Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score–Matched Analysis of Surveillance Data From 2006 to 2021

Abstract

Background Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. Objective We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. Methods We performed a propensity score–matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. Results A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. Conclusions The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.

Adapting Cognitive Remediation Group Therapy Online: Focus Groups with People Aging with HIV

“…Community-based services help people living with HIV to connect with each other and access programs and services for health and well-being. 47 , 48 While a systematic review and meta-analysis has determined that, overall, HIV infection did not significantly increase risk of COVID-19 mortality, 49 there were fears that the immunodeficiency virus could exacerbate COVID-19 infection. Discrete studies showed upwards of 38% greater risk of severe illness and death due to COVID-19 among people living with HIV compared to the general population.…”

Adapting cognitive remediation group therapy: A community-based, focus group study

“…Some participants highlighted a certain loss of community during the COVID-19 pandemic, and a desire to gather with their peers once again. The HIV/AIDS epidemic has long been understood as exceptional [45], and a key component of that exceptionalism is the existence of community-based HIV services (e.g., AIDS Committee of Toronto, AIDS Programs South Saskatchewan) in many cities worldwide where people living with HIV can connect with each other and access programs and services for health and well-being [46,47]. While a systematic review and meta-analysis has determined that overall, HIV infection did not significantly increase risk of COVID-19 mortality [48], there were fears that the immunodeficiency virus could exacerbate COVID-19 infection; discrete studies had found upwards of 38% greater risk of severe illness and death due to COVID-19 amongst people living with HIV compared to the general population [49].…”