Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers’ recommendations

BACKGROUND: The early initiation of antiretroviral therapy (ART) for people living with HIV (PLWH) benefits both individuals and societies. However, little is known about the intention to initiate ART among PLWH in China in the context of a scaling-up of treatment or how the recommendations of healthcare workers affect this intention. METHODS: A total of 451 ART-naïve PLWH were recruited from communities in Guangzhou, China for this study. Data were collected by trained physicians via face-to-face interviews. Logistic regression models were fitted for the data analyses. RESULTS: Of the participants, 93.8% were male, 72.7% were infected via homosexual behaviour and 68.5% reported an intention to initiate ART. In the latter category, 77.8, 41.9 and 20.0% of respondents received strong recommendations to initiate ART from healthcare workers at the Centres for Disease Control and Prevention (CDC), community healthcare centres and non-governmental organisations (NGOs), respectively. After adjusting for potential confounders, depression, anxiety and strong recommendations from healthcare workers at the CDC and NGOs correlated significantly with ART intention. In the adjusted final hierarchical logistic regression model, the duration of infection [multivariate odds ratio (OR(m)) = 0.30, p < 0.001], route of HIV infection (OR(m) = 0.18, p < 0.01), infection status of the current spouse/regular sex partner (OR(m) = 0.21–0.23, p < 0.01), anxiety (OR(m) = 2.44–2.65, p < 0.05) and strong recommendations from CDC physicians (OR(m) = 3.67, p < 0.01) or NGOs workers (OR(m) = 3.67, p < 0.01) were independently associated with the ART intention, whereas a recommendation from a community healthcare centre physician was not. CONCLUSIONS: In Guangzhou, the prevalence of ART intention was below the 90–90-90 targets. Further studies aimed at an in-depth understanding and encouragement of health care workers’ perceptions regarding early ART are warranted as a means of scaling up new ART strategies.