Factors Associated With Delayed and Late Initiation of Antiretroviral Therapy Among Patients With HIV in Beijing, China, 2010–2020

Mi, Yuanqi; Zhou, Mei; Zeng, Yuhong; Gao, Liangmin; Wang, Peicheng

doi:10.3389/ijph.2023.1605824

Cited by 4 publications

(6 citation statements)

References 32 publications

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“…Although marital status was not statistically significantly associated with TTAT-initiation in the present study, the predictor has been established as an independent factor elsewhere [44] with reports that being married is associated with lower risk of late ART-initiation [109]. The Iran study exploring factors associated with late ART-initiation observed that being single was associated with late ART start by 80% (aOR: 1.8, 95%CI:1.17-2.78) [103] as was also reported in China [104]. This study also found that dependency on guardian escort was 9% negatively associated with early ART-initiation.…”

Section: Discussionsupporting

confidence: 73%

“…The current study finding on younger age Vs TTAT are in congruent with West African multinational study reported that younger age (of at least 24 years) was associated with early ART-initiation [94] – a similar association was also observed from South African KwaZulu Natal study [102]. The KwaZulu Natal study reported that early mid-age (of 35-44 years) had a 63% positive association with early ART-initiation (in males) and 90% probability (in females) whereas being ≥45 years old was a barrier to early ART-initiation [102] – the findings also shared in a study from Iran where old age was reported to be significantly associated with risk of late ART-initiation [aOR:1.02, 95%CI:(1.00-1.04)] [103] and a similar pattern was also observed from China [104].…”

Section: Discussionsupporting

confidence: 61%

“…Contrastingly, a study from Mozambique reported that female gender was associate with lower risk of late ART-initiation [109]. In addition, an RSA study exploring determinants of time-to-ART-initiation observed similar to the present study that hypothesised that females were associated with early ART-initiation – i.e., females had higher probability to rapid ART-initiation [(aHR=3.12-fold, 95%CI:2.87–3.38, p < 0.0001), (aOR=11.92-fold, 95%CI:( 9.81–14.52), p < 0.0001)] [99] likewise a study from China [104]. The gender difference observed in the present study and from studies from other SSA nations in comparison to those from developed nations like the US highlight the fact that within developing nations, males have less health-seeking behaviours than females [110, 111].…”

Section: Discussionsupporting

confidence: 52%

“…Nonetheless, a multicentre study from Europe examining TTAT-initiation reported that Tuberculosis (TB), a mycobacterial condition, explained a 38% negative association with rapid ART-initiation (i.e., had longer time to ART-initiation) (aHR=0.62, 95%CI: 0.48-0.80), p<0.01 [100]. In a different study from China, TB was 42.80-fold highly likely to be associated with late/delayed ART start [104]. These findings, though the effect size (ES) estimates were larger than the present study, supports the present study’s findings on association of aetiological agents responsible for causing ODs; in this case, mycobacterial causes, on TTAT-initiation.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Salema

2024

Preprint

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BackgroundDespite globally adapted universal test-and-treat (UTT) strategy of HIV management, survival time-to-antiretroviral-therapy initiation (TTAT) remains heterogenous and affected by diverse factors which remain unexplained in Malawi. This study explored correlates to TTAT-initiation in Malawi among adults living with HIV.MethodsA multicentre retrospective cohort study was undertaken from eight centres. Medical records of (n=9,953) adult patients aged 15+ years old, were reviewed. A life table, the Kaplan-Meier log-rank, and Cox Proportion Hazard regression were used to calculate survival TTAT-initiation and its correlates, respectively. Adjusted Hazard ratio less than 1 (aHR <1) signified factors negatively associated, while aHR >1 meant factors positively associated with TTAT-initiation. Hazard ratio with 95% Confidence interval (95%CI) andp<0.05 were used to declare statistical significance.ResultsData from (n=9,953) adult HIV patients were abstracted from hospital medical records. Patients median age was 40 (IQR: 33-48 years). 60.8% were females, 45.2% were younger adults of 20-39 years, and 78.8% were either married or cohabiting. 48.1% had advanced HIV disease; WHO clinical stage III, 24.5% had WHO stage IV, whereas 27.5% were asymptomatic; thus; 24.9% initiated ART due to low CD4+ count and 2.6% under PMTCT’s Option-B+. Findings from TTAT-initiation survival function analysis show that each patient had a single entry into the study and provided a total of 5,414 event-time-intervals, giving a 100% total event-failure without censored observations. Mean and median survival times were 527.2 days and 6 (IQR 0-5,414) days, respectively. Treatment-initiation (time at risk) was observed at the rate of 0.002 per 5,247,268 person-years. From multivariable Cox PH regression analysis, independent factors identified to be negatively associated with early (timely) antiretroviral treatment-initiation included; older age of 55+ years by 16% [aHR 0.84, 95%CI: (0.71–0.97)], male gender by 4% [aHR=0.96, 95%CI: (0.92–0.98)], bacterial causes by 5% [aHR=0.95, 95%CI: (0.89–0.99)], mycobacterial causes by 14% [aHR=0.86, 95%CI: (0.81–0.92)], high viraemia VL>1,000 copies/mL by 17% [aHR=0.83, 95%CI: (0.81–0.95)], registered in secondary tier and tertiary tier health facilities by 21% [aHR 0.79, 95%CI: (0.73-0.86) and 14% [aHR 0.86, 95%CI: (0.79-0.93) respectively, longer HIV survivorship (duration) by 58% to 85%, and having respiratory symptoms like coughing or breathlessness by 7% [0.93 95%CI: (0.88–0.97)]. These factors acted as barriers to early time-to-ART-initiation. In contrast younger adults of 20-39 years; [aHR=1.04, 95%CI: (1.02–1.19)], early mid-aged patients of 40-54 years; [aHR=1.03, 95%CI: (1.01– 1.21)], incomplete basic education level; [aHR 1.09, 95%CI: (1.02-1.20)], secondary education level; [aHR=1.06, 95%CI: (1.01-1.12)], Northern and Southern regions ethnicity; [aHR=1.07, 95%CI: (1.02–1.16)] and [aHR=1.06, 95%CI: (1.01–1.12) respectively, manifesting chronic headache or fevers; [aHR=1.12, 95%CI: (1.04–1.21)], being asymptomatic; [aHR=1.02, 95%CI: (1.02–1.13), (p<0.041)], being immunosuppressed with WHO clinical stage III; [aHR=1.86, 95%CI: (1.21-3.45)], WHO clinical stage IV; [aHR=2.80, 95%CI: (1.20-3.22)], protozoal pathological infection; [aHR=1.06, 95%CI: (1.02-1.15)], low CD4+ cell count <250 cells/µL; [aHR=1.05, 95%CI: (1.01–1.09), self-employment [aHR=1.04, 95%CI: (1.00–1.09)], and year of HIV diagnosis variable, were all positively associated with treatment-initiation and acted as precursors to early (timely) ART-initiation.ConclusionThe study demonstrates that apart from meeting clinical eligible, different clinical and nonclinical factors contributed to time-to-treatment initiation among adults living with HIV. These factors; which are still prevalent in Malawi, have contributed to the spiralling and high mortality and morbidity from HIV/AIDS in Malawi and– hence, a knowledge of their existence, coupled with efforts to counteract and halt their occurrences, and strategies to strengthen and sustain the gained milestones in all tiers of health facility establishments across Malawi cannot be overemphasised.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Salema

2024

Preprint

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“…This pattern could result from underlying factors, including low perception of and misconceptions regarding transmission risks, stigma and subsequent underreporting of transmission from MSM, along with poor risk assessment and sexual history collection by healthcare providers [28]. Late initiation of ART was defined as having CD4 counts <200 cells/μl or having a clinical AIDS diagnosis at ART initiation [29]. The proportion with CD4 counts <200 cells/μl significantly decreased from 2010 to 2013 among PLWH in older and younger groups, and delayed initiation of ART significantly improved from 2014 to 2020 for both groups.…”

Section: Discussionmentioning

confidence: 99%

Treatment‐naïve people living with HIV aged 50 years or older in Beijing, China, 2010–2020: joinpoint regression model analysis of surveillance data

Wang,

Zhou,

Wang

et al. 2023

J Int AIDS Soc.

Self Cite

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IntroductionAs they age, people living with HIV (PLWH) must face new challenges, such as accelerated ageing and higher rates of comorbidities. This study described the characteristics of HIV acquisition among treatment‐naïve PLWH aged ≥50 years and <50 years in Beijing from 2010 to 2020, exploring associated risk factors for comorbidities.MethodsIn this cross‐sectional study, differences in HIV‐related and non‐HIV‐related characteristics were compared using the t‐test, Mann−Whitney U test and chi‐square test. Temporal trend data were analysed via joinpoint regression. A multivariate logistic regression model was conducted to analyse the associated factors with PLWH having one or more comorbidities.ResultsThe proportion of PLWH aged ≥50 years has significantly increased since 2013, with a corresponding increase in homosexual transmission in this age group over the past decade. The proportion of individuals with CD4 counts <200 cells/μl significantly decreased from 2010 to 2013 among PLWH aged ≥50 years and from 2010 to 2014 among those aged <50 years. Delayed initiation of antiretroviral therapy (ART) improved for both age groups over the course of the decade, especially from 2014 to 2020. Compared to PLWH aged <50 years, those aged ≥50 years had a higher proportion of CD4 counts <200 cells/μl, higher levels of plasma HIV RNA load and a higher prevalence of non‐HIV‐related risk factors. Multivariate analysis revealed that PLWH aged ≥50, male, not single, transmission through heterosexual contact or drug injection, WHO Stage IV, coinfection with hepatitis B virus/hepatitis C virus and CD4 counts <200 cells/μl at the initiation of ART were associated with higher risk of the presence of an HIV comorbidity.ConclusionsDue to the persistent burden of HIV‐related characteristics or symptoms and the increasing prevalence of coexisting comorbidities among treatment‐naïve PLWH aged ≥50 years, physicians should provide the highest‐quality screening, prevention, treatment and management of coexisting comorbidities, adopting a multidisciplinary approach.

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Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

sharafi,

Mirahmadizadeh,

Hassanzadeh

et al. 2024

Sci Rep

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Early initiation of Antiretroviral Treatment (ART) in HIV patients is essential for effectively suppressing the viral load and prognosis. This study utilized National HIV/AIDS Surveillance Data in Iran to identify factors associated factors with the duration to initiate ART. This hybrid cross-sectional historical cohort study was conducted on Iran’s National HIV/AIDS Surveillance Data from 2001 to 2019. Sociodemographic characteristics, route of transmission, HIV diagnosis date, and ART initiation date were collected. Multivariable linear and quantile regression models were employed to analyze the duration to initiate ART by considering predictor variables. This study included 17,062 patients (mean age 34.14 ± 10.77 years, 69.49% males). Multivariate quantile regression coefficients varied across different distributions of the dependent variable (i.e., duration to initiate ART) for several independent variables. Generally, male gender, injecting drug use (IDU), and having an HIV-positive spouse were significantly associated with an increased duration to initiate ART (p < 0.05). However, a significant decrease was observed in older patients, those with a university level education, men who had sex with men (MSM), and patients diagnosed after 2016 (p < 0.05). Despite improvements in the duration to initiate ART after implementing the WHO’s 2016 program in Iran, various sociodemographic groups were still vulnerable to delayed ART initiation in the region. Therefore, programs including early testing, early ART initiation, active care, educational and cultural interventions, and appropriate incentives are required for these groups.

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Factors Associated With Delayed and Late Initiation of Antiretroviral Therapy Among Patients With HIV in Beijing, China, 2010–2020

Cited by 4 publications

References 32 publications

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Treatment‐naïve people living with HIV aged 50 years or older in Beijing, China, 2010–2020: joinpoint regression model analysis of surveillance data

Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

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