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Background: We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy. Methods: A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy). Results: Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p A significant difference of mean score was detected in each HBM construct between pre- and post- scaleup groups (pp=0.006), has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa=0.71 to 1.83, pp>0.05). Conclusions: The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.

BackgroundChina started the new antiretroviral therapy (ART) strategy since 2016, after which free ART could be provided for all people living with HIV. We aimed to understand the prevalence of ART initiation among men who have sex with men (MSM) living with HIV and to explore how ART-related perceptions, psycho-social status etc. predict ART initiation under the new strategy.MethodsA cohort study (maximum follow-up period = 578 days) was conducted in Guangzhou, China. A total of 303 ART-naïve MSM were recruited from community. Baseline information collected demographic characteristics, HIV/AIDS-related health status, ART-related perceptions, weighting of pros versus cons and psycho-social status. The outcome was ART initiation. Cox regression models were fitted for data analyses.ResultsThe prevalence of ART initiation was 83.8% of all participants and 92.6% of MSM diagnosed recently (within 30 days). In multivariate Cox regression models, HIV-positive MSM received HIV diagnosis ≤30 days were less likely to initiate ART (HR = 0.37, 95% CI: 0.28-0.49). In adjusted analyses, belief that immediate ART initiation would have more benefit for themselves associated with increased ART initiation (HRa = 1.44, 95% CI: 1.06-1.96). In the final model, weighting of pros versus cons and time since diagnosis of HIV infection remained significant.ConclusionThe prevalence of ART initiation was high among MSM living with HIV in Guangzhou. To reach the second 90% target, measures should be focused on MSM previously diagnosed. Interventions showing HIV-positives the benefits of ART were also needed.