title: Disparities in HIV Care Along the Path From Infection to Viral Suppression: A Cross-sectional Study of HIV/AIDS Patient Records in 2013, Shandong Province, China.
abstract: The 90-90-90 targets recommended by the Joint United Nations Programme on HIV/AIDS require strengthening human immunodeficiency virus (HIV) care, which includes diagnosis, linkage to and retention in care, assessment for treatment suitability, and optimization of HIV treatment. We sought to quantify patient engagement along the continuum, 10 years after introduction of Chinese HIV care policies.
  
  
  
  We included patients from Shandong, China, who were diagnosed with HIV from 1992 to 2013. Records were obtained from the HIV/AIDS Comprehensive Response Information Management System to populate a 7-step HIV care continuum. Pearson χ(2) test and multivariate logistic regression were used for analysis.
  
  
  
  Of 6500 estimated HIV-infected persons, 60.1% were diagnosed, of whom 41.9% received highly active antiretroviral therapy (HAART). Only 59.6% of patients on HAART and 15% of all infected persons achieved viral suppression. Children infected by mother-to-child transmission (MTCT) and persons infected by intravenous drug use were less likely to be linked to and retained in care (odds ratio [OR], 0.33 [95% confidence interval {CI}, .14-.80] and OR, 0.58 [95% CI, .40-.90], respectively). Persons tested in custodial institutions were substantially less likely to be on HAART (OR, 0.22 [95% CI, .09-.59]) compared with those tested in medical facilities. Patients on HAART infected by homosexual or heterosexual transmission and those infected by MTCT were less likely to achieve viral suppression (OR, 0.18 [95% CI, .09-.34]; OR, 0.12 [95% CI, .06-.22]; OR, 0.07 [95% CI, .02-.20], respectively).
  
  
  
  Our report suggests, at the current rate, Shandong Province has to accelerate HIV care efforts to close disparities in HIV care and achieve the 90-90-90 goals equitably.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee.
authors.forename: Scottie
authors.initials: S
authors.lastname: Bussell
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Guoyong
authors.initials: G
authors.lastname: Wang
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Xingguang
authors.initials: X
authors.lastname: Yang
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Huang
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Yuesheng
authors.initials: Y
authors.lastname: Qian
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Xiaorun
authors.initials: X
authors.lastname: Tao
authors.affiliation: Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China.
authors.forename: Dianmin
authors.initials: D
authors.lastname: Kang
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: China; HAART; HIV care; continuum of care; disparity