Treatment adherence and health outcomes in MSM with HIV/AIDS: patients enrolled in "one-stop" and standard care clinics in Wuhan China

• Published in: PloS one Vol. 9; no. 12; p. e113736
• Main Authors: Zhou, Wang, Zhao, Min, Wang, Xia, Schilling, Robert F, Zhou, Sheng, Qiu, Hong-Yan, Xie, Nian-Hua, Liu, Man-Qing, Dong, Han-Sheng, Yao, Zhong-Zhao, Cai, Thomas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.12.2014; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; Adolescent; Adult; Aged; Aged, 80 and over; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Care and treatment; CD4 antigen; China; Demographic variables; Demographics; Disease control; HIV; HIV Infections - drug therapy; HIV patients; Homosexuality, Male; Human immunodeficiency virus; Humans; Male; Medical diagnosis; Medicine and health sciences; Middle Aged; Mortality; Multivariate analysis; Patient Compliance; Patient outcomes; Patient-Centered Care; Patients; Sexually transmitted diseases; Systematic review; Treatment Outcome; Young Adult; China; Beijing China; Los Angeles California; California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0113736

Conducted in Wuhan China, this study examined follow-up and health markers in HIV patients receiving care in two treatment settings. Participants, all men who have sex with men, were followed for 18-24 months. Patients in a "one-stop" service (ACC; N = 89) vs those in standard care clinics (CDC; N = 243) were compared on HIV treatment and retention in care outcomes. Among patients with CD4 cell count ≦350 cells/µL, the proportion receiving cART did not differ across clinic groups. The ACC was favored across five other indicators: proportion receiving tests for CD4 cell count at the six-month interval (98.2% vs. 79.4%, 95% CI 13.3-24.3, p = 0.000), proportion with HIV suppression for patients receiving cART for 6 months (86.5% vs. 57.1%, 95% CI 14.1-44.7, p = 0.000), proportion with CD4 cell recovery for patients receiving cART for 12 months (55.8% vs. 22.2%, 95% CI 18.5-48.6, p = 0.000), median time from HIV confirmation to first test for CD4 cell count (7 days, 95% CI 4-8 vs. 10 days, 95% CI 9-12, log-rank p = 0.000) and median time from first CD4 cell count ≦350 cells/µL to cART initiation (26 days, 95% CI 16-37 vs. 41.5 days, 95% CI 35-46, log-rank p = 0.031). Clinic groups did not differ on any biomedical indicator at baseline, and no baseline biomedical or demographic variables remained significant in the multivariate analysis. Nonetheless, post-hoc analyses suggest the possibility of self-selection bias. Study findings lend preliminary support to a one-stop patient-centered care model that may be useful across various HIV care settings.