Skip to main content
NCBI home page
PLOS One logoLink to PLOS One
. 2021 Mar 19;16(3):e0247754. doi: 10.1371/journal.pone.0247754

HIV testing and seroprevalence among couples of people diagnosed with HIV in China: A meta-analysis

Ci Zhang 1,2, Han-Zhu Qian 1,3, Xi Chen 4, Scottie Bussell 5, Yan Shen 1,2, Honghong Wang 1,2,*, Xianhong Li 1,2,*
Editor: Qigui Yu6
PMCID: PMC7978381  PMID: 33739981

Abstract

Background

Partner notification and testing could expand HIV testing and link infections to care. We performed a meta-analysis on HIV testing rate and prevalence among couples of people diagnosed with HIV in China.

Methods

Six electronic databases (PubMed, Cochrane Library, Embase, Web of Science, the China National Knowledge Internet, and WanFang) and abstracts of five HIV/sexually transmitted infections conferences were searched up to February 1, 2020. Meta-analysis was conducted using a random-effects model to assess HIV testing rate and prevalence among couples of Chinese people diagnosed with HIV.

Results

Of 3,657 records retrieved, 42 studies were identified. Among them, three studies were conducted among pregnant women and 10 among men who have sex with men. The pooled uptake rate of couples HIV testing among Chinese people diagnosed with HIV was 65% (95% confidence interval, 57% -73%; 23 studies). The pooled HIV prevalence among couples who had an HIV test was 28% [24%-32%] (38 studies). Subgroup analyses showed that the pooled couples HIV testing uptake rates among pregnant women and men who have sex with men were 76% [66%-86%] (3 studies) and 49% [30%-68%] (8 studies), and the pooled HIV prevalence in two populations was 53% [27%-78%] (3 studies) and 14% [10%-17%] (10 studies), respectively.

Conclusions

Nearly two-thirds of couples of people diagnosed with HIV have had an HIV test, of whom 28% were positive. Couples of MSM with a positive HIV diagnosis had a lower testing rate, which indicates more effective strategies need to be carried out to improve couples HIV testing among Chinese MSM.

Introduction

Historically, intravenous drug use played a major role in HIV transmission in China; however, currently, sexual intercourse is the main mode of HIV transmission [1, 2]. Only 68% of people living with HIV (PLWH) are aware of their positive status [3], which is well below from the 90% awareness target by 2020 as set by the Joint United Nations Programme on HIV and AIDS [4]. This suggests that there is still a significant gap of HIV testing in China.

Couples HIV Testing (CHT) is an approach to have couples tested for HIV and promote HIV testing [5]. This strategy can increase their knowledge of their serostatus and encourage disclosure among people who are in an ongoing sexual relationship [6, 7]. Studies show that CHT is a feasible strategy that can expand HIV testing and further, prevent HIV transmission by increasing condom use among discordant couples [8, 9]. In addition, encouraging CHT among people who have been diagnosed with HIV (PDWH) can identify additional HIV-infected individuals and direct them to early antiretroviral therapy (ART) [10].

The World Health Organization (WHO) released guidelines for the testing and counseling of couples in 2012 and strongly recommended CHT as an essential strategy to promote HIV testing and reach more PLWH [7]. In the 13th Five-Year Plan, which mapped out the tasks to build a healthy China, the Chinese government encouraged CHT among PDWH [11]. We conducted a meta-analysis examining CHT uptake rate and HIV prevalence among Chinese PDWH in order to provide a useful summary of evidence on CHT practice and outcomes.

Materials and methods

This meta-analysis was reported according to the PRISMA guidelines (S1 Table) [12].

Inclusion criteria

We defined CHT as 1) HIV testing of sexual partners (whether married or not) reported by participants; and 2) testing recorded by the Chinese Centers for Disease Control (CDC) staff. The target population was defined as Chinese PDWH who had documented records of CHT.

Studies were eligible if they reported data on at least one of the following outcomes: the proportion of CHT among Chinese PDWH, and the HIV prevalence among CHT for Chinese PDWH. CHT uptake rate was calculated using the following formula: (number of PDWH couples who had HIV testing) / (number of PDWH). HIV prevalence among CHT was calculated using the following formula: (number of infected couples)/(number of couples who had HIV testing). Randomized controlled trials (RCTs), quasi-experimental studies, and observational (cross-sectional, cohort, and case-control) studies were eligible for inclusion. For experimental trials and cohort studies, baseline data were used for the meta-analysis. Studies were excluded if they were qualitative, a review, or a duplicate report.

Search strategy

We searched six electronic databases (PubMed, Embase, Web of Science, Cochrane Library, the China National Knowledge Internet, and WanFang) and abstracts from the International AIDS Society (IAS), HIV Diagnostics Conference (HDC), Canadian Association of HIV Research (CAHR), Infectious Diseases Society of America (IDSA), and the International Congress of Behavioral Medicine (ICBM) for publications up to February 1, 2020. Our search terms included (China OR Chinese) AND ((“couple HIV testing” OR “couples HIV testing” OR “partner HIV testing” OR “partner testing” OR “couple testing” OR “couples testing”) OR ((test OR testing) AND ("couple" OR "couples" OR "partner" OR "partners"))) AND "HIV Infections"[MeSH] OR "HIV infections" OR "HIV infection" OR "Acquired Immunodeficiency Syndrome"[MeSH] OR "Acquired Immunodeficiency Syndrome" OR "Acquired Immunodeficiency Syndromes" OR AIDS OR HIV). The search was limited to human studies, and English and Chinese language publications. We included abstracts if full texts could not be accessed, and we contacted the authors for original data if needed. Gray literature was screened using Google Scholar. In addition, the reference lists of included studies and previously published reviews were searched for additional potentially eligible studies. The literature search and study selection procedures are described in Fig 1.

Fig 1. Flow chart of literature search and selection procedures and outcomes.

Fig 1

Open in a new tab

Data screening and extraction

Two reviewers (C.Z. and Y.S.) independently screened the titles and abstracts of the articles referring to Chinese PDWH and CHT, and then screened full texts for eligibility. Discrepancies (about 5%) were resolved by discussions with a third reviewer (X.L.). A standard data extraction form was used to extract the variables (including author, year, province, study design, study period, sample size, population, type of union, outcome measurement, CHT uptake, and HIV prevalence among CHT) from the identified studies.

Quality assessment

We performed a quality assessment of the included studies using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies [13]. RCTs, quasi-experimental studies, cohort studies, and case-control studies were also evaluated using the cross-sectional study checklist, as data was only extracted from the baseline phase. The checklist has eight items, so the total score for each study ranged from 0 to 8, and it was categorized as low quality ≤ 3, moderate = 4–6, and high quality ≥ 7. The quality assessment was conducted by two independent reviewers (C.Z. and Y.S.), and the disagreements were resolved by discussion with a third reviewer (X.L.).

Statistical analysis

STATA 12.0 was used to summarize the results. A meta-analysis was conducted using the DerSimonian-Laird random-effect model to produce pooled proportions and 95% confidence intervals (95% CI) [14, 15]. Heterogeneity was assessed using I2 statistics. In addition, subgroup analyses were performed to explore the source of heterogeneity by the study population and the type of couples. In this study, we classified couples into two types: couples that were defined as people in an ongoing sexual relationship and spouses that were defined as people who have a legal marital relationship. Egger’s tests and funnel plot visual inspection were performed to detect publication bias [16]. A sensitivity analysis was performed to detect the impact of each study on the pooled estimate using the leave-one-out approach, which is a repeating procedure of removing one study from the analysis each time. There are two ways to determine that one study impacts the pooled estimate significantly: the estimate after removing this study is across the upper or lower CI limit lines of the pooled estimate; the upper or lower CI limit lines after removing this study are across the pooled estimate line.

Results

Description of included studies

A total of 3,657 records were retrieved, of which 3,647 were from database searching and 10 from other sources. After removing duplicates, 2,918 records were identified and 2,803 records were excluded by reviewing the title or abstract. The eligibility of the remaining 115 records was assessed by reviewing the full-text articles, and 73 studies were excluded. Finally, 42 studies were included in the meta-analysis (Fig 1).

These included studies were conducted between 1989 and 2019 and published during 2009–2019, which are presented in Table 1 [17–58]. Thirty-eight studies were published in Chinese [17–51, 54, 55, 58] and four in English [52, 53, 56, 57]. Geographically, the 42 included studies covered 20 provinces (58.8%) of all 34 provinces in China, with 13 studies conducted in Yunnan Province [17, 18, 21–23, 27, 31, 35, 38, 39, 51, 56, 58] and 7 studies in Guangxi Province [19, 34, 36, 41, 42, 44, 51]. The sample size varied from 28 to 48,931. Most studies were cross-sectional (83.3%, 35/42) [17, 19–22, 25–30, 32–45, 47–55, 58]. The majority of studies were conducted among general PDWH (27/42, 64.3%) [18, 20, 22, 26, 27, 29, 32–52, 54], 11 (23.8%) among men who have sex with men (MSM) [19, 23–25, 28, 30, 31, 52, 55–57], 3 (7.1%) among pregnant women [17, 21, 58], and one (2.4%) among blood transfusion recipients [53]. In most studies (85.7%) [19, 20, 22–33, 35–47, 49–56, 58], the outcomes of CHT uptake and HIV infection were recorded by a CDC staff member when PDWH couples underwent HIV testing in a CDC. Reported outcome variables included uptake of CHT (23 studies) [17–21, 24, 25, 27–31, 33, 34, 39, 40, 44, 46–48, 55, 57, 58] and HIV prevalence among CHT (38 studies) [17, 20–43, 45, 47–58]. The quality of each study was evaluated in detail (S2 Table). Most studies were assessed as high quality (38/42, 90.5%) [17–34, 36–38, 41–43, 45–58].

Table 1. Study characteristics and outcomes of Chinese couples HIV testing (CHT).

Study characteristics Outcomes Quality score
No. Publication Province Study design Study period Sample size* Population Type of union Outcome measurement CHT uptake (%)** HIV prevalence among CHT (%)***
1 Zheng [17], 2019 Yunnan CS Jan 2012-Jun 2016 5086 Pregnant women Couples Self-report 81.3 32.7 8
2 Yu [18], 2017 Yunnan CC Jul 2012-Sep 2015 223 Unspecified Spouses Self-report 25.1 NA 8
3 Lan [19], 2017 Guangxi CS Until Nov 2016 405 MSM Spouses Observation 48.1 NA 8
4 Zhao [20], 2017 Jiangsu CS Until Dec 2015 158 Unspecified Couples Observation 74.7 18.6 8
5 Wang X [21], 2015 Sichuan, Yunnan, Xinjiang CS Jan 2012-Dec 2014 2007 Pregnant women Spouses Self-report 69.7 63.6 8
6 Bai [22], 2016 Yunnan CS Jan 2014-Dec 2015 263 Unspecified Spouses Observation NA 30.4 8
7 Li Q [23], 2016 Yunnan QE May 2014-Dec 2015 105 MSM Couples Observation NA 15.2 8
8 Li [24], 2019 Liaoning RCT Aug 2017-Jan 2019 94 MSM Couples Observation 17.0 26.3 8
9 Chen [25], 2019 Zhejiang CS Sep 2015-Sep 2016 321 MSM Couples Observation 41.1 13.8 8
10 Xu [26], 2013 Hebei CS Jan 1989-Dec 2011 232 Unspecified Couples or spouses Observation NA 20.7 8
11 Xu [27], 2014 Yunnan CS Jan 1995-Dec 2013 2762 Unspecified Couples or spouses Observation 88.7 49.0 8
12 Wang [28], 2018 Jiangsu CS Jan 2010-Dec 2016 199 MSM Couples Observation 80.0 10.5 8
13 Lian [29], 2019 Fujian CS Jan 2015-Dec 2018 2937 Unspecified Spouses Observation 89.9 20.5 7
14 Da [30], 2019 Hubei CS Jan 2013-Dec 2017 2772 MSM Spouses Observation 28.9 18.7 8
15 Li Y [31], 2016 Yunnan QE May 2014-Dec 2015 118 MSM Couples Observation 60.2 13.1 8
16 Liu [32], 2018 Shanxi CS Until Nov 2015 246 Unspecified Couples or spouses Observation NA 24.0 8
17 Wang M [33], 2015 Guangdong CS Jan 2010-Dec 2012 213 Unspecified Spouses Observation 82.2 41.1 8
18 Hu [34], 2014 Guangxi CS Aug 2012-Dec 2013 425 Unspecified Couples or spouses Self-report 70.4 40.5 8
19 Zhu [35], 2010 Yunnan CS Jan 1990-Sep 2009 196 Unspecified Spouses Observation NA 52.0 6
20 Zhong [36], 2016 Guangxi CS Jan 2015-Dec 2015 45 Unspecified Couples or spouses Observation NA 26.7 7
21 Chen [37], 2018 Anhui CS Jan 2000-Aug 2016 231 Unspecified Spouses Observation NA 20.3 8
22 Duan [38], 2004 Yunnan CS March 2003 84 Unspecified Spouses Observation NA 19.0 8
23 Xi [39], 2009 Yunnan CS Jan 1996-Dec 2008 88 Unspecified Couples or spouses Observation 83.0 31.5 6
24 Xu [40], 2011 Beijing CS NA 451 Unspecified Spouses Observation 84.7 7.3 6
25 Zhu [41], 2014 Guangxi CS NA 409 Unspecified Spouses Observation NA 34.7 8
26 Chen J [42], 2018 Guangxi CS Jan 2006-Dec 2015 1658 Unspecified Spouses Observation NA 34.1 8
27 Chen [43], 2015 Fujian CS Jan 2008-Dec 2013 872 Unspecified Couples or spouses Observation NA 26.5 8
28 Nong [44], 2019 Guangxi CS Before Apr 2014 1307 Unspecified Couples or spouses Observation 76.3 NA 6
29 Yang [45], 2018 Jiangxi CS Jan 2017-Dec 2017 765 Unspecified Spouses Observation NA 31.5 8
30 Yang [46], 2019 Jiangxi RCT Jan 2018-Dec 2017 206 Unspecified Couples or spouses Observation 50.0 NA 8
31 Wang [47], 2008 Shandong CS Jan 2003-Jun 2007 62 Unspecified Spouses Observation 66.1 39.0 8
32 Zhang [48], 2015 Shanghai CS Jul 1998-Jul 2014 307 Unspecified Couples or spouses Self-report 73.9 32.5 8
33 Zeng [49], 2010 Sichuan CS Jan 2008-March 2008 226 Unspecified Spouses Observation NA 25.7 8
34 Zhang [50], 2013 Xinjiang CS Aug 2010-Feb 2011 383 Unspecified Couples or spouses Observation NA 39.4 8
35 Li J [51], 2016 Yunnan, Henan, Sichuan, Guangxi, Xinjiang CS Jan 2011-Dec 2014 48931 Unspecified Spouses Observation NA 24.6 8
36 Lian [52], 2018 Beijing, Jiangsu, Shanxi, Chongqing, Zhejiang, Hubei CS Apr 2014- Dec 2015 829 MSM Couples Observation NA 11.0 8
37 Chen S [53], 2018 Hebei CS Jan 1995-Dec 2015 285 Blood transfusion recipients Spouses Observation NA 20.8 7
38 Lin [54], 2010 Zhejiang CS May 2008-Mar 2010 129 Unspecified Couples or spouses Observation NA 47.3 7
39 Li J [55], 2017 Unknown CS Jan 2014-Jun 2015 5081 MSM Spouses Observation 73.1 7.6 7
40 Fu [56], 2016 Zhejiang, Yunnan QS June 2014-May 2015 275 MSM Couples Observation NA 10.5 8
41 Mi [57], 2015 Sichuan QS Dec 2008-Sep 2009 160 MSM Couples Self-report 45.6 25.6 8
42 Qiu [58], 2009 Yunnan CS Jul 2005-Jue 2006 28 Pregnant women Spouses Observation 78.6 63.6 7
Open in a new tab

NA, no data available; CS, cross-sectional; RCT, randomized controlled trial; QE, quasi-experimental study; CC, case-control study; PDWH, people diagnosed with HIV; Unspecified means no specific classification on the population of PDWH; MSM, men who have sex with men.

*Sample size was based on the number of PDWH.

** CHT uptake was calculated by the formula: (number of PDWH couples who had HIV testing) / (number of PDWH).

*** HIV prevalence among CHT (%) was calculated by the formula: (number of infected couples)/(number of couples who had HIV testing). Couples were defined as people in an ongoing sexual relationship. Spouses were defined as people who have a legal marital relationship.

Uptake of CHT

The pooled proportion for the uptake of CHT among Chinese PDWH was 65% (95% CI: 57%–73%). Significant heterogeneity was observed between individual studies included in the analysis (I2 = 99.6%, P < 0.001) (Fig 2).

Fig 2. Forest plot of CHT uptake among Chinese PDWH.

Fig 2

Open in a new tab

HIV prevalence among PDWH couples

Among Chinese PDWH couples, the pooled HIV prevalence was 28% (95%CI: 24%–32%) (Fig 3). Significant heterogeneity, observed between individual studies, was included in the analysis (I2 = 99.1%, P < 0.001).

Fig 3. Forest plot of HIV prevalence among couples of Chinese PDWH.

Fig 3

Open in a new tab

Subgroup analysis

The subgroup analyses are shown in Table 2. The pooled uptake rate of CHT among pregnant women (76%, 95%CI: 66%–86%) was higher than that of MSM (49%, 95%CI: 30%–68%). Of the eight studies among MSM participants, three reported that their sexual partners were their spouses (legally married women). The uptake rate of CHT among PDWH couples (49%, 95%CI: 27%–70%) was similar to that among spouses (50%, 95%CI: 17%–83%). The CHT uptake rate in Yunnan province (69%, 95%CI: 59%–80%) was slightly higher than that in Guangxi province (65%, 95%CI: 49%–81%) (Table 2).

Table 2. Subgroup analyses of uptake rate of CHT and HIV seroprevalence among PDWH couples.

Characteristic Study, No. ES (95% CI) I2, % P value for heterogeneity
Uptake rate of CHT by study population
 Pregnant women 3 0.76 (0.66–0.86) 98.0 <0.001
 MSM 8 0.49 (0.30–0.68) 99.6 <0.001
Uptake rate of CHT by type of partners
 Couples 5 0.50 (0.17–0.83) 98.0 <0.001
 Spouses 3 0.49 (0.27–0.70) 99.9 <0.001
Uptake rate of CHT by province*
 Yunnan 6 0.69 (0.59–0.80) 99.0 <0.001
 Guangxi 3 0.65 (0.49–0.81) 98.1 <0.001
HIV prevalence in CHT by study population
 Pregnant women 3 0.53 (0.27–0.78) 99.5 <0.001
 MSM 10 0.14 (0.10–0.17) 89.2 <0.001
HIV prevalence in CHT by type union among MSM study participants
 Couples 8 0.13 (0.10–0.15) 40.9 0.106
 Spouses 2 0.13 (0.02–0.24) 98.3 <0.001
HIV prevalence in CHT by province**
 Yunnan 9 0.33 (0.25–0.42) 97.3 <0.001
 Guangxi 4 0.35 (0.32–0.39) 49.2 0.116
Open in a new tab

CHT, couples’ HIV testing; PDWH, people diagnosed with HIV; MSM, men who have sex with men.

* One study was excluded for analysis [21], which only reported the total uptake rate of CHT from several provinces.

** Three studies were excluded for analysis [21, 35, 40], which only reported total HIV prevalence in CHT from several provinces.

Subgroup analysis of HIV seroprevalence among CHT showed that the pooled prevalence among couples with HIV-infected pregnant women (53%, 95%CI: 27%–78%) was higher than that among couples of MSM (14%,95%CI: 10%–17%). Of the studies among MSM participants, two studies reported that their sexual partners were specifically their spouses. If these two studies were excluded, the pooled HIV prevalence was 13% (95% CI: 2%–24%) with moderate heterogeneity (I2 = 40.7%, P = 0.106) (Table 2). The pooled HIV prevalence in Guangxi province (35%, 95%CI: 32%–39%) was slightly higher than that in Yunnan province (33%, 95%CI: 25%–42%), with moderate heterogeneity (I2 = 49.2%, P = 0.116).

Publication bias

For the meta-analyses of CHT uptake rate and HIV prevalence among partners of PDWH, both Egger’s (t = -1.74, P = 0.097; t = 0.91, P = 0.369) tests found no statistically significant difference, which indicates that there was no publication bias. However, results from the funnel plot of CHT uptake rate among PDWH couples showed that there might be missing studies at the bottom right of the graph (Fig 4), while results from the funnel plot of HIV prevalence among PDWH couples indicated that there might be missing studies from the bottom left of the graph (Fig 5).

Fig 4. Funnel plot of CHT uptake rate among PDWH couples.

Fig 4

Open in a new tab

Fig 5. Funnel plot of HIV seroprevalence among PDWH couples.

Fig 5

Open in a new tab

Sensitivity analysis

Sensitivity analyses indicated that none of the included studies significantly changed the pooled estimates for either study outcomes (Figs 6 and 7).

Fig 6. Sensitivity analysis for pooled uptake rate of CHT.

Fig 6

Open in a new tab

Fig 7. Sensitivity analysis for HIV seroprevalence among PDWH couples.

Fig 7

Open in a new tab

Discussion

This meta-analysis provided pooled estimates of the uptake rate of CHT and HIV prevalence among Chinese PDWH couples, and presented the data according to study population, type of couple, and province. The CHT uptake rate was 65% among PDWH in China and 49% among couples of HIV-infected MSM. The results suggested that there were gaps in HIV testing among discordant sexual partners. The meta-analysis showed a pooled HIV prevalence of 28% among the PDWH couples in China. Our results highlighted the long-way PDWH couples have to go in order to achieve the Chinese government’s goal to reduce HIV transmission rates between discordant spouses to below 1% by 2030 [11].

In the WHO guidelines for the “Partner Notification Policy,” partner notification relied on the PDWH themselves to notify their sexual partners and receive CHT services [59]. While, taking HIV voluntary counseling and testing is voluntary for PDWH couples across most of China [60], partner notification in the four provinces of Yunnan, Henan, Zhejiang, and Gansu is mandatory among serodiscordant spouses [60]. The WHO guidelines also recommended the promotion of CHT by advocating HIV self-testing (HIVST) among high-risk populations and PDWH couples [59]. Few studies have shown the effectiveness of improved CHT uptake through the distribution of HIVST kits to sexual partners by antenatal and postpartum women [61]. The Chinese government also encouraged the implementation of HIVST and integrated it into routine HIV testing services [11]. However, there is no evidence based on rigorously designed studies that have explored the effects of HIVST on CHT uptake among PDWH in China.

CHT uptake rate is reasonably high among pregnant women study participants (76%), where the purpose may have been the prevention of mother-to-child transmission [62]. The uptake rate was only 49% among HIV-infected MSM study participants. HIV-infected Chinese MSM may have a low rate of disclosure to their sexual partners because of the high levels of stigma and discrimination [59]. In addition, married MSM may have been concerned about the negative consequences of disclosing their sexual orientation to their female spouses [19]. These may have also led to a low CHT uptake. The CHT uptake in Guangxi province (65%) was similar to the pooled CHT uptake rate, but slightly lower than that in Yunnan province (69%). This may be due to the mandatory CHT policy among serodiscordant spouses in Yunnan province [60].

The pooled HIV prevalence in CHT was 28%, which is much higher than that among key populations in China, including MSM, injecting drug users, and sex workers [63, 64]. It is suggested that promoting CHT could be an efficient strategy to identify new infections. HIV prevalence among couples of infected pregnant women (53%) was 3.79 times higher than that among couples of infected MSM (14%). Pregnant women are not typically regarded as a high-risk population and consistent condom use is low with their partners. A recent study showed that 69% of pregnant women and their couples reported inconsistent condom use [65]. HIV prevalence rates among couples and spouses of MSM were similar. The implication may be that the wives of MSM could also be a high-risk population for HIV infection, since up to 70% of Chinese MSM would get married with women under the “filial piety” culture belief [66]. HIV prevalence rates among CHT in Yunnan (33%) and Guangzi (35%) provinces were similar, but much higher than the pooled HIV prevalence (28%). The main reason may be that both provinces have the highest HIV prevalence in China [67].

Limitations

This meta-analysis had several limitations. First, selection bias could not be ruled out because the languages of the included studies were limited to English and Chinese. Second, information bias was likely to have existed because 14.3% of outcomes were evaluated by the participants’ self-reporting. Third, the heterogeneity across the included studies was high, which may account for publication bias and limit generalizability of the findings. The main reasons might be that samples were recruited from 20 provinces with diverse HIV prevalence and partner notification policies. In addition, some studies had small sample sizes, which might also contribute to the heterogeneity.

Conclusions

Two-thirds of Chinese couples living with HIV have had an HIV test, of which 28% were positive. Couples of MSM had a lower HIV testing rate, which indicates that more effective strategies need to be carried out to improve couples’ HIV testing among the Chinese MSM population.

Supporting information

S1 Table. PRISMA 2009 checklist.

(DOC)

Click here for additional data file. (50KB, doc)
S2 Table. Assessment of methodological quality of cross-sectional studies.

(DOC)

Click here for additional data file. (113.5KB, doc)

Data Availability

All relevant data are within the manuscript and its Supporting information files.

Funding Statement

This study was funded by Central South University Innovation-driven project (XL; 2018CX036; http://www.csu.edu.cn/) and National Natural Science Foundation of China (XL; 72074226; https://isisn.nsfc.gov.cn/egrantweb/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

  • 1.UNAIDS. Global HIV & AIDS statistics-2019 fact sheet; 2019 [Cited 2020 February 26]. https://www.unaids.org/en/resources/fact-sheet
  • 2.UNAIDS. UNAIDS Data 2019; 2019 [Cited 2020 February 26]. https://www.unaids.org/en/resources/documents/2019/2019-UNAIDS-data
  • 3.General Office of the State Council of China. Notification on the prevention and treatment of AIDS in China; 2017 [Cited 2020 February 26]. http://www.gov.cn/zhengce/content/2017-02/05/content_5165514.htm
  • 4.UNAIDS. 90-90-90—An ambitious treatment target to help end the AIDS epidemic; 2017 [Cited 2020 February 26]. https://www.unaids.org/en/resources/documents/2017/90-90-90.
  • 5.WHO. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach. Geneva: World Health Organization; 2012. [PubMed] [Google Scholar]
  • 6.Hailemariam TG, Nathan S, Seifu CN, Rawstorne P. Uptake of couples HIV testing and counselling among heterosexual couples in Sub-Saharan Africa: a systematic review and meta-analysis. AIDS care. 2020;32(2):137–47. 10.1080/09540121.2019.1619667 [DOI] [PubMed] [Google Scholar]
  • 7.Loubiere S, Peretti-Watel P, Boyer S, Blanche J, Abega SC, Spire B. HIV disclosure and unsafe sex among HIV-infected women in Cameroon: results from the ANRS-EVAL study. Soc Sci Med. 2009;69(6):885–91. 10.1016/j.socscimed.2009.05.044 [DOI] [PubMed] [Google Scholar]
  • 8.Allen S, Karita E, Chomba E, Roth DL, Telfair J, Zulu I, et al. Promotion of couples’ voluntary counselling and testing for HIV through influential networks in two African capital cities. BMC Public Health. 2007;7:349. 10.1186/1471-2458-7-349 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40. 10.1097/00002030-200303280-00012 [DOI] [PubMed] [Google Scholar]
  • 10.Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev. 2013(4):CD009153. 10.1002/14651858.CD009153.pub3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.General Office of the State Council of China. The "13th Five-year Plan" on HIV prevention and control in China; 2017 [Cited 2020 February 26]. http://www.gov.cn/zhengce/content/2017-02/05/content_5165514.htm
  • 12.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. 10.1371/journal.pmed.1000097 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual: 2016 edition. Australia: The Joanna Briggs Institute; 2016.
  • 14.Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67(11):974–8. 10.1136/jech-2013-203104 [DOI] [PubMed] [Google Scholar]
  • 15.Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72(1):39. 10.1186/2049-3258-72-39 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. 10.1136/bmj.315.7109.629 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Zheng M, Guo G, Zheng J, Zhang Y, Zhou D, Zhou L. Analysis of HIV testing and associate factors among 5086 spouses of HIV infected pregnant women in Yunnan Province. Soft Science of Health. 2019;33(06):93–7. [In Chinese] [Google Scholar]
  • 18.Yu H, Han Y, Shi Y, Huo JL, Zhang XB, Yang YC, et al. Case-control study of the correlation of partner notification and HVI testing with seroconversion of spouses among human immunodeficiency virus sero-discordant couples. Chin J AIDS STD. 2017;23(10):898–900+8. [Google Scholar]
  • 19.Lan G, Liang N. High risk behaviors of MSM group living with HIV/AIDS and influencing factors of partners to receive HIV testing. J Applied Prev Med. 2017;23(05):355–8. [In Chinese] [Google Scholar]
  • 20.Zhao W, Wang Y, Chen Y, Liu Y. Analysis on HIV testing and HIV infected situation among HIV infected spouses in Jiangdu District, Yangzhou. Henan J Prev Med. 2017;28(01):34–5+ 7. [Google Scholar]
  • 21.Wang X, Wang A, Wang F, Qiao YP, Wang Q, Dou LX, et al. Partner’s HIV testing and influence factors of HIV infected maternities in some high prevalence areas of China. Chin J AIDS STD. 2015;21(06):493–6+ 522. [Google Scholar]
  • 22.Bai X, Liu H, Wang D, Ma Y, Luo QY, Zheng L, et al. Analysis on influencing factors of HIV testing and rate of HIV infections among couples of people who living with HIV. J Dermatology and Venereology. 2016;38(03):193–5. [In Chinese] [Google Scholar]
  • 23.Li Q. Feasibility study on mobilizing sex partners of HIV-positive men for HIV testing. Thesis, Kunming Medical University; 2016. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD&dbname=CMFD201701&filename=1016295934.nh&v=MjM4MTJGeXJsVTd2S1ZGMjZHTEd4RzlqUHE1RWJQSVI4ZVgxTHV4WVM3RGgxVDNxVHJXTTFGckNVUjdxZlplUnY=
  • 24.Li J. A randomized trial of improving partner notification with assisted partner notification services among HIV positive MSM. Thesis, Chinese Medical Sciences University. 2019. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD&dbname=CMFDTEMP&filename=1019891871.nh&v=MTE5Njg3RGgxVDNxVHJXTTFGckNVUjdxZlplUnZGeXJsVnIzQVZGMjZGN3V4SDluTHJwRWJQSVI4ZVgxTHV4WVM=
  • 25.Chen L, Luo M, Wang H, Zhou X, Jiang TT, Chen WJ, et al. Characteristics of HIV testing and HIV infections status among 138 sexual partners of HIV positive MSM in Zhejiang. Chin J AIDS STD. 2019;25(05):464–7. [Google Scholar]
  • 26.Xu Z, Wang Z, Li C. Analysis of HIV antibody test results in 232 HIV/AIDS and their spouses or fixed sex partners. Zhongguo Wei Sheng Jian Yan. 2013;23(05):1245–7. [Google Scholar]
  • 27.Xu L, Bao W, Deng L, Qin L, Liu LM, Mao BB, et al. Factors Influencing HIV Testing of spouse/regular sexual partners of HIV/AIDS In Qujing City from 1995 to 2013. Chin J Derm Venereol. 2014;28(10):1040–2. [Google Scholar]
  • 28.Wang C, Rong Y. Follow-up analysis of HIV infected men who have sex with men in Guangling district, Yangzhou from 2010 to 2016. Jiangsu J Prev Med. 2018;29(5):520–1. [In Chinese] [Google Scholar]
  • 29.Lian Q, Zhang M, Liu M, Wu SB, Chen L. HIV detection and its influencing factors among spouses of newly registered HIV/AIDS patients in Fujian province. Chin J Public Health. 2019;35(11):1579–84. [Google Scholar]
  • 30.Da Q, Peng G, Tang H, Zheng W. Marital status and spouse’s HIV detection of HIV positive men who have sex with men in Hubei. Chin Trop Med. 2019;19(06):538–41 [Google Scholar]
  • 31.Li Y, Zhang R, Wang Y, Li Q, Li ZQ, Wang L, et al. Feasibility of their sex partners accepting HIV antibody tests mobilized by MSM infected with HIV. Chin J AIDS STD. 2016;22(11):883–6. [Google Scholar]
  • 32.Liu Y. Analysis on HIV testing and influencing factors among couples of HIV infections in Linfen City. Chinese Remedies & Clinics. 2018;18(02):282–4. [In Chinese] [Google Scholar]
  • 33.Wang M, Sun Y, Li L, Chen CY, Lai XH, Chen JH, et al. Analysis of the HIV antibody test and the follow up of the spouse of 213 HIV/AIDS in Zhongshan City. Chin J AIDS STD. 2015;21(09):766–9. [Google Scholar]
  • 34.Hu L. Serostatus disclosure and associated factors among people living with HIV/AIDS (PLWHA) in Liuzhou City, China. Thesis, Anhui Medical University; 2014. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD&dbname=CMFD201402&filename=1014320182.nh&v=MTIxMTRyblZMdkJWRjI2R3JDNkh0REVyWkViUElSOGVYMUx1eFlTN0RoMVQzcVRyV00xRnJDVVI3cWZaZVJ2Rnk=
  • 35.Zhu R, Xiang X. Analysis on HIV testing among 196 couples of HIV infections. Health World. 2010;04(2):69. [In Chinese] [Google Scholar]
  • 36.Zhong J, Pan Y, Chen Y. Survey on the status of HIV /AIDS patients’ spouses / fixed partners with HIV infection. J Med Pest Control. 2016;32(12):1358–60. [Google Scholar]
  • 37.Chen H, Ma G, Chen D. HIV infection and influencing factors in spouses of HIV/AIDS. Prev Med. 2018;30(7):658–61, 66. [Google Scholar]
  • 38.Duan S, Xiang L, Huang S, Wu QB, Liu WH, Li ZR, et al. Analysis on voluntary couples HIV testing of HIV infected patients. Chin J AIDS STD. 2004(01):62. [In Chinese] [Google Scholar]
  • 39.Xi J, Sun X, Su J, Hou WJ, Zhang JX. Situational investigation in HIV status among partners of people with HIV/AIDS. Soft Science of Health. 2009;23(02):232–3. [Google Scholar]
  • 40.Xu P, Liu K, Lv F. Analysis on status quo of spousal notification of HIV infectors. Chinese Journal of Health Policy. 2011(10):55–9. [Google Scholar]
  • 41.Zhu Q, Liu W, Zhu J, Zheng WB. Survey on people lived with HIV / AIDS and their spouses. J Prev Med Inf. 2014;30(9):700–3. [Google Scholar]
  • 42.Chen J, Liao J, Nong H, Liang X. Change trend and influencing factors of HIV infection among the spouses of HIV/AIDS patients in Baise. The Journal of Practical Medicine. 2018;34(15):2548–51. [Google Scholar]
  • 43.Chen L, Zhang M, Lin X, Yan YS. HIV infection among couples and regular sexual partners of HIV / AIDS patients in Fujian province. Chin J Public Health. 2015;31(12):1536–8. [Google Scholar]
  • 44.Nong L, He B, Tang H, Cen P, Lin Q, Li SS, et al. Referral service model and its effect evaluation among HIV/AIDS patients in Nanning city, Guangxi. Pract Prey Med. 2019;26(8):919–23. [Google Scholar]
  • 45.Yang Q, Hu Q, Zhang S. Analysis on HIV infections and influencing factors among couples of HIV infections in Jiangxi Province. Applied Prev Med. 2018;24(4):273–5. [In Chinese] [Google Scholar]
  • 46.Yang R, Yan Y, Gong X. Evaluation on the implementation of HIV/AIDS self-health management program in Ganzhou city, Jiangxi province. Guo Ji Bing Du Xue Za Zhi. 2019;26(5):341–4. [Google Scholar]
  • 47.Wang C, Zhang R. Survey of infectious status of HIV in couples in Caoxian County. CHINA TROPICAL Med. 2008;8(12):2201,13. [Google Scholar]
  • 48.Zhang Y, Yin F, Zhong P, He N. Practice and correlates of partner notification of HlV infection status among 307 HIV-Infected individuals of Shanghai. Chin J Prev Med. 2015;49(11):956–61. [PubMed] [Google Scholar]
  • 49.Zeng G, Chen H, Li C, Zhang JH, A LLQ, Ku YH, et al. Survey on HIV-infection of spouses of HIV infected persons in Liangshan, Sichuan province. Disease Surveillance. 2010;25(6):461–3. [Google Scholar]
  • 50.Zhang M, Wang Y, Lu Y, Ma L, He Z, Rui BL, et al. Survey of HIV Infection among HIV Positive Couples in Urumqi. Medical Information. 2013(17):58–9. [Google Scholar]
  • 51.Li J, Tang H, Han J, Xu J, Shen ZY, Lai WH, et al. HIV transmission in newly reported HIV infected couples before diagnoses in five provinces. China, 2011–2014. Chin J Epidemiol. 2016;37(11):1497–502. [DOI] [PubMed] [Google Scholar]
  • 52.Lian Y, Zhao Y, Wang J, Cynthia S, Kerong W, Xia W, et al. A health communication intervention to integrate partner testing with antiretroviral therapy service among men who have sex with men in China: an observational cohort study. BMC Public Health. 2018;18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Chen S, Lu X, Bai G, Zhang YQ, Li BJ, Wang W, et al. Twenty-seven year surveillance of blood transfusion recipients infected with HIV-1 in Hebei Province, China. Plos One. 2018;13(8). 10.1371/journal.pone.0202265 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Lin H, Fei J, Wu Q, Qiu DH, Gao MY, He N. Risk behavioral networks of newly reported HIVinfections in Taizhou prefecture, Zhejiang province. Chin J Epidemiol. 2010;31(11):1227–30. [PubMed] [Google Scholar]
  • 55.Li J, Han J, Xu J, Tang HL, Mao YR. Status of marriage and HIV transmission between couples in newly reported HIV cases before diagnosis was made, among men who have sex with men in China, 2014. Chin J Epidemiol. 2017;38(6):750–3. [DOI] [PubMed] [Google Scholar]
  • 56.Fu X, Qi J, Hu Y, Pan XH, Li YF, Liu H, et al. Partner notification in cooperation with community-based organizations among HIV-positive men who have sex with men in two Chinese cities. Int J STD AIDS. 2016;27(10):821–31. 10.1177/0956462416648827 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Mi G, Wu Z, Wang X, Shi CX, Yu F, Li T, et al. Effects of a quasi-randomized web-based Intervention on risk behaviors and treatment seeking among HIV-positive men who have sex with men in Chengdu, China. Curr HIV Res. 2015;13(6):490–6. 10.2174/1570162x13666150624104522 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Qiu XR, Zhou CD, Du J. Transmission mode of HIV /AIDS and spouse infection among 28 HIV positive pregnant women. Maternal and Child Health Care of China. 2009;24(31):4365–6. [Google Scholar]
  • 59.WHO. Guidelines on HIV Self-Testing and Partner Notification: Supplement to Consolidated Guidelines on HIV Testing Services. Geneva: World Health Organization; 2016. [PubMed] [Google Scholar]
  • 60.He HJ, Xu P, Xin QQ, Zeng J, Zhang LL, Sun DY, et al. Study on spousal notification in HIV discordant couples and associated factors in four provinces of China. Chin J Epidemiol. 2015;36(6):565–8. [PubMed] [Google Scholar]
  • 61.Masters SH, Agot K, Obonyo B, Napierala MS, Maman S, Thirumurthy H. Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial. PLoS Med. 2016;13(11):e1002166. 10.1371/journal.pmed.1002166 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37(5):1620–6. 10.1097/00126334-200412150-00016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63.Zhang Z, Li J, Chen LJ, Xu XH, W YL, Xu YY, et al. Characteristics of heterosexual behaviors and associated factors in men who have sex with men in Taizhou, Zhejiang,2018. Disease Surveillance. 2019;34(11):1017–21. [Google Scholar]
  • 64.Hao Y, Cui Y, Sun XH, Guo W, Xia G, Ding ZW, et al. A retrospective study of HIV /AIDS situation: a ten-year implementation of “four frees and one care”policy in China. Chinese journal of disease control & prevention. 2014;18(5):369–74. [Google Scholar]
  • 65.Hatcher AM, Darbes L, Kwena Z, Musoke PL, Rogers AJ, Owino G, et al. Pathways for HIV Prevention Behaviors Following a Home-Based Couples Intervention for Pregnant Women and Male Partners in Kenya. AIDS Behav. 2020;24(7):2091–2100. 10.1007/s10461-019-02774-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Zhang BC, Li XF, Shi TX, Yang LG, Zhang JD. Preliminary estimates of the gay/bisexual population and HIV prevalence in China. Chin J AIDS STD. 2002;(04):197–9. [Google Scholar]
  • 67.Ding QY, Yang Z, Zhou QY. Spatial changes of AIDS epidemic and population mobility in China. Tropical Geography. 2017; 37(4):538–546. [Google Scholar]

Decision Letter 0

Qigui Yu

12 Oct 2020

PONE-D-20-11075

HIV testing and seroprevalence among couples of people living with HIV in China: a meta-analysis

PLOS ONE

Dear Dr. Xianhong Li,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by April 8, 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Qigui Yu, M.D./Ph.D

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2.  We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.  

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following:

●      The name of the colleague or the details of the professional service that edited your manuscript

●      A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)

●      A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: First Read:

The paper is well written and does a great job reporting all necessary components of a systematic review and meta-analysis. The research questions and purpose are clear and straightforward. The search strategy and review methodology were clearly described and appropriate, however the manuscript needs to be reviewed for grammar and syntax, preferably by a native English speaker to improve clarity of your prose. Below are some of my concerns and questions.

General comments and questions:

To examine CHT and HIV prevalence among Chinese living with HIV - isn't this 100% prevalence? To be accurate should this be HIV prevalence among Chinese people. Or are you hoping to estimate prevalence of HIV among Chinese people who do not know their status? Or maybe discordant couples?

From further reading, I am assuming Chinese PLWH = Serodiscordant Chinese couples -> This needs to be better clarified and I have pointed it out in a few places, but this needs to be used consistently throughout the paper

Abstract:

It would be helpful to know how many studies attributed to each of the analysis with the estimates, it would clarify why MSM is stated to have 10 studies, however table 2 shows 8 studies for Uptake rate and 10 for HIV prevalence.

Line 21-22: "…among couples of Chinese people living with HIV…" - it is unclear whether or not both have HIV (seroconcordant) or only one person has HIV (serodiscordant). Assuming it is the latter, this needs to be written to be explicitly and clear throughout the paper.

Line 28-29: "We conducted three studies among…" - this is confusing, are there words missing? Should it be, "We conducted a subgroup analysis…"?

Line 36-37: "Almost two-thirds of Chinese couples living with HIV have had an HIV test, of which 28% were positive" - this implies that of the two-thirds that’s were tested, 28% were HIV positive. Were the 28% HIV-positive among the 65% who were tested or are these estimates separately calculated?

Introduction:

Line 45-46: the goals of 90-90-90 are: 90% of all people living with HIV will know their HIV status-90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy-90% of all people receiving antiretroviral therapy will have viral suppression. Testing coverage is not specified in the goals.

Line 53-54: "…encouraging CHT among PLWH could identify additional HIV infected individuals…" This is a very confusing statement, I think PLWH is meant to be "undiagnosed" or "serodiscordant"? Similar language is used throughout the introduction and needs to be clarified.

Methods:

Line 70: "…the proportion of CHT among Chinese PLWH…" for clarification, what is the denominator in this? Is it Chinese people living with HIV or Chinese couples or serodiscordant couples? This is somewhat described in the footnote in table 1, but this should be included in the text

Line 101: what were some of the variables extracted from the included studies? Was timeframe of testing abstracted, lifetime vs recent testing? This could have implications for interpreting results.

Line 118-119: were the couples assumed to be sexually monogamous couples or was this information collected?

Line108: Can you describe what some of these 8 items are assessing? Even in the supporting documents the scoring sheet does not describe the questions.

Line 121: What is the threshold for determining if a study does impact the pooled estimate in a meaningful way

Results:

The Uptake of CHT and Proportion of HIV among PLWH couples could be presented in tabular format, maybe integrated with table 2? The figures themselves can be difficult to interpret for readers who are not familiar with forest plots.

Line 136: Can an additional analysis of CHT and HIV prevalence be conducted among the some of the larger provinces that had a lot of data reported for them? This would be interesting to see.

Line 178: did any of the subgroup analyses uncover any sources of heterogeneity?

Line 200: The Eggers test may not have shown statistical evidence of publication bias, however I must disagree about the assessment of the funnel plots. Figure 4 seems to indicate there may be missing studies at the bottom right of the graph. Figure 5 seems to indicate some missing studies from the bottom left of the graph. However, this may not be helpful as these tests and bias assessments do not work well when heterogeneity is high. I think justifying lack of evidence for bias could be from your comprehensive search (of published and gray literature) would better serve the paper rather than the statistical testing.

Discussion:

The couples are now described as discordant sexual partners - This is the language that should be used throughout the paper rather than referring to them as Chinese PLWH couples.

Are there any efforts to increase serodiscordant couple HIV testing for the Chinese population? Are there any outside China that could be adapted and used?

Another potential limitation is the generalizability of the findings, meaning how well are these Chinese discordant couples included in the studies representative of all Chinese serodiscordant couples?

Tables and figures:

The figures need to be labeled and annotated in order for readers to be able to understand the them as a standalone result.

Reviewer #2: Please review and edit the article to be clearer. While the paper did meet expectations laid out in the abstract and the conclusions were well-thought out and appropriate given the data, there were several areas where more concise/clear language could have been used.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Jeffrey S Becasen

Reviewer #2: No

NOTE: While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Decision Letter 1

Qigui Yu

16 Feb 2021

HIV testing and seroprevalence among couples of people diagnosed with HIV in China: A meta-analysis

PONE-D-20-11075R1

Dear Dr. Li

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Qigui Yu, M.D./Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

Acceptance letter

Qigui Yu

10 Mar 2021

PONE-D-20-11075R1

HIV testing and seroprevalence among couples of people diagnosed with HIV in China: A meta-analysis

Dear Dr. Li:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Qigui Yu

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Table. PRISMA 2009 checklist.

    (DOC)

    Click here for additional data file. (50KB, doc)
    S2 Table. Assessment of methodological quality of cross-sectional studies.

    (DOC)

    Click here for additional data file. (113.5KB, doc)
    Attachment

    Submitted filename: Response to reviewers.docx

    Click here for additional data file. (259.4KB, docx)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting information files.

    Articles from PLoS ONE are provided here courtesy of PLOS

    RESOURCES