Kept clinical visits, as scheduled in the first 6 months of antiretroviral treatment, determine long-term treatment outcomes in people living with HIV: a large retrospective cohort study in China
Shu Su A , Limin Mao B , Jianmei He C , Xiuqing Wei C , Jun Jing D , Xi Chen C G and Lei Zhang A D E F G
+ Author Affiliations
- Author Affiliations
A School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6 The Alfred Centre (Lobby B), 99 Commercial Road, Melbourne, Vic. 3004, Australia.
B Center for Social Research in Health, Arts and Social Science, UNSW Australia, Goodsell Building, High Street, Kensington, NSW 2052, Australia.
C Hunan Provincial Center for Disease Control and Prevention, Kaifu, Furong Middle Road, Changsha, Hunan 410005, China.
D Research Center for Public Health, Room B405, Tsinghua University, Haidian District, Beijing 100084, China.
E Melbourne Sexual Health Centre, Alfred Health, Melbourne, 580 Swanston Street, Carlton, Vic. 3053, Australia.
F Present address: Central Clinical School, Faculty of Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
G Corresponding authors. Email: lei.zhang1@monash.edu; chenxi161@sohu.com
Sexual Health 15(1) 20-28 https://doi.org/10.1071/SH17099
Submitted: 15 February 2017 Accepted: 15 June 2017 Published: 14 September 2017
Abstract
Background: Routine HIV clinical monitoring is vital for people living with HIV (PLHIV) after treatment initiation. The relationship between clinical visits during the first 6 months after initial antiretroviral therapy (ART) and long-term, HIV-related mortality and service retention was investigated. Methods: A retrospective ART observational research database was established based on de-identified data extracted from 6959 records of adult HIV-positive registrants held by Hunan CDC (Center for Disease Control and Prevention) between 2003 and 2013. Results: During the first 6 months of initiation into ART, 2364 (34.0%) of PLHIV had completed four scheduled visits, meeting the Chinese ART clinical monitoring standards. From 6 months onwards (up to 36 months), this group had the lowest HIV-related mortality (4.4%) compared with those who had more or less than four kept visits in the first 6 months [one visit only: adjusted hazards ratio (AHR) = 3.15, 95% CI 2.24–3.88; two visits: AHR = 2.24, 95% CI 1.80–3.01; three visits: AHR = 1.86, 95% CI 1.69–2.05; and >4 visits: AHR = 1.37, 95% CI 1.11–1.72]. Those with less than three kept visits were also at increased risk of cohort loss to follow up (ART discontinuation, prolonged service disengagement or death). A myriad of personal, clinical and social factors are identified to be associated with increased HIV-related mortality and clinical retention. Conclusions: Enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.
Additional keywords: antiretrovirals, clinics, health services, HIV/AIDS.
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