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Viral Load Tests among People Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Wenshan Prefecture, Yunnan Province of China

  • Author(s): Xu, Youran
  • Advisor(s): Detels, Roger
  • et al.
Abstract

Background

China has made great achievements in antiretroviral therapy (ART) among people living with HIV (PLWH), however, there is still a gap with the 90-90-90 targets, especially in rural areas. This study investigated three topics about the centralized viral load (VL) testing in Wenshan, China, including the coverage and timeliness of VL tests, the turnaround time (TAT) of VL tests, and factors associated with sustained viral suppression (SVS).

Methods

To address the three topics, three clinic-based studies were conducted respectively. First, a retrospective cohort study was conducted among 815 PLWH who initiated ART from 2015 to 2016. Second, a sequential explanatory mixed-method study was conducted: (1) 2 892 VL tests performed in 2018 were reviewed; (2) in-depth interviews were conducted among 11 healthcare providers. Third, a questionnaire survey was conducted among 264 PLWH.

Results

First, in Wenshan, the cumulative VL testing rates (%) at 12, 18, and 24 months after ART initiation were 58.5%, 78.1%, and 93.0%, respectively. Patients who had healthier baseline status [adjusted hazard ratio (aHR)=1.40, 95% confidence interval (95%CI)=1.18-1.65] were more likely to undergo VL tests timely. On the contrary, patients who lived far away from ART sites (aHR=0.70, 95%CI=0.59-0.83) had delayed VL tests. Second, the median VL testing TAT was 54 days (IQR: 36, 92). Factors associated with prolonged TAT mainly included the annual urban-to-rural labor migration, the shortage of healthcare professionals and lab technicians, limited VL testing instruments, and the immature reagent procurement system and testing results reporting system. Third, 61.0% (n=161) of the PLWH who participated in the survey had achieved SVS. A total of 58.3% (n=154) participants reported they had ever proactively asked about VL testing results and they were more likely to achieve SVS [adjusted odds ratio (aOR)=3.08, 95%CI=1.52-6.26]. Other factors associated with SVS included baseline CD4 count, VL-related knowledge, support from non-governmental organizations (NGO), age, and time interval from HIV diagnosis to ART initiation.

Conclusions

To achieve the 90-90-90 targets, the VL testing in rural China should be improved by combining the efforts of PLWH, local healthcare providers, NGO staff, and healthcare policymakers at all levels of government.

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