title: Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes.
abstract: Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P< 0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08-1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07-1.29) and mortality rate by 11% (ARR = 1.11, 1.06-1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.
authors.affiliation: School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Shu
authors.initials: S
authors.lastname: Su
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Shifu
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Shunxiang
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China; Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Liangmin
authors.initials: L
authors.lastname: Gao
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Jincui
authors.initials: J
authors.lastname: Fu
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Guo
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
authors.affiliation: Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China.
authors.forename: Liang
authors.identifier: 0000-0001-6373-2442
authors.initials: L
authors.lastname: Chen
authors.affiliation: Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW, Australia.
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality and Evaluation and Control, Tsinghua University, Beijing, China.
authors.forename: Feng
authors.identifier: 0000-0003-3196-434X
authors.initials: F
authors.lastname: Cheng
authors.affiliation: School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
authors.forename: Lei
authors.identifier: 0000-0003-2343-084X
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors