A total of 439 valid questionnaires were collected. 252 cases were in the drop out group and 187 cases were in the group retained in care.
Social demographic characteristics and general situations of drop out group
There were 189 males (75%) and 63 females (25%) with average age of 39.46±11.88 years. There were 215 cases of Han nationality (85.3%). The marital status was mainly single or divorced, with 174 cases (69.0%). 176 cases (69.8%) educational level were junior high school or below. Their main occupations were farmers, housekeeping and unemployment accounting for 70.2% totally.84 cases (33.3%) had monthly income less than 500 CNY. 190 cases (75.4%) didn’t have minimum living allowances. The HIV transmission route:133 cases (52.8%) were heterosexual transmission,43 cases (17.1%) were homosexual transmission, and 76 cases (30.1%) were injection drug abuse transmission. By living status,111 cases (44.0%) were living alone, 94 cases (37.3%) were living with their families.
Univariate Analysis of the General Characteristics
Univariate analysis was used to compare two groups according to age, gender, marital status, educational level, monthly income and other factors. The results showed that age, residential area, educational level, occupation, monthly income, whether to receive the minimum living allowances, the HIV transmission route and living status had significant effects on the drop-out from ART (P< 0.05).
Table 1. Comparison of general characteristics between group retained in care and drop out group
Item
|
therapy status during investigation
|
c2
|
P
|
Drop out group (n=252)
|
Group retained in care (n=187)
|
Gender
|
|
|
0.78
|
0.38
|
Male
|
189(56.3)
|
147(43.8)
|
|
|
Female
|
63(61.2)
|
40(38.8)
|
Age
|
|
|
11.37
|
0.04
|
≤24
|
24(61.5)
|
15(38.5)
|
|
|
25-34
|
58(47.5)
|
64(52.5)
|
35-44
|
97(66.4)
|
49(33.6)
|
45-54
|
47(58.0)
|
34(42.0)
|
55-64
|
19(54.3)
|
16(35.7)
|
≥65
|
7(43.8)
|
9(56.3)
|
Nationality
|
|
|
0.97
|
0.33
|
Han nationality
|
215(58.4)
|
153(41.6)
|
|
|
Ethnic minority
|
37(52.1)
|
34(47.9)
|
Residential area
|
|
|
39.16
|
0.00
|
Countryside
|
140(74.5)
|
48(25.5)
|
|
|
Town
|
112(44.6)
|
139(55.4)
|
Household register
|
|
|
1.85
|
0.60
|
Local county
|
119(58.6)
|
84(41.4)
|
|
|
Other county of the city
|
20(47.6)
|
22(52.4)
|
Other city of the province
|
39(59.1)
|
27(40.9)
|
Other province
|
74(57.8)
|
54(42.2)
|
Marital status
|
|
|
1.08
|
0.78
|
Single
|
88(54.3)
|
74(45.7)
|
|
|
Married
|
71(60.2)
|
47(39.8)
|
Divorced
|
86(58.5)
|
61(41.5)
|
Bereaved wife or husband
|
7(58.3)
|
5(41.7)
|
Educational level
|
|
|
31.79
|
0.00
|
Illiteracy
|
10(90.9)
|
1(9.1)
|
|
|
Primary school
|
55(67.9)
|
26(32.1)
|
Junior high school
|
111(66.5)
|
56(33.5)
|
High school
|
34(45.3)
|
41(54.7)
|
College or above
|
42(40.0)
|
63(60.0)
|
Occupation
|
|
|
57.99
|
0.00
|
Farmer
|
112(78.9)
|
30(21.1)
|
|
|
Housework and unemployment
|
65(56.0)
|
51(44.0)
|
Service
|
27(39.7)
|
41(60.3)
|
Worker
|
11(37.9)
|
18(62.1)
|
Cadre staff
|
7(33.3)
|
14(66.7)
|
Retiree
|
1(8.3)
|
11(91.7)
|
Student
|
12(66.7)
|
6(33.3)
|
Migrant workers
|
9(52.9)
|
8(47.1)
|
Other
|
8(50.0)
|
8(50.0)
|
Monthly income
|
|
|
33.81
|
0.00
|
<500
|
84(75.0)
|
28(25.0)
|
|
|
500-1000
|
36(66.7)
|
18(33.3)
|
1000-2000
|
35(36.5)
|
61(63.5)
|
2000-3000
|
50(54.3)
|
42(45.7)
|
≥3000
|
47(55.3)
|
38(44.7)
|
Minimum living allowances
|
|
|
17.50
|
0.00
|
Yes
|
62(78.5)
|
17(21.5)
|
|
|
No
|
190(52.8)
|
170(47.2)
|
|
|
HIV transmission route
|
|
|
43.15
|
0.00
|
Injection drug abuse
|
76(83.5)
|
15(16.5)
|
|
|
Male to male transmission
|
43(40.2)
|
64(59.8)
|
Heterosexual transmission
|
133(55.2)
|
108(44.8)
|
Living status
|
|
|
10.88
|
0.01
|
Live alone
|
111(58.4)
|
79(41.6)
|
|
|
Usually live with strangers
|
20(83.3)
|
4(16.7)
|
|
|
Live with classmates/colleagues/friends
|
27(65.9)
|
14(34.1)
|
|
|
Live with family
|
94(51.1)
|
90(48.9)
|
|
|
Recent CD4 counts
|
|
|
0.65
|
0.723
|
<350
|
126(59.2%)
|
87(40.8%)
|
|
|
350~
|
47(57.3%)
|
35(42.7%)
|
|
|
500~
|
79(54.9%)
|
65(45.1%)
|
|
|
Univariate factor analysis of antiretroviral therapy services
Through univariate factor analysis of antiretroviral therapy services provided by HIV/AIDS prevention and control institutions. It was found that referral methods provided by follow-up institutions, whether ART information provided by follow-up institutions were the influencing factors of dropping out from ART (P < 0.05).
Table 2.A comparative analysis of ART for group retained in care and drop out group
item
|
therapy status during investigation
|
c2
|
P
|
drop out group (n=252)
|
group retained in care (n=187)
|
First Result Notification institution
|
|
|
6.26
|
0.28
|
Centers for Disease Control and Prevention (CDC)
|
179(61.5)
|
112(38.5)
|
|
|
Methadone maintenance sites
|
3(50.0)
|
3(50.0)
|
antiretroviral therapy institution
|
3(50.0)
|
3(50.0)
|
|
|
Non-governmental Organizations
|
8(47.1)
|
9(52.9)
|
|
|
General Hospital
|
52(50.5)
|
51(49.5)
|
|
|
Other
|
7(43.8)
|
9(56.3)
|
|
|
Referral methods by follow-up institution
|
|
|
100.44
|
0.00
|
Carry the card to go by oneself
|
196(77.8)
|
56(22.2)
|
|
|
Doctors escort
|
56(29.9)
|
131(70.1)
|
|
|
ART information provided by follow-up institutions
|
|
|
14.33
|
0.00
|
Yes
|
222(54.8)
|
183(45.2)
|
|
|
No
|
30(88.2)
|
4(11.8)
|
|
|
Multivariate logistic regression analysis
According to the results of univariate analysis and the inclusion criteria of P < 0.05, age, residential area, education level, occupation, monthly income, whether to receive minimum living allowances, HIV transmission route, living status, referral methods provided by follow-up institutions and whether to provide ART information were taken as independent variables. Whether HIV-infected patients dropped out from ART or retain in care as dependent variables (drop out=0, retain in care=1), with multivariate Logistic regression analysis. The results showed that HIV-infected patients living in rural areas were the protective factors for the drop out from ART compared with those living in cities or towns (OR=0.446,95%CI:0.234~0.849). HIV-infected patients who has monthly income between 500 to 1000 CNY compared with below 500 CNY(OR=2.153,95%CI:0.800~5.795),more than 3000 CNY compared with 2000-3000 CNY (OR=1.613,95%CI:0.691~3.769)were the risk factors for drop out. Not receiving minimum living allowances compared with who has minimum living allowances (OR=0.279,95%CI:0.127~0.616) was the protective factor for drop out. Patients carrying cards on their own was protective factor for drop out compared with follow-up institutions offered referral method to therapy institution (OR=0.148,95%CI:0.086~0.256).
Table 3. Logistic regression analysis about the influencing factors of dropout
item
|
category
|
β
|
S.E
|
Waldx2
|
P
|
OR(95%的CI)
|
Age
|
≤24
|
|
|
|
0.465
|
1.000
|
|
25-34
|
-0.979
|
1.001
|
0.957
|
0.328
|
0.376(0.053~2.673)
|
|
35-44
|
0.041
|
0.923
|
0.002
|
0.964
|
1.042(0.171~6.360)
|
|
45-54
|
0.029
|
0.890
|
0.001
|
0.974
|
1.030(0.180~5.897)
|
|
55-64
|
-0.269
|
0.918
|
0.086
|
0.769
|
0.764(0.126~4.623)
|
|
≥65
|
-0.400
|
0.971
|
0.170
|
0.681
|
0.670(0.100~4.499)
|
Residential area
|
Rural areas
|
|
|
|
|
1.000
|
|
Town
|
0.808
|
0.328
|
6.051
|
0.014
|
0.446(0.234~0.849)
|
Education
|
Illiteracy
|
|
|
|
0.282
|
1.000
|
|
Primary school
|
-2.356
|
1.323
|
3.197
|
0.074
|
0.094(0.007~1.256)
|
|
Middle school
|
-0.852
|
0.587
|
2.105
|
0.147
|
0.427(0.135~1.348)
|
|
High school
|
-0.584
|
0.503
|
1.347
|
0.246
|
0.558(0.208~1.495)
|
|
College or above
|
-0.091
|
0.478
|
0.036
|
0.849
|
0.913(0.358~2.331)
|
Occupation
|
Farmer
|
|
|
|
0.248
|
1.000
|
|
Housework and unemployment
|
-2.752
|
1.339
|
4.227
|
0.040
|
0.064(0.005~0.879)
|
|
Service
|
-2.022
|
1.327
|
2.322
|
0.128
|
0.132(0.010~1.784)
|
|
Worker
|
-1.699
|
1.340
|
1.608
|
0.205
|
0.183(0.013~2.527)
|
|
Cadre staff
|
-1.345
|
1.379
|
0.951
|
0.330
|
0.261(0.017~3.889)
|
|
Retiree
|
-2.220
|
1.413
|
2.470
|
0.116
|
0.109(0.007~1.731)
|
|
Student
|
-1.862
|
1.452
|
1.645
|
0.200
|
0.155(0.009~2.674)
|
|
Migrant workers
|
-2.322
|
1.479
|
2.464
|
0.117
|
0.098(0.005~1.781)
|
|
Other
|
-2.005
|
1.433
|
1.960
|
0.162
|
0.135(0.008~2.231)
|
Monthly income
|
|
|
|
|
|
|
|
<500
|
|
|
|
0.016
|
1.000
|
|
500-1000
|
0.767
|
0.505
|
2.307
|
0.129
|
2.153(0.800~5.795)
|
|
1000-2000
|
0.522
|
0.548
|
0.908
|
0.341
|
1.686(0.576~4.939)
|
|
2000-3000
|
1.648
|
0.509
|
10.490
|
0.001
|
5.199(1.917~14.097)
|
|
≥3000
|
0.478
|
0.433
|
1.220
|
0.269
|
1.613(0.691~3.769)
|
Minimum living allowances
|
Yes
|
|
|
|
|
1.000
|
|
No
|
-1.276
|
0.404
|
9.988
|
0.002
|
0.279(0.127~0.616)
|
HIV transmission route
|
Injecting drug abuse
|
|
|
|
|
1.000
|
|
Male to male transmission
|
2.317
|
1.196
|
3.750
|
0.053
|
19.007(1.869~193.312)
|
|
Heterosexual transmission
|
1.390
|
1.235
|
1.266
|
0.261
|
4.014(0.357~45.198)
|
Living status
|
Live alone
|
|
|
|
0.053
|
1.000
|
|
Usually live with strangers
|
-0.665
|
0.304
|
4.796
|
0.029
|
0.514(0.283~0.932)
|
|
Live with classmates/colleagues/friends
|
-1.449
|
0.749
|
3.742
|
0.053
|
0.235(0.054~1.019)
|
|
Live with family
|
-0.820
|
0.499
|
2.702
|
0.100
|
0.440(0.166~1.171)
|
Referral methods by follow-up institution
|
Carry the card to go by oneself
|
|
|
|
|
1.000
|
|
Staff escort to go
|
1.910
|
0.279
|
46.931
|
0.000
|
0.148(0.086~0.256)
|
Reasons for drop-out from antiretroviral therapy in HIV-infected patients
The top three reasons of drop-out from antiretroviral therapy in HIV-infected patients were: serious side effects, need to persist in taking medicine regularly, medication interruption due to incarcerated.
Table 4. Reasons that HIV-infected persons in dropout of ART
Reason
|
The number of response
|
The rates of response(%)
|
side effects are too serious to tolerate
|
87
|
34.5
|
to persist in taking medicine regularly is difficult
|
72
|
28.6
|
medication interruption due to incarcerated
|
67
|
26.6
|
therapy information is asynchronous due to the change of current address
|
60
|
23.8
|
not necessary to continue taking medicine for better health
|
39
|
15.5
|
consider the therapy is ineffective
|
25
|
9.9
|
family members do not support therapy
|
14
|
5.6
|