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Steps towards preventive HIV treatment in Fujian, China: problems identified via an assessment of initial antiretroviral therapy provision.

ABSTRACT: BACKGROUND: At the end of 2009, a total of 501 AIDS patients were receiving antiretroviral therapy (ART) in Fujian Province in China, yet there were no assessments to determine treatment efficacy and HIV-1 preventive potency under the current health care delivery system. METHODS: During the period of 2005-2009, we assessed the outcomes of initial ART by following up 381 patients for 12 months in Fujian Province. CD4? T-lymphocyte (CD4) count, plasma viral load (VL), and patient characteristics were analysed. The results were compared between 4 groups divided by the baseline CD4 values at the 25, 50 (median), and 75 percentiles. FINDINGS: Over three-quarters of the subjects reported heterosexual contact as the probable route of transmission. After 12 months of ART, CD4 recovery varied between the 4 groups (P < 0.001), but VL sharply declined regardless of the baseline CD4 count (P = 0.136). Although this VL decline indicates the potency of ART as an HIV-1 prevention tool, the time between positive diagnosis and ART initiation suggests serious delay in both diagnosis and treatment; the medians of periods for the lowest and highest baseline CD4 quartiles were 1.2 and 9.6 months, respectively. CONCLUSION: Current limitations in VL determination make it difficult to assess the efficacy of initial ART, and delays in diagnosis and treatment suggest that subjects contributed to HIV-1 transmission while they were not receiving ART. The current National Free ART scheme does not provide free treatment for sexually transmitted infection (STI), and there is no link between ART and the STI care delivery system. This may interfere with the HIV-1 preventive potency of ART. We highly recommend establishing a collaborating mechanism with STI care, strengthening the VL determination system, and promoting HIV tests and early ART initiation.

SUBMITTER: Xia P

PROVIDER: S-EPMC3782456 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Steps towards preventive HIV treatment in Fujian, China: problems identified via an assessment of initial antiretroviral therapy provision.

Xia Pincang P Okumura Junko J Yan Pingping P Xie Meirong M Wu Shouli S Zhuang Meizhu M Zheng Jian J Zhang Chunyang C Zhang Mingya M Kato Masaya M Cai Guoxi G Yamamoto Taro T

PloS one 20130924 9

<h4>Background</h4>At the end of 2009, a total of 501 AIDS patients were receiving antiretroviral therapy (ART) in Fujian Province in China, yet there were no assessments to determine treatment efficacy and HIV-1 preventive potency under the current health care delivery system.<h4>Methods</h4>During the period of 2005-2009, we assessed the outcomes of initial ART by following up 381 patients for 12 months in Fujian Province. CD4⁺ T-lymphocyte (CD4) count, plasma viral load (VL), and patient char ...[more]

PMID: 24086744

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Project description:BackgroundAchieving global targets of adherence to treatment, retention in care, and treatment success remains a challenge. Health system investment to make antiretroviral therapy services more responsive to patients' needs and values could address these impediments. Appropriate resource allocation to implement differentiated HIV treatment services demands research evidence. This study aimed to provide an overview of the patients' preferences for antiretroviral therapy service delivery features.MethodsElectronic databases (PubMed, Web of Science, Embase, and CINAHL) and search engines (Google and Google Scholar) were searched. This review has followed a convergent segregated approach to synthesis and integration. Data from the included studies were systematically extracted, tabulated, and summarised in a narrative review. Studies that analysed preferences for antiretroviral therapy regardless of the method used and published in the English language in any year across the world and HIV positive clients who were 15 years and above on 4th February 2021 were included for this review. The quality of the included studies was assessed using the mixed methods appraisal tool. A thematic synthesis of the data from the findings section of the main body of the qualitative study was undertaken. ATLAS.ti software version 7 was used for qualitative synthesis.ResultsFrom the 1054 retrieved studies, only 23 studies (16 quantitative, three qualitative, and four mixed-methods) fulfilled the inclusion criteria. The median number of attributes used in all included quantitative studies was 6 (Inter Quartile Range 3). In this review, no study has fulfilled the respective criteria in the methodological quality assessment. In the quantitative synthesis, the majority of participants more valued the outcome, whereas, in the qualitative synthesis, participants preferred more the structure aspect of antiretroviral therapy service. The thematic analysis produced 17 themes, of which ten themes were related to structure, three to process, and four to outcome dimension of Donabedian's quality of care model. The findings from individual quantitative and qualitative syntheses complement each other.ConclusionsIn this review, participants' value for antiretroviral therapy service characteristics varied across included studies. Priorities and values of people living with HIV should be incorporated in the policy, practice, research, and development efforts to improve the quality of antiretroviral therapy service hence avoid poor patient outcomes.

Dataset Information

Steps towards preventive HIV treatment in Fujian, China: problems identified via an assessment of initial antiretroviral therapy provision.

Publications

Steps towards preventive HIV treatment in Fujian, China: problems identified via an assessment of initial antiretroviral therapy provision.

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