Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
Front Public Health. 2022 Jul 8;10:851117. doi: 10.3389/fpubh.2022.851117. eCollection 2022.
Late testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on the whole PLHIV in Guangdong Province, China. We designed two tendency analyses in aggregative form and two cohorts (surveillance and ART cohort) in individuals' perspectives based on the HIV/AIDS Comprehensive Response Information Management System. Two interrupted time series models were conducted for tendency analysis from 2009 to 2018 to explore the all-cause and short-term mortality decrease after the test-and-immediate-treat policy. A time-dependent Cox model was performed for the surveillance cohort from 1992 to 2018 and a joint model was utilized for the ART cohort to identify the effect of immediate ART and the influence of late testing and ART on death. The tendency analysis included 324,914 and 68,679 person-year for all-cause/short-term mortality. A total of 49,289 and 26,287 PLHIV were recruited in the surveillance and ART cohort with 5,557 and 459 deaths, respectively. The short-term mortality dropped from 4.69 cases/100 person-year in January 2009 to 0.35 cases/100 person-year in December 2018 (standardized rate). The all-cause mortality saw a decreasing trend from 1.46 cases/100 person-year in January 2009 to 0.14 cases/100 person-year in December 2018 (standardized rate). The tendency analysis showed a significant short-term mortality slope decrease after the test-and-immediate-treat policy ( = 0.024). From the surveillance cohort, late testing, in general, was a risk factor for all-cause mortality [ ( = 1.330, 95% , 1.250, 1.416]. ART cohort showed higher hazards of all-cause mortality among PLHIV with no late testing, but late ART ( = 1.690, , 1.166, 2.451) and both the late testing and late ART ( = ). Immediate ART might decrease the hazard of all-cause death though it is insignificant ( = 0.923, 95% CI: 0.755, 1.129) in the ART cohort. The test-and-immediate-test policy brought benefit to PLHIV. We should enlarge HIV testing using comprehensive approaches to decrease late testing and ART and increase the benefit of immediate ART.
迟检测和抗逆转录病毒治疗（ART）在艾滋病毒感染者（PLHIV）中普遍存在，并影响了立即开始 ART 的获益。本研究旨在确定中国的检测即治疗政策的获益，即时 ART 的效果，以及广东 PLHIV 中迟检测和 ART 的整体影响。我们基于艾滋病综合防治信息管理系统，设计了两个聚合形式的倾向分析和两个个体视角的队列（监测和 ART 队列）。采用两个截断时间序列模型，从 2009 年至 2018 年进行趋势分析，以探讨检测即治疗政策后全因和短期死亡率的下降。对监测队列（1992 年至 2018 年）进行时间依赖性 Cox 模型分析，对 ART 队列进行联合模型分析，以确定即时 ART 的效果以及迟检测和 ART 对死亡的影响。倾向分析包括全因/短期死亡率的 324914 和 68679 人年。监测和 ART 队列分别纳入了 49289 和 26287 名 PLHIV，分别有 5557 和 459 人死亡。短期死亡率从 2009 年 1 月的 4.69 例/100 人年下降至 2018 年 12 月的 0.35 例/100 人年（标准化率）。全因死亡率从 2009 年 1 月的 1.46 例/100 人年下降至 2018 年 12 月的 0.14 例/100 人年（标准化率）。趋势分析显示，检测即治疗政策后短期死亡率斜率显著下降（ = 0.024）。从监测队列来看，一般来说，迟检测是全因死亡的危险因素[ = 1.330，95%CI：1.250，1.416]。ART 队列中，无迟检测的 PLHIV 全因死亡率较高，但 ART 队列中迟检测和 ART （ = 1.690，95%CI：1.166，2.451）和两者都迟（ = ）。尽管在 ART 队列中即时 ART 对全因死亡的影响不显著（ = 0.923，95%CI：0.755，1.129），但它可能降低全因死亡的风险。检测即治疗政策为 PLHIV 带来了获益。我们应该采用综合方法扩大 HIV 检测，以减少迟检测和 ART，并增加即时 ART 的获益。
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