Outcome of Sentinel Hospital-based and CDC-based ART Service Delivery: A Prospective Open Cohort of People Living with HIV in China

Chuanyi Ning,Fuchun Zhang,Chase D Mccann,Kumi M Smith,Hao Liang,Jinmin Zhao,Joseph D Tucker,Fengyu Hu,Yun Lan,Weiping Cai

doi:10.1038/srep42637

Abstract

The primary objective of this study was to obtain insights into the outcomes of people living with HIV who accessed services through HIV/AIDS sentinel hospital-based and ART service delivery in China. Post-hoc analyses of an open cohort from an observational database of 22 qualified HIV/AIDS sentinel hospital-based and two CDC-based drug delivery facilities (DDFs) in Guangdong Province was completed. Linkage to care, mortality and survival rates were calculated according to WHO criteria. 12,966 individuals received ART from HIV/AIDS sentinel hospitals and 1,919 from DDFs, with linkage to care rates of 80.7% and 79.9%, respectively (P > 0.05). Retention rates were 94.1% and 84.0% in sentinel hospitals and DDFs, respectively (P < 0.01). Excess mortality was 1.4 deaths/100 person-years (95% CI: 1.1, 1.8) in DDFs compared to 0.4 deaths/100 person-years (95% CI: 0.3, 0.5) in hospitals (P < 0.01). A Cox-regression analysis revealed that mortality was much higher in patients receiving ART from the DDFs than sentinel hospitals, with an adjusted HR of 3.3 (95% CI: 2.3, 4.6). A crude HR of treatment termination in DDFs was 7.5 fold higher (95% CI: 6.3, 9.0) compared to sentinel hospitals. HIV/AIDS sentinel hospital had better retention, and substantially lower mortality compared to DDFs.

Highlights

Numerous countries around the world have formulated and improved relevant policies concerning publicity, education, comprehensive intervention, and follow-up visit management for HIV treatment[6,7,8]
Since beginning a pilot combination antiretroviral therapy program among former plasma donors in 2002, China has rapidly scaled up the National Free Antiretroviral Treatment Program (NFATP) in Center for Disease Control (CDC)-based ART service delivery facilities[16]
The mean age of participants was 38.5 years, 73.2% were men, 55.6% were infected through heterosexual transmission, 19.1% through injection drug use (IDU), 18.4% through male-to-male homosexual transmission, and 29.2% had baseline symptoms within the last 3 months

Summary

Introduction

Numerous countries around the world have formulated and improved relevant policies concerning publicity, education, comprehensive intervention, and follow-up visit management for HIV treatment[6,7,8]. By the end of 2014, more than 295,358 patients across the country had received free antiretroviral treatment[20] Implementation of this treatment model was driven by thousands of CDC-based ART service delivery facilities focused solely on drug delivery, where delegation of physician tasks to less well-trained staff has hampered the effectiveness of antiretroviral therapy. Guangdong Province has established a system of Sentinel hospitals in which patients wishing to receive HIV treatment through the NFATP are cared for by highly trained Infectious Disease specialists. To evaluate patients’ outcome and retention rate of HIV/AIDS Highly Active ART (HAART) program on HIV-infected patients in the sentinel hospital and drug delivery facilities (DDFs), we analyzed data on mortality, immunologic response status, and risk factors of all previously treatment naive adult patients enrolled in the China NFATP of Guangdong province between 2005–2014

Objectives

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Results

Conclusion