Some patient-related factors associated with late access to ART in China's free ART program.

Highly active antiretroviral therapy (HAART) has become widely available in China during the past seven years. However, many patients still initiate treatment at very late stages. To understand the distribution of baseline CD4 and factors associated with late antiretroviral therapy (ART) access, the National Free ART Database was retrospectively reviewed and a total of 49,321 HIV/AIDS patients were identified in this study based on the following inclusion criteria: (1) age ≥18; (2) initiated HAART between 1 July, 2006 and 31 December, 2009; (3) have recorded baseline CD4 cell count. This study showed that although both the median and mean baseline CD4 increased consistently over the study period, there were still about 30% of HIV/AIDS patients accessing ART at a very late stage (CD4 ≤ 50 µl) in 2009. Risk factors for late ART access included being male, single, having a short time interval between HIV diagnosis and treatment, and being infected through heterosexual contact. Being infected through injection drug use and homosexual contact were protective. Transmission route and marriage status showed different effects in a gender stratified analysis. A strengthened HIV testing and screening program is the key to improving the accessibility of ART and populations that are vulnerable to sexual transmission of HIV should be the primary target of the program.