Study On The Current Situation And Influence Factors About Acceptance And Maintenance Of ART Among PLWHA

Objective: To investigate the current situation about receiving and maintaining anti-retroviral therapy(ART)among people living with HIV and AIDS(PLWHA),and analysis the influencing factors.To explore the strategies and measures of increasing the ART ratio,providing some refrences for carring out “Treat all” measures,achieving the target of “HIV/AIDS 90-90-90”,and expanding ART coverage.Methods: Selecting Chongqing and Qiandongnan of Guizhou province as the research sites.This study combines with structured and unstructured interview.Structured interview: using the data from the system for prevention and control of AIDS during the July 1,2016 to November 30,2016.PLWHA were grouped by never taking ART,persisting in ART,and withdrawing ART.The persons who can visit will be investigated by Questionnaire from face to face.The questionnaire including personal,AIDS-related,ART-related general situation.Descriptive analysis method was used to describe the characteristics of PLWHA.Unconditional logistic regression to analyze the main impacts factors about accepting and maintaining ART.The unstructured interview:We conducted in-depth individual interviews on PLWHA and staff of the health administration department,medical insurance agency,CDC and hospitals.The interview results were summarized and sorted out to further analyse the factors affecting the acceptance and maintenance of ART.Results: This study collected 563 valid questionnaires totally,including 250 were never treated group and 227 were persisting in treatment group,the other 86 were withdrawal treatment group.Qualitative interviews with 17 staff members and 17 PLWHA.1.The impact factors about accepting ART: Univariate analysis showed that age,gender,nation,marital status,years of HIV diagnosis,whether to raise children or get medical assistance,were associated with the acceptability of ART(P<0.05).These factors were included into a multivariable logistic regression model,the results indicated that the willingness to accept ART were associated with the following factors(P<0.05): The Miao and Dong minority(OR=2.351,95%CI:1.532~3.590),unmarried(OR=1.842,95%CI:1.215~2.795),divorced/widowed/separated(OR=2.970,95%CI : 1.965~4.567),years of HIV diagnosis in 1~5(OR=2.990,95%CI :1.703~5.250),not the object of medical assistance(OR=3.092,95%CI :1.705~5.607),are the adverse factors for receiving ART.2.The impact factors about maintaining ART: Univariate analysis showed that age,nation,education level,profession,ways of infection,whether to raise children or support the elders,whether to take drugs on time or occur ART drug side effects,whether get the support by family members or going out for work in the past 5 years,years of HIV dagnosis(P<0.05).These factors were included into a multivariable logistic regression model,the results indicated that: People aged 40 and above(OR=3.701,95%CI:1.149~9.862),the Miao and Dong minority(OR=7.924,95%CI:1.920~3.590),going out for work in the recent 5 years(OR=6.931,95%CI:1.832~10.593),have occured ART drug side effects(OR=19.429,95%CI:5.640~34.299),not take drugs on time(OR=22.563,95%CI:4.802~49.741),are the adverse factors for maintaining ART.3.Through in-depth interviews,the main reasons affecting local PLWHA’ willingness about receiving and maintaining ART were summed up as follows:From the perspective of ART service system for AIDS,there are some problems in mechanism of ART work,allocation of resources and the measures of medical insurance and assistance.From the perspective of PLWHA’ own aspect,these factors such as their general,economic,physical and social support situation,have an influence on whether to accept and maintain ART or not.Conclusion: 1.The impact factors about accepting ART manily include: nation,marital status,years of HIV diagnosis confirmation,whether get medical assistance.2.The impact factors about maintaining ART manily include: age,nation,whether take drugs on time or occur drug side effects,whether going out for work in the past 5 years.3.Through in-depth interviews,whether to receive and maintain ART or not is affected by many factors of their own and the whole ART service system for AIDS.So it is not only do we need to educate and interfere with PLWHA,but also need to strengthen the construction of the whole AIDS antiviral treatment service and guarantee system.We can improve the work mechanism of ART,deploy medical resources rationally,improve medical insurance and assistance measures,encourage the development of ART drugs,and creat a social environment without discrimination.