Loss to Follow-Up from HIV Screening to ART Initiation in Rural China

PLoS One

Julio Montaner¹  Roger Detels²  Qiuying Zhu³  Zhiyong Shen³  Zhenzhu Tang³  Albert Hasson⁴  Walter Ling⁴  Lynda Erinoff⁵  David Liu⁵  Robert Lindblad⁶  Paul Van Veldhuisen⁶  Zunyou Wu⁷  Xia Jin⁷  Yurong Mao⁷  Juan Xu⁷  Ran Xiong⁷  Diane Gu⁷ 

[1]BC Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada

[2]Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America

[3]Guangxi Center of Disease Control and Prevention, Nanning, Guangxi, China

[4]Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America

[5]National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA

[6]The EMMES Corporation, Rockville, MD, United States of America

[7]The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

关键词: HIV;    Antiretroviral therapy;    HIV diagnosis and management;    HIV prevention;    Screening guidelines;    Hospitals;    Health services research;    HIV infections;   

DOI  :  10.1371/journal.pone.0164346

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Background Patients who are newly screened HIV positive by EIA are lost to follow-up due to complicated HIV testing procedures. Because this is the first step in care, it affects the entire continuum of care. This is a particular concern in rural China. Objective(s) To assess the routine HIV testing completeness and treatment initiation rates at 18 county-level general hospitals in rural Guangxi. Methods We reviewed original hospital HIV screening records. Investigators also engaged with hospital leaders and key personnel involved in HIV prevention activities to characterize in detail the routine care practices in place at each county. Results 699 newly screened HIV-positive patients between January 1 and June 30, 2013 across the 18 hospitals were included in the study. The proportion of confirmatory testing across the 18 hospitals ranged from 14% to 87% (mean of 43%), and the proportion of newly diagnosed individuals successfully initiated antiretroviral treatment across the hospitals ranged from 3% to 67% (mean of 23%). The average interval within hospitals for individuals to receive the Western Blot (WB) and CD4 test results from HIV positive screening (i.e. achieving testing completion) ranged from 14–116 days (mean of 41.7 days) across the hospitals. The shortest interval from receiving a positive EIA screening test result to receiving WB and CD4 testing and counseling was 0 day and the longest was 260 days. Conclusion The proportion of patients newly screened HIV positive that completed the necessary testing procedures for HIV confirmation and received ART was very low. Interventions are urgently needed to remove barriers so that HIV patients can have timely access to HIV/AIDS treatment and care in rural China.

【 授权许可】

CC BY