Analysis of inter-provincial movement and the effect of antiretroviral therapy of HIV/AIDS cases after first follow up in China, 2016-2018

Abstract

Objective: To analyze the interprovincial movement of newly reported HIV/AIDS cases after the first follow up in China and understand their movement characteristics and the effect of antiretroviral therapy (ART) after adjustment of ART inclusion criteria. Methods: The data of HIV/AIDS cases, including the effects of ART, were extracted from the information system for HIV/AIDS prevention and control. Descriptive analysis and χ2 test was used to explore the characteristics of the movement of HIV/AIDS cases and its relationship with ART effect and viral suppression. Results: In 289 218 HIV/AIDS cases, 22 426 (7.8%) cases experienced inter-provincial movement after the first follow up. Higher prevalence of inter-provincial movement was found in males (8.3%, 18 557/223 713), those with education level of senior high school (9.6%, 4 317/44 877) and college degree and above (9.5%, 4 792/45 858), the unmarried (11.5%, 10 538/91 572), those diagnosed in detention center (16.0%, 1 268/7 927) and those infected by homosexual behavior (11.4%, 9 069/79 735). The rates of ART initiation within 1 year of diagnosis and viral suppression were lower in HIV/AIDS cases with inter-provincial movement (77.1%, 17 296/22 426 and 70.7%, 15 858/22 426) than in those without inter-provincial movement (86.7%, 231 293/266 792 and 78.6%, 209 760/266 792). After the first follow-up, 41.4% (18 887/45 570) of HIV/AIDS cases diagnosed in non-native provinces experienced inter-provincial movement, of which 92.9% (17 538/18 887) went back to native province. The top five provinces (municipalities) with outflows of HIV/AIDS cases were Guangdong, Zhejiang, Shanghai, Beijing and Sichuan. The top five provinces with inflows of HIV/AIDS cases were Sichuan, Guizhou, Guangdong, Anhui and Hunan. Conclusions: The inter-provincial movement affects ART effect and viral suppression of HIV/AIDS cases. It is necessary to pay more attention to the discovery and management of HIV/AIDS in floating population and eliminate policy barriers to ensure the timeliness and effectiveness of ART.