Study On The Current Situation And Effect Of Antiretroviral Therapy Among Newly Reorted Human Immunodeficiency Virus/Acquired Immunodefeiciency Syndrome Cases In Guangdong Province

Objective:To investigate the current situation and effect of antiretroviral therapy?ART?among newly reported human immunodeficiency virus/acquired immunodeficiency syndrome?HIV/AIDS?cases in Guangdong Province,and understand their factors,thus to provide a scientific basis for increasing the rate and effectiveness of ART.Methods:A cohort study was performed in six cities as the research sites in Guangdong Province by using convenient sampling method.Participations were considered for enrollment in this study if they were newly diagnosed from May 1^st,2018 to June 30^st,2019,aged 18 years and over,living in Guangdong recently.Based on the national HIV/AIDS comprehensive information system,a self-designed electronic questionnaire was administered to collect sociodemographic characteristics,HIV infection-related information,HIV-related symptoms before diagnosis and medical treatment behavior,knowledge and attitudes of ART and intentions to receive ART,social capital,social support,HIV-related stigma,depressive symptoms.Participations who received ART were followed up until November 31^st,2019.Statistical analyses were performed using SAS version 9.4.Quantitative data consistent with normal distribution were described using?±and qualitative data were described using frequency and percentage.Logistic regression models were used to explore influencing factors of receiving and delaying ART.Cox proportional hazards model was constructed to assess influencing factors of virological failure.Results:1.Sociodemographic characteristics:The median age of 1101participations was 44.53?30.90?56.37?years old.Most of participants weremale,age at diagnosis of HIV infection?40 years old,junior high schooland below education,married,individuals with medical insurance,personal month income?3000 yuan,persons infected with HIV through heterosexual transmission,those from medical institutions and with first CD4⁺T lymphocyte count?200 cells/?L.The delayed HIV diagnosis rate was 40.92%?408/997?.2.HIV-related symptoms and medical treatment behavior:Of 1011participations,577?57.07%?had HIV-related symptoms in the past yearbefore HIV diagnosis.The main symptoms were included“unexplained weight loss,a progressive decrease of>10%within 3 months”,“recurrent respiratory tract infection?such as colds,acute sore throat,tonsillitis,etc.?”,and“recurrent symptoms of unexplained cough,sputum,chest distress,chest pain at least 1 month”.For these 577,550?95.26%?participationshad medical treatment behavior.3.Willingness to receive ART and knowledge about ART:Most of participations?97.52%,986/1011?were willing to receive ART.In terms of ART attitudes and knowledge,61.52%?622/1011?knew that“The countryprovided ART for free.”,76.85%?777/1011?believed that“Earlier ART would delay the progress of disease.”,31.65%?320/1011?said that“Later ART would lead to drug resistance.”,70.33%?711/1011?believed that“Earlier ART could prevent spouse/lover/sex partner to be infected.”,74.88%?757/1011?agreed that“It was still a need to use condoms for each sexual behavior after ART.”,46.69%?472/1011?and 43.62%?441/1011?worried that“Earlier ART would increase the burden of life.”and“Earlier ART would make people around you suspect that you were sick.”.4.Social capital,social support,HIV-related stigma and depressive symptoms:Social capital contains four dimensions:social trust,collective efficacy,social participation,and social cohesion.The response rate of the first three dimensions were 39.76%?402/1011?,17.71%?179/1011?,and8.31%?84/1011?,respectively.The average score for social cohesion was?5.60?0.97?.The total average score of social support was?32.38?7.25?,and the average score of objective support,subjective support,and utilization of support were?6.94?2.46?,?19.52?4.97?,and?5.91?1.77?,respectively.The overall average score for HIV-related stigma was?21.93?5.04?,and the average scores of personal shame,fear of publicity,negative self-image,and concern for public attitudes were?6.45?1.81?,?3.96?1.23?,?7.51?1.98?and?4.02?1.25?,respectively.Depressive symptoms accounted for 60.04%?607/1011?.5.Status and influencing factors of receiving ART:The rate of receiving ART was 86.84%?878/1011?.Females?aOR=2.85,95%CI1.54?5.25?,college education or above?a OR=3.71,95%CI 1.37?10.08?,willing to receive ART?a OR=3.11,95%CI 1.22?7.92?were protective factors of receiving ART.The baseline CD4⁺T lymphocyte count?500cells/?L were less likely to receive ART?aOR=0.39,95%CI 0.23?0.67?.6.Situation and influencing factors of delaying ART:Prevalence of delayed ART accounted for 42.14%?370/878?.HIV diagnosis aged?30?49?years old?aOR=1.73,95%CI 1.10?2.71?and 50 years old or above?aOR=2.00,95%CI 1.18?3.42?,and those with HIV-related symptoms?aOR=1.73,95%CI 1.30?2.31?were more likely to delay ART.Participations derived from the test and consultation agency?a OR=0.69,95%CI 0.49?0.97?and with high score of social support?a OR=0.69,95%CI 0.52?0.93?had less possibility of delaying ART.7.Incidence and influencing factors of virological failure:Incidence of virological failure was 5.85%?19/325?among those who received ART for at least 6 months and received viral load test.The result of multivariate Cox proportional hazards analysis showed that,missing ART drugs?aOR=3.56,95%CI 1.18?10.72?was the risk factors of virological failure.Conclusions:1.The rate of receiving ART and virological suppression among the newly reported HIV/AIDS cases in Guangdong Province was relatively high.But the prevalence of delaying ART was also relatively high.2.The influencing factors of receiving ART were gender,education,baseline CD4⁺T lymphocyte count,and willingness to receive ART.Male,HIV/AIDS with high school education and below,those who were unwilling to receive ART,and baseline CD4⁺T lymphocyte count?500cells/?L were less likely to receive ART.3.The influencing factors of delaying ART were age at HIV diagnosis,the source of participants,HIV-related symptoms,and social support.HIV infection diagnosis aged 30 years old or above,persons with HIV-related symptoms,derived from medical institutions,and had low social support were more likely to delay ART.4.The influencing factor of virological failure was missing medications.Those who had missed medications had a higher risk of virological failure compared with those who didn't miss medications.