  • 2005
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States