Yuhua Ruan

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

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Publications (196)

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    Yu Liu · Yuhua Ruan · Shiela M. Strauss · [...] · Sten H. Vermund Dr
    [Show abstract] [Hide abstract] ABSTRACT: Background: Few studies have employed standardized alcohol misuse measures to assess relationships with sexual risk and HIV/syphilis infections among Chinese men who have sex with men (MSM). Methods: We conducted a cross-sectional study among MSM in Beijing during 2013-2014. An interviewer-administered survey was conducted to collect data on sociodemographics, high-risk behaviors, and alcohol use/misuse patterns (hazardous/binge drinking and risk of alcohol dependence) in the past 3 months using Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). We defined AUDIT-C score ≥4 as recent hazardous drinkers, and drinking ≥6 standard drinks on one occasion as recent binge drinkers. Results: Of 3588 participants, 14.4% reported hazardous drinking, 16.8% reported binge drinking. Hazardous and binge drinking are both associated with these factors (p<0.05): older age, being migrants, living longer in Beijing, township/village origin, being employed, higher income, self-perceived low/no HIV risk, and sex-finding via non-Internet venues. Hazardous (vs non-hazardous) or binge (vs. non-binge) drinkers were more likely to use illicit drugs, use alcohol before sex, have multiple partnerships, pay for sex, and have condomless insertive anal intercourse. MSM who reported binge (AOR, 1.34, 95% CI, 1.02-1.77) or hazardous (AOR, 1.36, 95% CI, 1.02-1.82) drinking were more likely to be HIV-infected. MSM at high risk of current alcohol dependence (AUDIT-C ≥8) were more likely to be HIV- (AOR, 2.37, 95% CI, 1.39-4.04) or syphilis-infected (AOR, 1.96, 95% CI, 1.01-3.86). Conclusions: Recent alcohol misuse was associated with increased sexual and HIV/syphilis risks among Chinese MSM, emphasizing the needs of implementing alcohol risk reduction programs in this population.
    Full-text available · Article · Sep 2016 · Drug and alcohol dependence
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    [Show abstract] [Hide abstract] ABSTRACT: Objective: To explore the effect of depression and anxiety on adherence to antiretroviral therapy (ART) among men who have sex with men (MSM) with newly diagnosed HIV infections. Design: We conducted a prospective study of Chinese MSM with newly diagnosed HIV infections. Methods: The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety at baseline, 6 and 12 months, separately. ART adherence was self-reported once every three months (“perfect” or no missing dose in the past three months vs. “imperfect” adherence or at least one missing dose in the past three months). We utilized a priori substantial knowledge guided by causal models to identify confounding covariates, and performed mixed-effect logistic regression to assess the effects of depression and anxiety on ART adherence. Results: We included 228 participants who initiated ART after HIV diagnosis and before the end of study. A one-unit increase in the depression and anxiety score was associated with a 16% increase (adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.02-1.32) and a 17% increase (aOR, 1.17; 95% CI, 1.03-1.33) in the odds of reporting imperfect ART adherence, respectively. When depression and anxiety were categorized (normal, borderline, and likely), only likely anxiety had a significant association with ART adherence (aOR, 4.79; 95% CI, 1.12-20.50). Conclusions: Depression and anxiety are risk factors for imperfect ART adherence among Chinese MSM with newly diagnosed HIV infections. Intensive intervention on depression and/or anxiety beyond regular post HIV-testing counseling may increase adherence to ART, and improve HIV treatment outcomes. Keywords: Depression; Anxiety;; Antiretroviral Therapy (ART); Adherence; Men who have sex with men (MSM); newly diagnosed HIV infections; China
    Full-text available · Article · Sep 2016 · AIDS
  • [Show abstract] [Hide abstract] ABSTRACT: This study aimed to identify the association of unsafe sex behaviors with HIV infection among the male clients who purchase commercial sex in low-cost sex venues. A cross-sectional study was conduct in a southern province of China among male, low-cost commercial sex clients, who were over 50 years old. Participants were interviewed using a structured questionnaire and had completed HIV testing. Among the 3,485 participants, the prevalence of HIV was 2.96% (95% confidence interval: 2.40–3.52%). The associated risk factors studied for HIV infection included (1) not currently married; (2) use of counterfeit TCMs with sildenafil; (3) noncondom use during commercial purchased sex; and (4) recent engagement of commercial sex within past week. Given the high prevalence of HIV infection among the study group, more political policy intervention and health education should be considered for the identified subpopulation (over 50-year-old men in low-cost commercial venues, counterfeit TCMs with sildenafil and noncondom use).
    Article · Sep 2016 · International Journal of Sexual Health
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    [Show abstract] [Hide abstract] ABSTRACT: Background: High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. Methods: As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. Results: A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). Conclusion: The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
    Full-text available · Article · Sep 2016 · Substance Use & Misuse
  • Stephen W Pan · Dongliang Li · Richard M Carpiano · [...] · Yuhua Ruan
    Article · Sep 2016 · The Lancet
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: This study aimed to identify the association of unsafe sex behaviors with HIV infection among the male clients who purchase commercial sex in low-cost sex venues. Methods: A cross-sectional study was conduct in a southern province of China among male, low-cost commercial sex clients, who were over 50 years old. Participants were interviewed using a structured questionnaire, and had completed HIV testing. Results: Among the 3485 participants, the prevalence of HIV was 2.96% (95% CI: 2.40–3.52%). The associated risk factors studied for HIV infection included: 1) not currently married; 2) use of counterfeit TCMs with sildenafil; 3) Non-condom use during commercial purchased sex; and 4) Recent engagement of commercial sex within past week. Conclusions: Given the high prevalence of HIV infection among the study group, more political policy intervention and health education should be considered for the identified subpopulation (over 50-years-old men in low-cost commercial venues, counterfeit TCMs with sildenafil and non-condom use).
    Article · Aug 2016 · International Journal of Sexual Health
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: WHO and UNAIDS recommend male circumcision (MC) as an additional HIV prevention measure. This study aims to assess three models for promoting MC and their effects on preventing HIV infection among drug users in western China. Methods: We carried out a cohort study in three provinces of western China. The HIV-seronegative male drug users were recruited from methadone maintenance therapy (MMT) clinics and cluster-randomized into three intervention models. At baseline, 6-month, and 9-month follow-up, changes in MC knowledge, acceptability of MC, MC surgery uptake, and the costs of model implementation were analysed. Results: Of 1,304 male drug users who were screened, 1,218 were enrolled in the study. The participants' knowledge about MC was significantly increased after interventions by all three models. The one-stage model led to the highest increase in MC acceptability and the greatest increase in MC uptake. Multivariable Cox regression analysis showed that the one-stage model was also the most effective method to promote MC uptake, compared with those of the two-stage model (RR = 0.602, 95% CI, 0.420-0.862)and three-stage model (RR = 0.555, 95% CI, 0.382-0.807). The HIV incidence rate in the MC group was lower than that in the non-MC group (RR = 0.234; 95% CI, 0.056-0.974). Moreover, the one-stage model required the lowest cost per circumcision. Conclusions: The one-stage model is the most effective and the most cost-effective intervention to increase MC uptake among male drug users in western China, and could decrease the HIV incidence rate, based on a short follow-up investigation.
    Article · Jul 2016 · AIDS Research and Human Retroviruses
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    [Show abstract] [Hide abstract] ABSTRACT: Little is known about the relationship between HIV stigma and depression among newly diagnosed HIV-infected men who have sex with men (MSM). We measured HIV-related stigma and current depression using standard scales among 367 Chinese MSM who had been diagnosed very recently with HIV infection, analyzing key associations with multivariable ordinal logistic regression. Current depression prevalence was 36 %. Median scores for felt, vicarious, and internalized stigma were 17, 2, and 5, respectively, each on a 0–30 scale. A one-point increase in the total stigma score was associated with a 4 % increase in the odds of current depression [adjusted odds ratio (aOR) = 1.04, 95 % confidence interval (CI) 1.03–1.05]. Internalized stigma had the strongest association with depression (aOR = 1.09, 95 % CI 1.07–1.12). Effective interventions to address coping with HIV-related stigma immediately following HIV-diagnosis might help reduce depression, improve long-term mental health, and improve engagement in their care.
    Full-text available · Article · Jul 2016 · AIDS and Behavior
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Religion can profoundly impact the sociocultural contexts that shape sexual HIV vulnerability among men who have sex with men (MSM). However, the relationship between religion and HIV vulnerability remains poorly understood for MSM in China, where religious affiliations and practices are rapidly increasing. Methods: Using cross-sectional survey data collected in Beijing and Tianjin, China from 2013-2014 (n=400), this study tests three hypotheses regarding religion and HIV sexual risk: (1) HIV vulnerabilities and testing patterns among religiously affiliated MSM are lower than for areligious MSM, (2) Religiosity is inversely associated with HIV vulnerabilities and testing, and (3) The magnitude of inverse association between religiosity and HIV vulnerabilities/ testing will be stronger among Christian and Muslim MSM than Buddhist and areligious MSM. Results: Compared to areligious participants, Buddhists had higher odds of reporting unprotected anal intercourse (UAI) (adjusted odds ratio (AOR): 2.06, 95% confidence interval (CI): 1.13-3.75) and more male sex partners (AOR: 1.95, 1.16-3.27); while Muslims had lower odds of reporting UAI (AOR: 0.33, 95% CI: 0.15-0.73) and higher odds of reporting male circumcision (AOR: 3.04, 95% CI: 1.45-6.40). Reporting of forced sex was associated with more frequent participation in social religious activities (AOR: 1.25, 95% CI: 1.02-1.52) and private religious activities (AOR: 1.30, 95% CI: 1.04-1.61). Among Christians, participation in private religious activities was associated with lower odds of reporting anal intercourse (AOR: 0.49, 95% CI: 0.27-0.88). Conclusion: The sustained growth of multiple religious traditions in China appears to have important implications for HIV vulnerability among religious minority MSM.
    Article · Jul 2016 · JAIDS Journal of Acquired Immune Deficiency Syndromes
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    [Show abstract] [Hide abstract] ABSTRACT: Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV = 12.7%; syphilis = 7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM.
    Full-text available · Article · May 2016 · AIDS Care
  • [Show abstract] [Hide abstract] ABSTRACT: We report a novel HIV circulating recombinant form (B/C) identified from ten epidemiologically unlinked individuals in Sichuan province, China, all self-report infected by heterosexual behavior. Sequencing and analyzing the near-full-length genome of these strains revealed this recombinant forms to be composed of subtype B (China and Thailand), and subtype C (India), with two subtype B segments inserted into the vpu and nef regions of the subtype C backbone. To our knowledge, this identified HIV-1 recombinant form differs from previously documented B/C forms in its distinct backbone, inserted fragment size and breakpoints. In agreement with the current HIV nomenclature system, this novel recombinant form constitutes a novel CRF (CRF85_BC). Our present findings further enrich the diversity of the prevalent HIV-1 CRFs in China.
    Article · May 2016 · AIDS Research and Human Retroviruses
  • Yi Chen · Scottie Abraham Bussell · Zhiyong Shen · [...] · Yuhua Ruan
    [Show abstract] [Hide abstract] ABSTRACT: Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs). We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40–49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time. By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%–2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%–0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%). Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.
    Article · May 2016 · Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: As a response to a severe HIV epidemic in the Liangshan Prefecture, one of the worst in China, population based HIV interventions, including two population-wide HIV screening, have been carried out since 2005 at two townships in a remote mountainous region of Liangshan. The objective of our mathematical modeling study is to assess the temporal dynamics of the HIV epidemic in the two townships based on the data collected in the study area during the period 2005–2010.
    Full-text available · Article · May 2016
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    H. Qian · Y. Ruan · Y. Liu · [...] · D. Milam
    Full-text available · Conference Paper · May 2016
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    Jing Yan · Jia Liu · Bin Su · [...] · Hui Xing
    [Show abstract] [Hide abstract] ABSTRACT: Background: The assessment of adherence to antiretroviral therapy (ART) is important in order to predict treatment outcomes. Lamivudine (3TC) is one of the most widely used NRTIs in China, but its concentrations in hair and association with virologic failure and drug resistance have not been studied. Methods: We conducted a cross-sectional survey to investigate 3TC concentrations in hair as a predictor of virologic failure and drug resistance among HIV patients receiving free ART. We also compared the capacity of hair 3TC concentrations with self-reported adherence in predicting virologic responses. Hair 3TC concentrations were detected through the LC-MS/MS system. Results: In patients without HIV drug resistance (HIVDR), with a threshold hair 3TC concentration of 260 ng/g, the sensitivity and specificity in predicting virologic suppression were 76.9% and 89.9%, respectively. Some factors, including CD4+ cell counts, initial treatment regimens with 3TC, and current regimens with second-line drugs, influenced the association between hair 3TC concentrations and virologic suppression. In patients who experienced virologic failure with HIVDR, with a threshold of 180 ng/g, the sensitivity and specificity were 70.0% and 74.4%, respectively. Hair 3TC concentrations had higher sensitivity and specificity in predicting virologic failure and drug resistance than self-reported adherence. Conclusions: The hair 3TC concentration was a stronger indicator than self-reported adherence in predicting virologic failure and drug resistance in HIV patients receiving free ART.
    Full-text available · Article · Apr 2016 · PLoS ONE
  • Jing Yan · Jia Liu · Bin Su · [...] · Hui Xing
    [Show abstract] [Hide abstract] ABSTRACT: Stratified analysis to explore factors influencing the association between viral loads and hair 3TC concentrations. (DOCX)
    File available · Data · Apr 2016
  • Jing Yan · Jia Liu · Bin Su · [...] · Hui Xing
    [Show abstract] [Hide abstract] ABSTRACT: The impact factors of virologic failure. (DOCX)
    File available · Data · Apr 2016
  • Jing Yan · Jia Liu · Bin Su · [...] · Hui Xing
    [Show abstract] [Hide abstract] ABSTRACT: Stratified analysis of factors which may influence the association between the hair 3TC concentration and the emergence of drug resistance. (DOCX)
    File available · Data · Apr 2016
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    Han-Zhu Qian · Yuhua Ruan · Yu Liu · [...] · Sten H. Vermund
    [Show abstract] [Hide abstract] ABSTRACT: Background: Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. Methods: Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. Results: Among1155 participants (242 known seropositives and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by exam) was associated with 47% lower odds of being HIV seropositive (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.27-1.02) after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR, 0.38, 95%CI, 0.09-1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR, 0.54, 95%CI, 0.25-1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR, 0.15; 95%CI, 0.04-0.65). Circumcision was not associated clearly with lower syphilis risk (aOR, 0.91; 95%CI, 0.51-1.61). Conclusions: Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
    Full-text available · Article · Apr 2016 · JAIDS Journal of Acquired Immune Deficiency Syndromes
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Recent studies have suggested that CD4 cell count monitoring has little added value in patients who are virologically suppressed and immunologically stable if viral load (VL) testing is routinely available. These conclusions have not been directly assessed by mortality as a study endpoint in a real-world setting. Methods: This HIV treatment cohort study from 2008 to 2014 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between CD4 and VL testing frequency and death. Results: Compared to testing CD4 counts at least three times within the first year of ART initiation, as currently suggested by The Chinese National Free Antiretroviral Treatment Program (NFATP), testing CD4 counts less than twice per year within the first year of ART initiation was significantly associated with death; however, testing CD4 counts twice in the first year of ART initiation did not significantly increase mortality. Compared to testing VL at least once within the first year of ART initiation, as currently suggested by NFATP, no VL tests in the first year of ART initiation was significantly associated with higher mortality. Routine CD4 cell count monitoring did not have an impact on death among HIV patients with VL <1000 copies/mL or CD4≥350 cells per microliter after 12-months post-ART initiation. Conclusions: Our study suggests that CD4 testing can be reduced to two times within the first year of ART initiation, and be reduced or stopped for patients who have achieved virological suppression or immunologically stability after 12-months of treatment.
    Article · Mar 2016 · Clinical Infectious Diseases