Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

Shu Su; Shifu Li; Shunxiang Li; Liangmin Gao; Ying Cai; Jincui Fu; Chunyuan Guo; Jun Jing; Liang Chen; Limin Mao; Feng Cheng; Lei Zhang

doi:10.1155/2016/2648923

Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

Biomed Res Int. 2016:2016:2648923. doi: 10.1155/2016/2648923. Epub 2016 Dec 22.

Authors

Shu Su¹, Shifu Li², Shunxiang Li², Liangmin Gao³, Ying Cai², Jincui Fu², Chunyuan Guo², Jun Jing⁴, Liang Chen², Limin Mao⁵, Feng Cheng⁶, Lei Zhang⁷

Affiliations

¹ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
² Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
³ Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China; Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
⁴ Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
⁵ Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW, Australia.
⁶ Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality and Evaluation and Control, Tsinghua University, Beijing, China.
⁷ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.

Abstract

Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm³) contributed slowly in CD4 recovery after treatment initiation (8% less, P < 0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08-1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07-1.29) and mortality rate by 11% (ARR = 1.11, 1.06-1.21), based on multivariable Cox regression. Conclusion. Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

Publication types

Observational Study

MeSH terms

Acquired Immunodeficiency Syndrome* / blood
Acquired Immunodeficiency Syndrome* / diagnosis
Acquired Immunodeficiency Syndrome* / drug therapy
Adult
CD4 Lymphocyte Count
Female
Follow-Up Studies
Humans
Male
Medication Adherence*
Middle Aged
Retrospective Studies
Time Factors