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Health disparities affecting persons living with HIV (PLWH) as well as those affecting individuals who use substances have been documented in China. However, health status and outcomes within the intersectional population of those who both live with HIV and use substances is not well understood. One hundred and sixty-nine PLWH receiving care in China completed surveys assessing HIV-clinical factors, substance use, and HIV-related physical health symptoms. We tested associations between substance use and health symptoms using multivariate logistic and ordinal regressions. Using one substance over the past week was associated with greater maximal severity of physical symptoms (p

Vaccines play essential roles in the fight against the COVID-19 pandemic. The development and assessment of COVID-19 vaccines have generally focused on the induction and boosting of neutralizing antibodies targeting the SARS-CoV-2 spike (S) protein. Due to rapid and continuous variation in the S protein, such vaccines need to be regularly updated to match newly emerged dominant variants. T-cell vaccines that target MHC I- or II-restricted epitopes in both structural and non-structural viral proteins have the potential to induce broadly cross-protective and long-lasting responses. In this work, the entire proteome encoded by SARS-CoV-2 (Wuhan-hu-1) is subjected to immunoinformatics-based prediction of HLA-A*02:01-restricted epitopes. The immunogenicity of the predicted epitopes is evaluated using peripheral blood mononuclear cells from convalescent Wuhan-hu-1-infected patients. Furthermore, predicted epitopes that are conserved across major SARS-CoV-2 lineages and variants are used to construct DNA vaccines expressing multi-epitope polypeptides. Most importantly, two DNA vaccine constructs induce epitope-specific CD8 + T-cell responses in a mouse model of HLA-A*02:01 restriction and protect immunized mice from challenge with Wuhan-hu-1 virus after hACE2 transduction. These data provide candidate T-cell epitopes useful for the development of T-cell vaccines against SARS-CoV-2 and demonstrate a strategy for quick T-cell vaccine candidate development applicable to other emerging pathogens.

ABSTRACTAlthough depression has been associated with low QOL, limited research has quantified the change of depression to improvement of QOL among naïve PLHIV using ART in Shanghai, China. This study examined the association between depression symptoms and QOL among Chinese PLWH in a six-month longitudinal study. Data were collected from 111 people living with HIV at baseline, 3rd month and 6th month after initiating ART, using the WHOQOL-HIV BREF and the Center for Epidemiologic Studies Depression Scale (CES-D), and analyzed using a mixed effects model. QOL is improved after initiating ART, while the symptoms of depression did not decrease significantly. The depression symptoms were strong and negatively associated with QOL and all domains of QOL, and the strength of this association decreased over time in the six months follow-up. ART had different impacts on depression symptoms and QOL. Besides, depression symptoms were strong and negatively associated with QOL among PLHIV over time. Mental health practitioners and nurses should consider the ART and time factors when designed interventions to improve QOL by targeting depression symptoms. Interventions designed to improve QOL and depression symptoms should be developed targeting both ART and self-management among PLHIV.

ObjectiveWe aimed to describe how the prevention and controlling strategies have been experienced by COVID-19 patients in China, especially those who had passed through the suspected, diagnosed, hospitalized, and recovery stages of the disease.DesignA descriptive qualitative study followed the Standards for Reporting Qualitative Research guidelines.SamplesCOVID-19 patients were recruited from a COVID-19-designated facility in Shanghai, China, from April to June 2020, by the purposive sampling method.MethodsSemi-structured, in-depth interviews by cell phone were used and transcriptions were analyzed using inductive qualitative content analysis method.ResultsWe recruited 26 COVID-19 patients. Three theme categories emerged from the data analysis. The first was "Consciously adhere to COVID-19-related controlling strategies." The second category was "Positive experiences of the COVID-19-related controlling strategies." These patients experienced a quick and adequate medical response, confident in the medical system, or received help from community workers. The third category was "Negative experiences of the COVID-19-related controlling strategies." These patients experienced psychological distress, stigma, privacy exposures, and inconveniences from the controlling strategies.ConclusionsIt is urgent to develop a culturally sensitive intervention to eliminate the psychological distress and stigma of patients with COVID-19 and to protect their privacy during and after the pandemic.

BackgroundThe aim of this study was to adapt and modify the HIV/AIDS Stigma Instrument-Patient to develop the COVID-19 Stigma Instrument-Patient (CSI-P) and validate its psychometric characteristics, as well as explore how affected individuals in China experienced COVID-related stigma and its associated variables, including depressive symptomology and quality of life (QOL).MethodsFrom September to October 2020, 151 COVID-19 survivors recruited in Shanghai, China, completed a set of measures of demographic characteristics, depression, stigma, and QOL.ResultsThe 15-item CSI-P-2 achieved a Cronbach's α of 0.67 to 0.91. The six-factor structure was obtained by exploratory factor analysis. The mean score for the CSI-P-2 in Chinese COVID survivors was 8.14 ± 9.98. Regression analysis showed that survivors' age, comorbid diseases, education levels, and loneliness level were the factors influencing their COVID-19 stigma, explaining 37.80% of the total variance (F = 19.25, p

ObjectiveTo investigate the status of different antiretroviral therapy（ART） initiation times in patients with HIV/AIDS and analyze the relevant characteristics and influencing factors of delayed ART.MethodsFrom December 2018 to December 2020， a survey was conducted among adult HIV/AIDS patients treated in 28 designated AIDS prevention and treatment institutions in Beijing， Shanghai， Guangdong， Jiangsu， Henan， Jiangxi， Guangxi， Yunnan and other places. Data of the basic demographic information， lifestyle and chronic disease prevalence， and characteristics of diagnosis and treatment were collected. The characteristics and related factors of delayed ART were compared and analyzed.ResultsThe median age of 1 741 patients was 41 years old （IQR： 32‒52）. The initial CD4 count of most patients was less than 200 cells·μL-1（51.4%）. Among them， 1 027 patients had delayed ART （59.0%）， and the association between ART initiation time and initial CD4 count varied with the time of diagnosis of HIV infection. Multivariate logistic analysis showed that the older age （aOR=0.99， 95%CI： 0.98‒0.99） was associated with a higher rate of starting ART within 1 month after diagnosis， while those diagnosed before 2017 and with the initial CD4 count >200 cells·μL-1 were more likely to delay ART. Delayed initiation of ART may be a risk factor for poor sleep quality and co-infection in HIV/AIDS patients.ConclusionWith the expansion of free ART in China， the proportion of delayed ART with HIV/AIDS shows a downward trend. Timely ART management should be strengthened for the young HIV/AIDS patients and patients with high CD4 counts.

BackgroundThe aim of this study was to adapt and modify the HIV/AIDS Stigma Instrument-Patient to develop the COVID-19 Stigma Instrument-Patient (CSI-P) and validate its psychometric characteristics, as well as explore how affected individuals in China experienced COVID-related stigma and its associated variables, including depressive symptomology and quality of life (QOL).MethodsFrom September to October 2020, 151 COVID-19 survivors recruited in Shanghai, China, completed a set of measures of demographic characteristics, depression, stigma, and QOL.ResultsThe 15-item CSI-P-2 achieved a Cronbach's α of 0.67 to 0.91. The six-factor structure was obtained by exploratory factor analysis. The mean score for the CSI-P-2 in Chinese COVID survivors was 8.14 ± 9.98. Regression analysis showed that survivors' age, comorbid diseases, education levels, and loneliness level were the factors influencing their COVID-19 stigma, explaining 37.80% of the total variance (F = 19.25, p

ABSTRACTAlthough depression has been associated with low QOL, limited research has quantified the change of depression to improvement of QOL among naïve PLHIV using ART in Shanghai, China. This study examined the association between depression symptoms and QOL among Chinese PLWH in a six-month longitudinal study. Data were collected from 111 people living with HIV at baseline, 3rd month and 6th month after initiating ART, using the WHOQOL-HIV BREF and the Center for Epidemiologic Studies Depression Scale (CES-D), and analyzed using a mixed effects model. QOL is improved after initiating ART, while the symptoms of depression did not decrease significantly. The depression symptoms were strong and negatively associated with QOL and all domains of QOL, and the strength of this association decreased over time in the six months follow-up. ART had different impacts on depression symptoms and QOL. Besides, depression symptoms were strong and negatively associated with QOL among PLHIV over time. Mental health practitioners and nurses should consider the ART and time factors when designed interventions to improve QOL by targeting depression symptoms. Interventions designed to improve QOL and depression symptoms should be developed targeting both ART and self-management among PLHIV.

The aim of this study was to describe the resilience of nurses who cared for patients with a confirmed COVID-19 diagnosis, as well as factors that potentially contributed to that resilience. A total of 23 frontline nurses who cared for patients with COVID-19 were recruited from a COVID-19-designated facility in Shanghai, China, using purposive sampling strategies. In-depth interviews were conducted from March to May 2020. Qualitative data were transcribed verbatim and content analysis was used. Nurses exhibited psychological resilience while caring for patients with COVID-19. They displayed an ability to bounce back from negative mental experiences and transform to a positive mindset to cope with the stress they faced. Factors that enhanced the nurses' resilience during the pandemic were their becoming familiar with infectious disease protocols, having a sense of professional achievement, receiving social support, having trust in the infection-control response team in the hospital, and using self-regulation strategies. This study could guide the design of future resilience-enhancing interventions that provide positive coping strategies for nurses caring for individuals with infectious diseases during a pandemic.

COVID-19 infection can cause psychological distress and profoundly impact patients' lives, but it can also lead to positive changes and post-traumatic growth (PTG), or positive psychological change in response to challenging life circumstances. Current research on the influence of COVID-19 infection has mainly focused on its negative effects. Therefore, the aim of this study was to investigate whether patients with COVID-19 in China experienced PTG and, if so, what changed for them during the process of PTG. We used a qualitative descriptive approach to conduct this study. Using the purposive sampling recruitment method, patients with a confirmed COVID-19 diagnosis were recruited from a COVID-19 designated hospital in Shanghai, China, from April to July 2020. Data were collected using semi-structured, in-depth interviews conducted via cell phone or in person while social distancing to prevent the spread of COVID-19. Forty confirmed COVID-19 patients (19-68 years old) were recruited. Several prominent themes and subthemes were extracted from the interview responses regarding participants' experiences of PTG. The following are among the positive changesthat occurred for these participants after their diagnosis of COVID-19: (1) Reevaluation of their life priorities, which included a greater appreciation of being alive and re-evaluating their values and goals, (2) Improved relationships within their social circles, which included establishing or maintaining closer relationships with family and friends and a greater willingness to help others, and (3) Perceived changes regarding themselves, which included personal growth and increased awareness of the importance of their health. The study identified potential positive impacts of COVID-19 on patients, which could be helpful in the implementation of interventions to facilitate PTG among COVID-19 survivors.

The authors have requested that this preprint be removed from Research Square.

Although parental HIV disclosure has benefits for parents and children, the disclosure rate among parents remains low. This study aims to qualitatively examine parental concerns regarding disclosure of their HIV status to their children. Eighty parents were enrolled in a randomized controlled trial of a three-session disclosure-support intervention, with forty receiving the intervention and forty receiving treatment as usual. Intervention sessions were audio recorded, and transcriptions were qualitatively coded for content related to concerns of disclosure. Four themes emerged: Intention to disclose, disclosure approach, indicators for disclosure, and fears about disclosure. These themes reveal struggles that parents experience when considering HIV disclosure suggesting that an effective disclosure intervention must help parents assess pros and cons, discuss the emotions of the children after the disclosure, and monitor the impact on children's lives after disclosure over time. Future research is needed to implement interventions supporting HIV-positive parents' disclosure decision-making and actions.

Non-tuberculous mycobacteria (NTM), an opportunistic pathogen, generally rarely causes disease in immunocompetent populations unless host immune defenses are compromised. Acquired immune deficiency syndrome (AIDS) patients have a severe deficiency in immune function due to the destruction of CD4+ T lymphocytes by human immunodeficiency virus (HIV) in the body. When patients are infected with NTM, NTM is likely to colonize and eventually lead to disseminated NTM disease (DNTM). In recent years, the number of tuberculosis patients worldwide has been on a downward trend. However, the number of AIDS patients with NTM is on the rise with the AIDS epidemic, the increase in the number of immunosuppressed people, and the continuous advances in laboratory techniques for NTM testing. Compared with tuberculosis, our public health administration system has not incorporated NTM infection into the reporting system, and the previous clinical attention was insufficient, so the systematic studies are limited. The 5-year case fatality rate of AIDS patients with DNTM in some areas of China was as high as 26.7%. The disease is a great threat to patients' life and health, and consumes a lot of medical resources. At present, China still faces great challenges in differential diagnosis, treatment, and high fatality rate of NTM. Therefore, it is urgent to strengthen the clinical knowledge of DNTM and improve disease prevention and control as well as clinical response capabilities. In this study, the recent research progress of DNTM was reviewed to provide a reference and basis for clinicians to diagnose and treat AIDS with DNTM.

AimTo understand COVID patients' experiences of and perspectives on disclosure of their illness and to explore and describe the factors affecting disclosure decisions among COVID patients in China.BackgroundDisease disclosure is a critical component of prevention and control of a virus outbreak, and this is especially true during the COVID-19 pandemic. Understanding COVID patients' experiences and perspectives on disclosure could play a vital role in COVID management.DesignA qualitative study.MethodsA semi-structured interview guide was used to conduct qualitative in-depth interviews from April to June 2020. All the interviews were audio-recorded and transcribed, and then, a thematic analysis was conducted. The Standards for Reporting Qualitative Research (SRQR) were applied to this study.ResultsA total of 26 COVID-confirmed patients were recruited for the in-depth interviews. Four themes emerged from the thematic analysis on disclosure: persons disclosed to, reasons for disclosure, reasons for nondisclosure and impact of disclosure. The participants disclosed their COVID diagnosis to different groups, including family, close friends, community members and workplace contacts. The main reasons for disclosure included the following: government policy, social responsibility, gaining support and fear of being blamed for nondisclosure. However, some participants decided not to disclose to some groups for fear of facing stigma and discrimination or to protect family members from discrimination. Despite the potential benefits of obtaining support after disclosure, many participants did experience stigma and discrimination, privacy exposure, psychological distress and social isolation.ConclusionsAn individual's decision as to whether to disclose their COVID-positive status is affected by many factors. To prevent the spread of COVID-19 and reduce the potential risks of disclosure, such as discrimination and privacy exposure, a balanced intervention should be designed to protect COVID patients and to secure any contact tracing. Therefore, the chances of discrimination could be decreased and patients' confidentiality could be protected.Relevance to clinical practiceAs the number of COVID patients increases, disclosure of an individual's infectious status is encouraged by health departments. Despite the potential benefits of disclosure, discrimination and privacy exposure should not be ignored. A disclosure protocol is necessary to ensure patients' privacy regarding their COVID status.