{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T06:15:54Z","timestamp":1777184154259,"version":"3.51.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study leverages Zhejiang Province\u2019s HIV-confirmed positive blood donor database (2017\u20132024), integrating multidimensional data including demographic, serological, geospatial, and policy indicators to systematically analyze infection risk factors, screening marker characteristics, spatiotemporal distribution patterns, migration impacts, and the regulatory effects of healthcare resource allocation and government investment on donor HIV positivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>5,204,965 voluntary donors underwent nucleic acid\/serological testing. Multivariate logistic regression, spatiotemporal scan statistics (SaTScan), estimated annual percentage change (EAPC) modeling, and correlation analyses were applied. Healthcare capacity was evaluated via principal component analysis (PCA) index; future trends projected using autoregressive integrated moving average (ARIMA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During April 2017 to December 2024, 449 HIV-positive donors were confirmed (8.63 per 100,000 donors), with significant risk factors including people moving in from high-prevalence areas (OR 1.56), male gender (OR 7.32), self-employed (OR 1.46), and non-regular donation status (OR 1.86), while older age (OR 0.97) and government employment (OR 0.49) served as protective factors. Among confirmed positives, 98.44% exhibited HIV Ag\u207aAb\u207aNAT\u207a reactivity. There was significant provincial decline in positivity (EAPC\u202f=\u202f\u221212.41, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001) with March\u2013July seasonal peak (<jats:italic>p<\/jats:italic>\u202f=\u202f0.017) and spatial cluster in northeastern Zhejiang during March 2018 (p\u202f&amp;lt;\u202f0.001). The monthly HIV-positive rate among blood donors was significantly correlated with general population AIDS incidence (r\u202f=\u202f0.445, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Age-gender disparities profiling revealed peak male positivity among 21-25-year-olds concentrated in northern Zhejiang, while females aged 46\u201350 showed the highest burden in eastern Zhejiang. Migration analysis indicated 31.02% (125\/403) of HIV-positive donors originated from 10 high-incidence provinces from 2018 to 2024, and influx correlated with birthplace-specific positivity (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Healthcare capacity (<jats:italic>p<\/jats:italic>\u202f=\u202f0.014) and government health expenditure (<jats:italic>p<\/jats:italic>\u202f=\u202f0.034) were both inversely correlated with donor positivity. ARIMA projections for 2025\u20132030 indicate oscillating declines in overall and male donors, while female rates stabilize.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Centralized testing and cross-regional deferral strategies have significantly reduced HIV positivity among Zhejiang\u2019s donors. Persistent challenges include window-period transmission, low-viremia infections under antiretroviral therapy. Further reduction of residual transfusion risks requires integrated epidemiological surveillance, high-risk population interventions, and optimized healthcare resource allocation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1666694","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T12:42:49Z","timestamp":1759408969000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Interplay of population mobility, healthcare resources, and spatiotemporal clustering: epidemiology and prevention strategies for HIV among blood donors in Zhejiang, China"],"prefix":"10.3389","volume":"13","author":[{"given":"Danxiao","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaling","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaotao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangshu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1001\/jama.2024.20424","article-title":"Restrictive vs Liberal transfusion strategy in patients with acute brain injury: the TRAIN randomized clinical trial","volume":"332","author":"Taccone","year":"2024","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1001\/jama.2022.10725","article-title":"Effect of high- vs low-dose Tranexamic acid infusion on need for red blood cell transfusion and adverse events in patients undergoing cardiac surgery: the OPTIMAL randomized clinical trial","volume":"328","author":"Shi","year":"2022","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1001\/jama.2023.12914","article-title":"Red blood cell transfusion: 2023 AABB international guidelines","volume":"330","author":"Carson","year":"2023","journal-title":"JAMA"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e00352","DOI":"10.1128\/JCM.00352-18","article-title":"Transfusion-transmitted infections: an update on product screening, diagnostic techniques, and the path ahead","volume":"56","author":"Dean","year":"2018","journal-title":"J Clin Microbiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1007\/s11904-019-00471-4","article-title":"History of the HIV epidemic in China","volume":"16","author":"Wu","year":"2019","journal-title":"Curr HIV AIDS Rep"},{"key":"ref6","year":"2025"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3431","DOI":"10.1111\/trf.15515","article-title":"Prevalence of HIV infection among Chinese voluntary blood donors during 2010-2017: an updated systematic review and meta-analysis","volume":"59","author":"Yu","year":"2019","journal-title":"Transfusion"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2024\/4749097","article-title":"Prevalence and residual risk of HIV in volunteer blood donors of Zhejiang Province, China, from 2018 to 2022","volume":"2024","author":"Zhu","year":"2024","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1111\/trf.18025","article-title":"Prevalence, incidence, and residual risk for human immunodeficiency virus among blood donors from 2003 to 2022 in Guangzhou, China","volume":"64","author":"Xie","year":"2024","journal-title":"Transfusion"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1007\/s15010-024-02389-5","article-title":"Insights into the molecular network characteristics of major HIV-1 subtypes in developed eastern China: a study based on comprehensive molecular surveillance data","volume":"53","author":"Fan","year":"2025","journal-title":"Infection"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1186\/s12889-025-21860-y","article-title":"Status and comparison of HIV knowledge, HIV testing and other healthy behavior between men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a cross-sectional study in Zhejiang Province, China","volume":"25","author":"Yang","year":"2025","journal-title":"BMC Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1186\/s12879-023-08796-7","article-title":"Factors associated with the choice of having multiple sexual partners among male college students with casual heterosexual sex in Zhejiang Province, eastern China","volume":"23","author":"Yang","year":"2023","journal-title":"BMC Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1186\/s12879-022-07279-5","article-title":"The impact of nucleic acid testing to detect human immunodeficiency virus, hepatitis C virus, and hepatitis B virus yields from a single blood center in China with 10-years review","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.ijid.2022.12.033","article-title":"Combining molecular network analysis and field epidemiology to quantify local HIV transmission and highlight ongoing epidemics","volume":"128","author":"Zhang","year":"2023","journal-title":"Int J Infect Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2326","DOI":"10.1080\/22221751.2022.2119167","article-title":"Molecular genetics and epidemiological characteristics of HIV-1 epidemic strains in various sexual risk behaviour groups in developed eastern China, 2017-2020","volume":"11","author":"Fan","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/trf.15636","article-title":"HIV prevalence and incidence estimates among blood donors in five regions in China","volume":"60","author":"Shi","year":"2020","journal-title":"Transfusion"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.tmrv.2016.11.001","article-title":"The history and challenges of blood donor screening in 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territories","volume":"392","author":"Foreman","year":"2018","journal-title":"Lancet"},{"key":"ref21","year":"2025"},{"key":"ref22","year":"2025"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1056\/NEJMcp1915826","article-title":"HIV infection - screening, diagnosis, and treatment","volume":"384","author":"Saag","year":"2021","journal-title":"N Engl J Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"120207","DOI":"10.1016\/j.cca.2025.120207","article-title":"Optimizing HIV testing: comparing diagnostic signatures and assay performance in ART-treated and general screening populations","volume":"570","author":"Liu","year":"2025","journal-title":"Clin Chim Acta"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.tmrv.2020.02.001","article-title":"Screening blood donors for HIV, HCV, and HBV at the American red Cross: 10-year trends in prevalence, incidence, and residual risk, 2007 to 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students","volume":"364","author":"Li","year":"2019","journal-title":"Science"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1186\/s12879-021-06033-7","article-title":"A spatial analysis of the epidemiology of HIV-infected students in Zhejiang province, China","volume":"21","author":"Chen","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1038\/455609a","article-title":"The changing face of HIV in China","volume":"455","author":"Lu","year":"2008","journal-title":"Nature"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e067429","DOI":"10.1136\/bmjopen-2022-067429","article-title":"Health inequalities in infectious diseases: a systematic overview of reviews","volume":"13","author":"Ayorinde","year":"2023","journal-title":"BMJ Open"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"538","DOI":"10.13284\/j.cnki.rddl.002961","article-title":"Spatial changes of AIDS 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