title: Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China.
abstract: BACKGROUND
  The initiation and expansion of China's national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.
  
  
  METHODS
  We evaluated all patients ≥ 16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi. Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.
  
  
  RESULTS
  A total of 83 556 patients were included. Over the study period, 30 635 (37%) of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status, incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.
  
  
  CONCLUSIONS
  Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005 - 2009. However, a sizable proportion of HIV positive patients still lack CD4 testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link patients with ART services and optimize treatment coverage.
authors: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing 100050, China.
authors: Yao
authors: Y
authors: Zhang
authors: Lin
authors: L
authors: Lu
authors: Hui-Qin
authors: HQ
authors: Li
authors: Wei
authors: W
authors: Liu
authors: Zhi-Rong
authors: ZR
authors: Tang
authors: Hua
authors: H
authors: Fang
authors: Jennifer Y
authors: JY
authors: Chen
authors: Ye
authors: Y
authors: Ma
authors: Yan
authors: Y
authors: Zhao
authors: Ray Y
authors: RY
authors: Chen
authors: Fu-Jie
authors: FJ
authors: Zhang
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D016015:Logistic Models; D008297:Male