National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.
Medical School of Chinese PLA, Beijing, China.
HIV Med. 2020 Dec;21(11):708-717. doi: 10.1111/hiv.13028.
To explore the barriers to early diagnosis of HIV infection and timely initiation of antiretroviral therapy (ART).
We assessed the annual number and proportion of ART-naïve people living with HIV infection (PLWH) with severe immunosuppression in Shenzhen, China, from 2008 to 2019. Selected ART-naïve PLWHs with severe immunosuppression who were seeking treatment for the first time in the hospital in 2019 were subjected to an in-depth interview.
The proportion of severely immunosuppressed, ART-naïve PLWH decreased from 36.73% in 2008 to 8.94% in 2015, and then plateaued at approximately 10% from 2015 to 2019. Overall, 55 patients, 70% of whom were men who had sex with men, participated in the qualitative interviews. Ten of them delayed treatment after diagnosis, with a median [interquartile range (IQR)] interval of 5.83 (3.98-8.54) years between diagnosis and ART. More than 80% of the patients reported casual sexual contact within a median period of 6 years and with a median (IQR) of nine (4-20) casual sex partners. The major barriers to HIV testing and diagnosis included lack of knowledge about HIV and high-risk behaviours, low awareness about HIV testing, and resistance to HIV testing. The major barriers to ART initiation included lack of knowledge about the importance of ART and change of national ART eligibility policy, and HIV-related stress.
The number of PLWHs with severe immunosuppression who seek treatment remains high in Shenzhen, China. Thus, current HIV-related care programmes targeting access to early diagnosis and treatment need to be improved.
探索艾滋病病毒（HIV）感染早期诊断和及时开始抗逆转录病毒治疗（ART）的障碍。
我们评估了 2008 年至 2019 年期间中国深圳未经 ART 治疗的 HIV 感染者（PLWH）中严重免疫抑制人数和比例。2019 年，在医院首次寻求治疗的严重免疫抑制且未经 ART 治疗的 PLWH 中，选择了一些患者进行深入访谈。
严重免疫抑制、未经 ART 治疗的 PLWH 比例从 2008 年的 36.73%降至 2015 年的 8.94%，随后在 2015 年至 2019 年期间稳定在 10%左右。共有 55 名患者（70%为男男性行为者）参加了定性访谈。其中 10 人在诊断后延迟治疗，诊断和 ART 之间的中位（四分位距）间隔为 5.83（3.98-8.54）年。超过 80%的患者报告在中位 6 年内有过偶然性行为，中位数（四分位距）为 9（4-20）个性伴侣。HIV 检测和诊断的主要障碍包括对 HIV 和高危行为缺乏了解、对 HIV 检测意识低，以及对 HIV 检测的抵制。ART 启动的主要障碍包括对 ART 重要性和国家 ART 资格政策变化的认识不足，以及与 HIV 相关的压力。
中国深圳严重免疫抑制的 PLWH 寻求治疗的人数仍然很高。因此，目前针对早期诊断和治疗的 HIV 相关护理方案需要改进。
