Impact of Expanded HIV Testing and Rapid Antiretroviral Therapy Initiation in Southwest China: An Interrupted Time-Series Analysis

This study evaluates the impact of an expanded HIV testing initiative, launched in June 2018 in Luzhou, Sichuan, China, on antiretroviral therapy (ART) initiation rates among people living with HIV (PLWH). Using an uncontrolled interrupted time-series design, we analyzed data from 11,040 PLWH between June 2016 and December 2022, extracted from 108 health facilities via the Center for Disease Control and Prevention's ART database. The primary outcome measures were ART initiation rates within 7 and 30 days of HIV diagnosis. Results showed a significant improvement in the 30-day ART initiation rate following expanded testing, increasing from 46.1% to 90.9% by the study's end. The 7-day initiation rate also improved but remained below 30%. The study found that expanded testing enhanced the role of primary health care institutions in ART initiation. However, the COVID-19 pandemic, beginning January 2020, negatively impacted ART initiation rates, with a slight effect on 30-day rates but a persistent negative impact on 7-day rates. Despite these challenges and an increased HIV burden, Luzhou's ART initiation rates surpassed the national average. This study emphasizes the effectiveness of expanded HIV testing in ensuring timely ART access, crucial for HIV epidemic control, and improved patient outcomes. It also reveals challenges in maintaining HIV services during public health crises, offering insights into health care system resilience. Future research should focus on evaluating long-term treatment outcomes and strategies to support ending the AIDS epidemic.