Spatiotemporal patterns and influencing factors of genotypic resistance testing utilization among people living with HIV: A 10-year retrospective analysis at a tertiary care hospital in Beijing, China (2014–2023)

IF 3.5 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Biosafety and Health Pub Date : 2025-06-01 DOI:10.1016/j.bsheal.2025.05.001

Defu Yuan , Fei Zhao , Shanshan Liu , Li Li , Hongxia Yan , Lifeng Liu , Tong Zhang , Christiane Moog , Bei Wang , Bin Su

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Abstract

Prior research indicated low genotypic resistance testing (GRT) for human immunodeficiency virus (HIV) utilization in China due to partial cost coverage under national antiretroviral therapy policies, limited testing accessibility, and financial barriers. Temporal and spatial data on GRT trends were also scarce. We analyzed GRT patterns among 6,895 untreated individuals at a tertiary hospital using Joinpoint regression, multivariable logistic modeling, and spatial analysis (GeoDa/SatScan). GRT rates showed a significant two-phase upward trend, increasing from 5.36 % in 2014 to 74.17 % in 2023, with an average annual percentage change of 31.30 % (P < 0.001). Beijing residency (adjusted odds ratio [aOR] = 2.596, 95 % confidence interval [CI]: 2.307–2.921) and older age were associated with higher GRT uptake. Specifically, ages 35–44 years (aOR = 1.207, 95 % CI: 1.026–1.420), 45–54 years (aOR = 1.335, 95 % CI: 1.104–1.613), and ≥ 55 years (aOR = 1.424, 95 % CI: 1.126–1.802) had significantly higher odds of testing. Lower testing rates were observed in individuals with lower education attainment (high school or technical secondary: aOR = 0.827; junior high school: aOR = 0.835; primary school: aOR = 0.695), unknown sexually transmitted diseases (STDs) history (aOR = 0.415), and non-heterosexual transmission routes (homosexual: aOR = 0.834). Spatial analysis identified GRT clustering across Beijing until 2021, with two space–time clusters identified in 2019–2023 and 2018–2022. This study demonstrates substantial increase in GRT uptake achieving more balanced district-level distribution since 2021. Age, educational attainment, STDs history, and transmission route influence GRT utilization. Improving access, reducing costs, and implementing targeted interventions are critical for optimizing testing and guiding antiretroviral therapy decisions.

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2014-2023年北京市某三级医院HIV感染者基因型耐药检测使用时空格局及影响因素分析

先前的研究表明，由于国家抗逆转录病毒治疗政策的部分费用覆盖、检测可及性有限以及财政障碍，中国人类免疫缺陷病毒（HIV）利用的基因型耐药检测（GRT）水平较低。关于GRT趋势的时空数据也很少。我们使用Joinpoint回归、多变量logistic模型和空间分析（GeoDa/SatScan）分析了一家三级医院6895名未经治疗的患者的GRT模式。GRT率呈明显的两期上升趋势，从2014年的5.36%上升到2023年的74.17%，年均变化幅度为31.30% (P <；0.001)。北京市居民（调整比值比[aOR] = 2.596, 95%可信区间[CI]: 2.307-2.921）和年龄与较高的GRT摄取相关。具体来说，35-44岁（aOR = 1.207, 95% CI: 1.026-1.420）、45-54岁（aOR = 1.335, 95% CI: 1.104-1.613）和≥55岁（aOR = 1.424, 95% CI: 1.126-1.802）的检测几率明显更高。受教育程度较低的个体(高中或中专：aOR = 0.827；初中：aOR = 0.835；小学：aOR = 0.695)、性传播疾病史未知（aOR = 0.415）、非异性传播途径（同性恋：aOR = 0.834）。空间分析确定了2021年前北京市的GRT聚类，并确定了2019-2023年和2018-2022年的两个时空聚类。该研究表明，自2021年以来，GRT的吸收大幅增加，实现了更平衡的地区一级分布。年龄、受教育程度、性传播疾病史和传播途径影响GRT的使用。改善可及性、降低成本和实施有针对性的干预措施对于优化检测和指导抗逆转录病毒治疗决策至关重要。

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