Objectives: To determine factors associated with late and delayed antiretroviral therapy (ART) initiation in China and provide evidence for HIV prevention.Methods: Logistics regression model was used to determine factors associated with three outcomes: late (CD4 cell count <200 cells/µL or clinical AIDS diagnosis prior to ART initiation), delayed (more than 1 month between HIV diagnosis date and ART initiation) and either late or delayed ART initiation.Results: Multivariable analysis revealed that male, heterosexual, HIV diagnosis before 2014, HBV/HCV seropositive, and tuberculosis were associated with increased odds of all three outcomes. Conversely, married or cohabiting patients were less likely to have delayed ART initiation and either late or delayed ART initiation, while people who inject drugs were more likely to have these two outcomes. Additionally, older age was associated with an increased risk of having either late or delayed ART initiation, but a decreased risk of delayed ART initiation.Conclusion: The proportion of late and delayed ART initiation decreased significantly after the release of the 2016 guidelines in China. To further improve late diagnosis and early treatment, precise interventions for key populations are required.

What is already known about this topic?Antiretroviral therapy (ART) eligibility criteria and treatment regimens were updated in national guidelines. However, whether treatment was timely and followed guidelines was under-assessed. What is added by this report? Among 22,591 people living with human immunodeficiency virus (PLWH) who initiated ART in Beijing between 2010 and 2020, the time from diagnosis to initiating ART decreased, the clinical condition of PLWH improved, and ART regimens changed in accordance with guidelines. What are the implications for public health practice? Over the past decade, improvements in clinical status have been observed among PLWH; however, a proportion of PLWH remain who started ART late. Early linkage to human immunodeficiency virus (HIV) care should be further improved.

ObjectiveMen who have sex with men in China meet the definition of the population at “substantial risk” of contracting human immunodeficiency virus (HIV) according to the World Health Organization; therefore, initiating pre-exposure prophylaxis (PrEP) is recommended for this population. Lack of convincing evidence on cost-effectiveness has resulted in the lack of large-scale PrEP implementation at a national level. The objective of this review is to assess the cost-effectiveness of pre-exposure prophylaxis implementation among men who have sex with men in China.MethodsThe following databases were used to search studies of pre-exposure prophylaxis in China in both English and Chinese: PubMed, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database. Inclusion criteria included pre-exposure intervention, year for publication (2007–2021), setting (China), and cost-effectiveness estimation.ResultsSeven studies were identified. We found that pre-exposure prophylaxis is only cost-effective among men who have sex with men without prioritization with at least a 5.5% reduction in the market price in the models. Pre-exposure prophylaxis is potentially cost-effective when using the latest market price, combined with other preventive programs or delivered to the population with a high risk of HIV exposure.ConclusionOur study identifies key considerations in cost-effectiveness evaluation: cost assumptions, implementation coverage, and targeted population. The scarce evidence available is not comparable to some extent. However, combined with the latest market and policy reform, the cost-effectiveness of PrEP could be achieved as estimated by the underlying model of the included studies. Consequently, it calls for more standard and transparent modeling studies that include the latest drug types and market prices.