UCLA

Background

This study is to comprehensively investigate antiretroviral therapy (ART) initiation and retention among domestic migrants living with HIV (DMLH) in Guangdong, China.

Methods

Mixed methods were applied in this dissertation. In-depth interviews were conducted among service providers and DMLH. Two retrospective cohort studies based on secondary data were to investigate ART initiation and retention among DMLH from July 1, 2016, to December 31, 2019.

Results

In the first study, there were four levels of barriers to ART initiation and retention. The policy-level challenges were lack of appropriate medical insurance policy for DMLH and lack of effective reward and punishment mechanism for institutions. Barriers from institutions included a lack of cooperation across different institutions and a lack of flexibility in spending government funds. At the service provider level, shortage of experienced service providers and limited career prospects and low salaries were added to the barriers. Challenges identified at the individual level comprised of lack of HIV related knowledge, side effect, inconvenience to take a leave, lack of family support, and fear of stigma.

In the second study, over half of 22,773 participants were DMLH. Inter-provincial migrants were less likely to initiate ART than that among residents (HR=0.90, 95%CI: 0.86~0.94) and intra-provincial migrants (HR=0.90, 95%CI: 0.86~0.94). Compared to those without migration during the follow-up, those moving to their hometown (HR=0.06, 95%CI: 0.05~0.07) and other cities (HR=0.22, 95%CI: 0.17~0.27) were less likely to take ART. The probability of ART initiation among those returning to their hometown was lower than that among those moving to other cities (HR=0.30, 95%CI: 0.22~0.40).

In the third study, the probability of attrition among inter-provincial migrants (HR=1.15, 95%CI: 1.00~1.33) and intra-provincial migrants (HR=1.20,95%CI: 1.00~1.43) tended to be higher than that among residents in Region A. In Region B, the probability of ART attrition among inter-provincial migrants (HR=0.88, 95%CI: 0.74~1.05) and intra-provincial migrants (HR=0.79, 95%CI: 0.57~1.09) tended to be lower than that among residents.

Conclusion

There were multifaceted barriers for ART initiation and retention among DMLH. Future policies and interventions should properly take domestic migrants’ vulnerability and regional disparity into consideration to improve ART initiation and retention.