title: Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men.
abstract: BACKGROUND
  Early antiretroviral therapy (ART) initiation is crucial to achieve HIV viral suppression and reduce transmission. HIV-infected Chinese men who have sex with men (MSM) were less likely to initiate ART than other HIV-infected individuals. We assessed predictors of ART initiation among Chinese MSM.
  
  
  METHODS
  In 2010-2011, a cross-sectional study was conducted among MSM in Beijing, China. We examined ART initiation within the subgroup who were diagnosed with HIV infection prior to participation in the survey. Logistic regression models were fitted to evaluate socio-demographic and behavioral factors associated with ART initiation. The eligibility criterion in the 2010/2011 national HIV treatment guidelines was CD4 cell count <350 cells/μL or World Health Organization (WHO) clinical stage III/IV.
  
  
  RESULTS
  Of 238 eligible HIV-infected participants, the median duration of HIV infection was 15 months (range: 31 days-12 years); 62 (26.1 %) had initiated ART. Among 103 men with CD4 counts <350 cells/μL, 38 (36.9 %) initiated ART. Being married to a woman (adjusted odd ratios [aOR]: 2.50; 95 % confidence interval [CI]: 1.07-5.87), longer duration of HIV infection (aOR: 10.71; 95 % CI: 3.66-31.32), and syphilis co-infection (aOR: 2.58; 95 % CI: 1.04-6.37) were associated with a higher likelihood of ART initiation. Of 135 men with CD4 count ≥350 cells/μL, 24 (18 %) initiated ART. Being married to a woman (aOR: 4.21; 95 % CI: 1.60-11.06), longer duration of HIV infection (aOR: 22.4; 95 % CI: 2.79-180), older age (aOR: 1.26; 95 % CI: 1.1-1.44), Beijing Hukou (aOR: 4.93; 95 % CI: 1.25-19.33), presence of AIDS-like clinical symptoms (aOR: 3.97; 95 % CI: 1.32-14.0), and history of sexually transmitted infections (aOR: 4.93; 95 % CI: 1.25-19.43) were associated with ART initiation. Compared with men who did not initiated ART, those with ART were more likely to receive counseling on benefits of ART (96.8 % vs. 66.4 %, P = 0 < 0.01), HIV stigma coping strategy (75.8 % vs. 65.9 %, P = 0.04), mental health (66.1 % vs. 52.9 %, P = 0.02), and substance use (46.7 % vs. 36.6 %, P = 0.04).
  
  
  CONCLUSIONS
  We documented low rates of ART initiation among Chinese MSM. Policy changes for expanding ART eligibility and interventions to improve the continuum of HIV care are in progress in China. Impact evaluations can help assess continuing barriers to ART initiation among MSM.
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. yu.liu@vanderbilt.edu.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China. ruanyuhua92@163.com.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. sten.vermund@vanderbilt.edu.|Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. sten.vermund@vanderbilt.edu.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. chandra.osborn@vanderbilt.edu.|Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. chandra.osborn@vanderbilt.edu.
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. pingsheng.wu@vanderbilt.edu.|Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. pingsheng.wu@vanderbilt.edu.
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. jiay946@163.com.
authors.forename: Yujiang
authors.initials: Y
authors.lastname: Jia
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China. yshao08@gmail.com.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. han-zhu.qian@vanderbilt.edu.|Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. han-zhu.qian@vanderbilt.edu.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology* / Q000706:statistics & numerical data; D000068476:Beijing; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012749:Sexually Transmitted Diseases / Q000821:virology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000523:psychology / Q000821:virology; D013587:Syphilis / Q000150:complications