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.

The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England

“…The first strand focuses on physical health conditions with most studies in the area of nonurgent surgical procedures such as hip and knee replacement (Braybrooke et al, 2007;Hamilton & Bramley-Harker, 1999;Hamilton, Hamilton, & Mayo, 1996;Hirvonen et al, 2007;Hirvonen et al, 2009;Ho, Hamilton, & Roos, 2000;Nikolova, Harrison, & Sutton, 2016;Quintana et al, 2011;Tuominen et al, 2009Tuominen et al, , 2010, or more urgent surgical procedures such as organ transplantation (Meier-Kriesche et al, 2000;Rauchfuss et al, 2013), and coronary artery bypass surgery (Manji, Jacobsohn, Grocott, & Menkis, 2013;Moscelli, Siciliani, & Tonei, 2016;Sari et al, 2007). Fewer studies investigate the relationship of waiting time with nonsurgical treatments such as rehabilitation (Collins, Suskin, Aggarwal, & Grace, 2015;Pedersen, Bogh, & Lauritsen, 2017), radiotherapy (Gupta, King, Korzeniowski, Wallace, & Mackillop, 2016;Noel et al, 2012;Seidlitz et al, 2015), or HIV treatment (Su et al, 2016). Results are inconsistent as to whether longer waiting causes worse chances of functional remission, recurrence, treatment adherence, quality of life, and mortality.…”

Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014: Data from the ICONA Foundation Study cohort

“…These benefits translate in a reduced clinical progression in previous cohort studies [ 10 , 11 ]. Similarly, retrospective studies have shown that long pretreatment waiting time in HIV-positive patients is associated with a higher risk of reduced cART adherence and subsequent higher mortality [ 35 ]. As previously demonstrated by HPTN052 trial, besides reducing AIDS and non AIDS related diseases, early cART initiation is also associated with a reduction of 96% in HIV transmission [ 18 , 36 ].…”

Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade

“…A recent study has shown that even in the era of ART for all PLHIV, health care providers deferred ART initiation for nearly one-in three-PLHIV due to the diagnosis of a common CMD or SUD [73]. Deferral of ART results in poor HIV clinical outcomes with an increase in lost-to-follow-up, as well as, increased mortality [74]. There are interventions for health care providers and the community, such as education and social contact, that have shown short-term gains in reducing the stigma associated with CMDs, but long term solutions remain elusive [75].…”