title: Loss to Follow-Up from HIV Screening to ART Initiation in Rural China.
abstract: BACKGROUND
  Patients who are newly screened HIV positive by EIA are lost to follow-up due to complicated HIV testing procedures. Because this is the first step in care, it affects the entire continuum of care. This is a particular concern in rural China.
  
  
  OBJECTIVE
  To assess the routine HIV testing completeness and treatment initiation rates at 18 county-level general hospitals in rural Guangxi.
  
  
  METHODS
  We reviewed original hospital HIV screening records. Investigators also engaged with hospital leaders and key personnel involved in HIV prevention activities to characterize in detail the routine care practices in place at each county.
  
  
  RESULTS
  699 newly screened HIV-positive patients between January 1 and June 30, 2013 across the 18 hospitals were included in the study. The proportion of confirmatory testing across the 18 hospitals ranged from 14% to 87% (mean of 43%), and the proportion of newly diagnosed individuals successfully initiated antiretroviral treatment across the hospitals ranged from 3% to 67% (mean of 23%). The average interval within hospitals for individuals to receive the Western Blot (WB) and CD4 test results from HIV positive screening (i.e. achieving testing completion) ranged from 14-116 days (mean of 41.7 days) across the hospitals. The shortest interval from receiving a positive EIA screening test result to receiving WB and CD4 testing and counseling was 0 day and the longest was 260 days.
  
  
  CONCLUSIONS
  The proportion of patients newly screened HIV positive that completed the necessary testing procedures for HIV confirmation and received ART was very low. Interventions are urgently needed to remove barriers so that HIV patients can have timely access to HIV/AIDS treatment and care in rural China.
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Diane
authors: D
authors: Gu
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Yurong
authors: Y
authors: Mao
authors: Guangxi Center of Disease Control and Prevention, Nanning, Guangxi, China.
authors: Zhenzhu
authors: Z
authors: Tang
authors: BC Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada.
authors: Julio
authors: J
authors: Montaner
authors: Guangxi Center of Disease Control and Prevention, Nanning, Guangxi, China.
authors: Zhiyong
authors: Z
authors: Shen
authors: Guangxi Center of Disease Control and Prevention, Nanning, Guangxi, China.
authors: Qiuying
authors: Q
authors: Zhu
authors: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America.
authors: Roger
authors: R
authors: Detels
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Xia
authors: X
authors: Jin
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Ran
authors: R
authors: Xiong
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Juan
authors: J
authors: Xu
authors: Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
authors: Walter
authors: W
authors: Ling
authors: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
authors: Lynda
authors: L
authors: Erinoff
authors: The EMMES Corporation, Rockville, MD, United States of America.
authors: Robert
authors: R
authors: Lindblad
authors: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
authors: David
authors: D
authors: Liu
authors: The EMMES Corporation, Rockville, MD, United States of America.
authors: Paul
authors: P
authors: Van Veldhuisen
authors: Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
authors: Albert
authors: A
authors: Hasson
authors: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors: Zunyou
authors: Z
authors: Wu
mesh_terms: D015492:AIDS Serodiagnosis; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002681:China; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D012424:Rural Population
chemical_list: D019380:Anti-HIV Agents