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Prevalence and Factors of Antiretroviral Therapy Usage among HIV-positive Men Who Have Sex with Men under a New Treatment Policy in China
Başlık:
Prevalence and Factors of Antiretroviral Therapy Usage among HIV-positive Men Who Have Sex with Men under a New Treatment Policy in China
Yazar:
Yang, Xueying, author.
ISBN:
9780438147959
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (182 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-11(E), Section: B.
Advisors: Tak Fai Joseph Lau; Jinling Tang.
Özet:
Introduction: The HIV epidemic among men who have sex with men (MSM) remains severe in China. China updated their national guideline for the provision of free antiretroviral therapy (ART) to people living with HIV (PLWH) from CD4 levels .350 to .500 cells/mm3 in May 2014 and to all PLWH irrespective of CD4 levels in June 2016. The new policy has strong implications of HIV prevention and care, while few studies were reported to focus on its implementation among MSM.
Objectives: Targeting HIV-positive MSM with CD4 levels >350 cells/mm3, our study had three objectives: i) to investigate the prevalence and associated factors of ART initiation in a sample of participants with CD4 levels of 351--500 cells/mm3 and received HIV diagnosis after the update of the new treatment policy (i.e., May 2014); ii) to investigate the prevalence and associated factors of behavioral intention to initiate ART in a subgroup of those who had never received ART; and iii) to investigate the prevalence and associated factors of ART adherence in a subgroup of those who were on ART.
Subjects and Methods: A cross-sectional study was conducted among HIV-positive MSM in Chengdu, Hangzhou, Fuzhou and Shenyang in China from February to November 2016. Using structural questionnaire, three NGOs and one CDC facilitated the data collection. Three dependent variables included the prevalence of ART initiation, behavioral intention to initiate ART, and adherence to ART. Both individual and interpersonal level variables were considered in explaining these dependent variables. Univariate and multivariate logistic regression models were used for data analysis.
Results: Disregarding perceived eligibility, the prevalence of ART initiation was 70.2% among 141 HIV-positive MSM with CD4 levels of 351--500 cells/mm3. Among those with perceived eligibility to receive free ART, 83.9% were on ART, and its facilitators included i) health professionals' recommendation for immediate ART initiation; ii) perceived adequate explanations of beneficial outcomes of ART from health professionals; iii) perceived adequate explanations of harmful outcomes of ART from health professionals; iv) received more types of assessments for ART readiness from health professionals; and v) health professionals' overall stronger emphasis on benefits versus harms of ART.
Among 204 HIV-positive MSM with CD4 counts >350 cells/mm3 and had never received ART, 63.7% indicated their intention to initiate ART in the next six months. Variables at the individual level, including constructs from Theory of Planned Behavior, weighing of potential benefits versus harms of ART, and perceived level of difficulties in accessing free ART were all associated with such intention. At the interpersonal level, two factors, such as the high level of influence of NGO workers on ART decision-making and emotional support received from NGO workers were also associated with such intention.
Among 167 HIV-positive MSM who were on ART (i.e., initiated ART when CD4 counts >350 cells/mm3), no one missed any dose in the past four days before the survey, while 25.7% of them did not strictly follow the dosing schedule or dietary instructions of ART. Only one variable (i.e., perceived emotional support received from NGO workers) was associated with non-compliance to dosing schedule or dietary instructions of ART.
Conclusion: The implementation of the new treatment policy has a positive impact on ART usage among MSM. The prevalence of ART initiation, behavioral intention to initiate ART and adherence to ART were all quite high among HIV-positive MSM with high CD4 counts after the revision of the national treatment guideline. The health professionals played an important role in ART initiation, yet their communication with the participants was inadequate. The Theory of Planned Behavior could be used as a framework to guide future intervention designs for the promotion of ART initiation. Capacity building of NGO workers may also be helpful. The compliance with dosing schedule or dietary instruction of ART needs to be emphasized to achieve the viral suppression in the delivery of future counseling services. Further longitudinal studies are warranted to gain a better understanding of the associations determined in the present study.
Notlar:
School code: 1307
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
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