%0 Journal Article
%T Simplified HIV Testing and Treatment in China: Analysis of Mortality Rates Before and After a Structural Intervention
%A Zunyou Wu&nbsp
%A Yan Zhao&nbsp
%A Xianmin Ge&nbsp
%A Yurong Mao&nbsp
%A Zhenzhu Tang&nbsp
%A Cynthia X. Shi&nbsp
%A Chi Chen&nbsp
%A Yong Li&nbsp
%A Xuejun Qiu&nbsp
%A Guide Nong
%J PLOS Medicine
%D 2015
%I Public Library of Science (PLoS)
%R 10.1371/journal.pmed.1001874
%X Background Multistage stepwise HIV testing and treatment initiation procedures can result in lost opportunities to provide timely antiretroviral therapy (ART). Incomplete patient engagement along the continuum of HIV care translates into high levels of preventable mortality. We aimed to evaluate the ability of a simplified test and treat structural intervention to reduce mortality. Methods and Findings In the ※pre-intervention 2010§ (from January 2010 to December 2010) and ※pre-intervention 2011§ (from January 2011 to December 2011) phases, patients who screened HIV-positive at health care facilities in Zhongshan and Pubei counties in Guangxi, China, followed the standard-of-care process. In the ※post-intervention 2012§ (from July 2012 to June 2013) and ※post-intervention 2013§ (from July 2013 to June 2014) phases, patients who screened HIV-positive at the same facilities were offered a simplified test and treat intervention, i.e., concurrent HIV confirmatory and CD4 testing and immediate initiation of ART, irrespective of CD4 count. Participants were followed for 6每18 mo until the end of their study phase period. Mortality rates in the pre-intervention and post-intervention phases were compared for all HIV cases and for treatment-eligible HIV cases. A total of 1,034 HIV-positive participants (281 and 339 in the two pre-intervention phases respectively, and 215 and 199 in the two post-intervention phases respectively) were enrolled. Following the structural intervention, receipt of baseline CD4 testing within 30 d of HIV confirmation increased from 67%/61% (pre-intervention 2010/pre-intervention 2011) to 98%/97% (post-intervention 2012/post-intervention 2013) (all p < 0.001 [i.e., for all comparisons between a pre- and post-intervention phase]), and the time from HIV confirmation to ART initiation decreased from 53 d (interquartile range [IQR] 27每141)/43 d (IQR 15每113) to 5 d (IQR 2每12)/5 d (IQR 2每13) (all p < 0.001). Initiation of ART increased from 27%/49% to 91%/89% among all cases (all p < 0.001) and from 39%/62% to 94%/90% among individuals with CD4 count ≒ 350 cells/mm3 or AIDS (all p < 0.001). Mortality decreased from 27%/27% to 10%/10% for all cases (all p < 0.001) and from 40%/35% to 13%/13% for cases with CD4 count ≒ 350 cells/mm3 or AIDS (all p < 0.001). The simplified test and treat intervention was significantly associated with decreased mortality rates compared to pre-intervention 2011 (adjusted hazard ratio [aHR] 0.385 [95% CI 0.239每0.620] and 0.380 [95% CI 0.233每0.618] for the two post-intervention phases, respectively, for all newly
%U http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001874