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Objective To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China.Methods Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015.Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China.Results The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1％ (17 784/250 645) in 2011 to 10.3％ (54 596/528 226) in 2015 (Z=51.38,P＜ 0.000 1) in China.The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3％ (6 641/17 784) in 2011 to 71.0％ (38 783/54 596) in 2015,showing a significant rising tendency (Z=96.23,P＜0.000 1),but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5％,338 654/473 630).Multivariate logistic regression analysis showed that the PLWHA who were females,aged ≥50 years,of Han ethnic group,married or had spouse,had the educational level of high school or above,infected through homosexual intercourse,with CD4+T cells counts ≤500 cells/μl at the first visit,identified to be infected with HIV in medical setting,living in urban areas et al,were more likely to receive free antiretroviral therapy.Conclusions The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics.It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.
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Objective To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China.Methods Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015.Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China.Results The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1％ (17 784/250 645) in 2011 to 10.3％ (54 596/528 226) in 2015 (Z=51.38,P＜ 0.000 1) in China.The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3％ (6 641/17 784) in 2011 to 71.0％ (38 783/54 596) in 2015,showing a significant rising tendency (Z=96.23,P＜0.000 1),but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5％,338 654/473 630).Multivariate logistic regression analysis showed that the PLWHA who were females,aged ≥50 years,of Han ethnic group,married or had spouse,had the educational level of high school or above,infected through homosexual intercourse,with CD4+T cells counts ≤500 cells/μl at the first visit,identified to be infected with HIV in medical setting,living in urban areas et al,were more likely to receive free antiretroviral therapy.Conclusions The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics.It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.
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Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.
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Objective To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago.Methods Retrospective cohort study and cross-sectional analysis had been conducted in this study.368 449 cases that had received the ‘free antiviral therapy’ from 2002 to 2014 were selected from the National Treatment Database.Data from the baseline (initial time of ART,CD4 cell count,and antiretroviral regimen) and from the follow-up program (dates and status of follow-up,CD4 cell counts) were gathered and analysed by SAS 9.3.Results The number of cases that having received new treatment was increasing year by year,accounting for 75.4％ of all the cases identified from 2010 to 2014.Constituent ratios of patients with baseline CD4 cell count ＜200 cells/μl and clinical diagnosis of AIDS were decreasing from 81.0％ in 2006 to 39.7 ％ in 2014.Status on drug optimization showed that:3TC replaced DDI,EFV replaced NVP and TDF replaced D4T,making the utilization rates as 99.5％,75.7％,and 60.6％,respectively,by 2014.Regions that were covered by the treatment accounted for 75.4％ of all the counties/districts involved.The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model.Proportion on the twice-CD4-testing model had been 75.2％ since 2010,with the rate of virological detection increased from 70.8％ in 2010 to 87.4％ in 2014 and the virological unsuccessful testing rate decreased from 17.6％ in 2010 to 11.8％ in 2014.Among all the patients,the 1,5 and 10 year survival rates appeared as 92.2％,80.5％ and 69.6％,respectively.For patients with baseline CD4 cell counts as ＜50 cells/μl or ＞350 cells/μl,the corresponding survival rates showed as 81.6％,69.9％,60.9％ and 97.9％,89.8％,81.0％,respectively.Conclusion China's HIV/AIDS free anti-retroviral therapy program appeared as a national treatment cohort which involved large number of participants,with new patients joining in,annually.Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO.Management program on treatment had gradually turned to hospital-based,with follow-up and laboratory testing programs guaranteed,ended up with satisfactory treatment effects.