The Current Status And Relevant Influencing Factors Of Cotrimoxazole (CTX) Prophylaxis In AIDS Adult Patients In A High HIV Prevalence Area

ObjectiveTo study the current status and influencing factors of cotrimoxazole (CTX) prophylaxis on Acquired Immune Deficiency Syndrome (AIDS)-related opportunistic infections (OIs) among AIDS adult patients in high HIV prevalence area, namely Liangshan Yi Autonomous Prefecture, Sichuan Province, and to provide solutions to the problems, evidence for policy making aimed at reducing mobidity and motality resulted from AIDS-related OIs.MethodsWe conducted the study with combination of quantitative and qualitative research methods.The quantitative research included the following three parts:a) The antiretroviral therapy(ART) database of AIDS control and prevention comprehensive information system from January2010to April2013in Liangshan was used to describe demographic characteristics of AIDS adult patients with record of nadir CD4T-lymphocyte cell (CD4cell) count less than200/mm3tested after year2010. We compared the demographic characteristics between CTX group and no-CTX group.b) We selected3counties in Liangshan to conduct questionnaire investigations among AIDS adult patients with or without ART, who had at least one record of CD4cell count less than200/mm3tested between January1,2010and Apri30,2013. The questionnaire included demographic characteristics, the patients’CTX prophylaxis and awareness of CTX, accessibility to CTX and HIV/AIDS knowledge. We utilized the Non-conditional Logistic Regression to explore the influencing factors of CTX prophylaxis.c) We investigated the doctors in charge of HIV control and prevention in local areas with self-designed questionnaire which included HIV control related training, CTX prophylaxis knowledge and prescription of CTX in medical practice. Multiple linear regression was utilized to explore the influencing factors of CTX prophylaxis knowledge of doctors.The qualitative research included the interviews of the doctors face to face. We enquired the doctors about HIV realted training, knowing of CTX prophylaxis, barrier of CTX prophylaxis and suggestions on CTX prophylaxis. We summarise the doctors’main opinions on CTX prophylaxis after coding, classification and checking of the investigated materials.Resultsa) After analysis of ART database of AIDS control and prevention comprehensive information system, we knew that the proportion of CTX prophylaxis of AIDS adult patients in Liangshan is19.5%(276/1416). The CD4cell count at ART baseline of CTX group was lower than that of no-CTX group. The on-ART years between CTX group and no-CTX group were not significantly different.b) We collected412questionnaires of AIDS patients with the median age37years old (Interquantile range,1QR32-42). Among these patients, the male accounted for69.9%(288/412), Yi nationality86.7%(357/412), married73.3%(302/412), illeterated54.1%(223/412), peasants86.2%(355/412), respectively. Sixty two point four percent of the patients infected HIV via injection drug use.Eighty nine patients out of412(21.6%) reported having taken CTX. Three hundred and twenty three patients did not take CTX prophylaxis, mainly due to lacking of doctors’recommendation (66.9%,216/323) or their unawareness of CTX (26.9%,87/323). Eighty nine patients took CTX prophylaxis, mainly due to doctors’recommendation (80.9%,72/89) or awareness of the benefit of CTX prophylaxis (14.6%,13/89). The median time of CTX prophylaxis in patients with CTX prophylaxis is5months (IQR2.5-12).The doctors’recommendation of CTX to the patients, the awareness of the benefit of CTX prophylaxis were the factors fasciliting CTX prophylaxis, the odds ratios (ORs, and95%CIs) were483.5(98.6-4839.7) and6.3(1.1-35.6), respectively. Yi nationality got less education, and were less likely to take CTX prophylaxis compared with other nationalities.c) We investigated40doctors in A and B counties about their CTX knowledge. The median time of ART related job is2years, with IQR of1-4.5years. The median training time is30days, with IQR of14-68days. The full scores of CTX knowledge is17and the average score of the40doctors’is6.7±3.75. The doctor’s education levels and work time are the main influencing factors of CTX prophylaxis knowledge.ConclusionsThe proportion of CTX prophylaxis among AIDS adult patients in Liangshan is low, merely20%. The low proportion of CTX prophylaxis is mainly due to lacking of relevant training of the doctors, lacking of the awareness of the benefit of CTX prophylaxis and partially due to no energy and time on CTX prophylaxis. The low education of AIDS adult patients resulted in the unawareness of the benefit of CTX prophylaxis, and publication on HIV/AIDS and CTX prophylaxis should be strengthened.