Behavioral Intention to Initiate Antiretroviral Therapy (ART) Among Chinese HIV-Infected Men Who Have Sex With Men Having High CD4 Count in the Era of “Treatment for All”

Abstract

China has updated its national guideline recommending antiretroviral therapy (ART) to all people living with HIV (PLWH) since 2016. This study was to investigate the prevalence of behavioral intention to initiate ART among HIV-infected men who have sex with men (MSM) with CD4 levels >350 cells/mm3, who had just become eligible to receive free ART in China. A cross-sectional survey was conducted among 262 eligible HIV-infected MSM who had never received ART. The theory of planned behavior (TPB) was used to guide the variable selection. The prevalence of behavioral intention to initiate ART was 69.9%. After adjusting for significant background variables, all five constructs of TPB were significantly associated with behavioral intention to initiate ART. These significant constructs were: positive attitudes (adjusted odds ratios, AOR: 1.14; 95% CI [1.06, 1.24]) and negative attitudes (AOR: 0.89; 95% CI [0.82, 0.97]) toward immediate ART initiation; perceived their significant others would support them to initiate ART immediately (perceived subjective norm; AOR: 1.14; 95% CI [1.03, 1.25]); perceived high proportion of PLWH having similar CD4 cell levels were on ART (perceived descriptive norm; AOR: 2.22, 95% CI [1.16, 4.24]); and being confident in initiating ART immediately (perceived behavioral control; AOR: 1.21; 95% CI [1.04, 1.39]). Prevalence of behavioral intention to initiate ART was high among this group of MSM. Effective health promotion is needed to translate behavioral intention into related action. TPB may be a useful framework for developing future health promotion increasing ART coverage in this group.

Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year

“…In recent published studies, the TPB has been successfully used to explain willingness to use PrEP among GBMSM in general [27], transgender women sex workers [36] and heterosexual population [37]. Moreover, many published studies also used the TPB to explain sexual behaviors [38][39][40], and utilization of HIV testing [41] and antiretroviral therapy [42].…”

HIV Diagnosis Time Differentiates ART Initiation: Implications from a Prospective Cohort Study in China

“…Another study in South Africa found that among PLWH with CD4 between 201 to 350 cells/ul, those diagnosed after 2011 (South Africa guideline increased the threshold of CD4 to start ART from 200 to 350 cells/ul in 2011) had higher ART initiation rate than those previously diagnosed [19]. Research in China among HIV positive adolescents [20] and MSM [21] showed similar results. These cohort studies mentioned above con rmed the positive effects of broadened spectrum of eligible individuals on improving timely treatment and ART coverage.…”

Antiretroviral Therapy–Related Experiences Predict Mental Health Status Among People Living with HIV in China: A Prospective Observational Cohort Study

“…Furthermore, PLWH without xed incomes or with relatively low incomes should be prioritized in future programs, as they not only tend to drop out of programs but also to have a higher prevalence of mental health problems one year after receiving ART. Although ART is provided for free to all PLWH in China [53], PLWH still need to pay for compulsory physical examinations every three months. This nancial burden may become a stressor, especially for those with lower incomes.…”