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HBV and HCV test uptake and correlates among men who have sex with men in China: a nationwide cross-sectional online survey
  1. Thomas Fitzpatrick1,
  2. Stephen W Pan2,3,
  3. Weiming Tang3,
  4. Wilson Guo4,
  5. Joseph D Tucker3,5
  1. 1 School of Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Department of Public Health, Xi’an Jiaotong–Liverpool University, Suzhou, Jiangsu, China
  3. 3 UNC Project-China, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4 Gillings School of Global Public Health—Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, USA
  5. 5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Thomas Fitzpatrick, School of Medicine, University of Washington, Seattle WA 98195, USA; tsfitz{at}


Objectives Hepatitis B virus (HBV) and hepatitis C virus (HCV) cause substantial morbidity and mortality in low-income and middle-income countries, including China. WHO guidelines recommend men who have sex with men (MSM) receive HBV and HCV screening. The purpose of this study was to determine the proportion of MSM in China who have HBV and HCV tested and identify correlates of test uptake.

Methods We conducted an online cross-sectional survey of young MSM in China. Respondents were asked to report previous HBV and HCV testing, sociodemographic information, sexual risk factors for hepatitis infection, other STI testing and primary care physician (PCP) status. Associations were analysed by logistic regression.

Results 503 eligible MSM completed the survey. 41.0% (206/503) of MSM had HCV tested, and 38.2% (60/157) of MSM with no or uncertain HBV vaccination had HBV tested. In multivariate analysis, HCV testing was correlated with HBV testing (adjusted OR (aOR) 22.98, 95% CI 12.11 to 43.60), HIV testing (aOR 3.64, 95% CI 1.92 to 6.91), HIV-positive status (aOR 1.78, 95% CI 1.07 to 2.98) and having a PCP (aOR 2.40, 95% CI 1.44 to 3.98). Among MSM with no or uncertain HBV vaccination, HBV testing was correlated with HCV testing (aOR 80.85, 95% CI 20.80 to 314.33), HIV testing (aOR 5.26, 95% CI 1.81 to 15.28), HIV-positive status (aOR 3.00, 95% CI 1.22 to 7.37) and having a PCP (aOR 2.69, 95% CI 1.00 to 7.26).

Conclusions Our data suggest many young MSM in China have not received hepatitis testing. HCV testing rates were lower than those recently reported among MSM in Australia and the USA. The strong correlation between HBV and HCV testing suggests bundled testing interventions may be useful for MSM in China. Men with a PCP were more likely to have received hepatitis testing, consistent with literature demonstrating the importance of primary care in expanding access to testing.

  • hepatitis B
  • hepatitis C
  • China
  • gay men

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  • Handling editor Gary Brook

  • Contributors TF and JDT conceived the study. TF, JDT, WT, SWP and WG contributed to survey development. SWP and WT provided statistical expertise. JDT provided oversight. TF wrote the initial drafts of the paper and oversaw the editing process with input from JDT, SWP and WT. All authors read and authorised the final manuscript before submission.

  • Funding This work was supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at University of North Carolina Chapel Hill. TF is a Doris Duke International Research Fellow. This work was also supported the National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310-01), UNC–South China STD Research Training Center (Fogarty International Center 1D43TW009532-01), National Institutes of Health Fogarty International Center (R25TW009340) and SESH Global ( This work also received administrative assistance from the Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou Eighth People’s Hospital, UNC Chapel Hill and UNC Project-China.

  • Disclaimer The listed funders played no role in the development or implementation of this study.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board (IRB) approval was obtained from the following institutions prior to study enrolment: University of North Carolina at Chapel Hill (IGHID 11706) and Nanshan Center for Disease Control.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We encourage interested parties to contact the corresponding author with data sharing requests, including for access to additional unpublished data.