Attrition of MSM with HIV/AIDS along the continuum of care from screening to CD4 testing in China

Abstract

The aim of this study is to describe attrition of newly diagnosed men who have sex with men (MSM) living with HIV/AIDS from screening to CD4 testing and provide suggestions to improve HIV case management in China. Data from 15 China-Gates Program project cities were collected on number of MSM who underwent each step from HIV screening to CD4 testing. Descriptive statistics were calculated. A total of 76,628 HIV screening tests were performed among MSM, of which 4563 were HIV-positive. Most attrition occurred at confirmatory and CD4 testing. Within the same year, 21% (1065/4063) of MSM who screened HIV-positive did not receive confirmatory testing and 34% (1025/3024) of MSM newly diagnosed with HIV/AIDS did not receive CD4 testing. Marked differences were observed between project areas in attrition at these points of the care continuum. Marked differences were also observed across areas in the rate of CD4 counts <350 cells/mcl, ranging from 23% to 87%. In the current process for diagnosis and management of HIV infection in China, many MSM are lost to follow-up at HIV confirmation and CD4 testing. Actions should be taken to reduce complexity and time lag from screening to CD4 test and emphasize the importance of remaining in care during posttest counseling.

Keywords:

• Gay men
• HIV testing
• linkage to care
• China

Acknowledgments

This work was supported by the China-Gates Foundation HIV Cooperation Program [grant number Opp49277]. We acknowledge the significant contribution of project officers and community-based organizations in 15 project areas for data collection and reporting, and Nora Kleinman and Serena Fuller of the CDC Global AIDS Program – China Office for their review of the manuscript.