The Effectiveness of Antiretroviral Therapy in Mitigating New HIV Infections in Southwest China: An Ecological Study

Xiwei Sun,1 Hang Chen,2 Shu Liang,3 Ticheng Xiao,2 Yali Zeng,3 Hong Liu,2 Liao Feng,3 Dinglun Zhou1 1West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Center for AIDS/STD Control and Prevention, Luzhou Center for Disease Control and Prevention, Luzhou, Sichuan, People’s Republic of China; 3Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Liao Feng, Email [email protected] Dinglun Zhou, Email [email protected]: Antiretroviral therapy (ART) has been shown to reduce the number of local HIV (Human Immunodeficiency Virus) reported cases; however, there is insufficient research on the relationship between new HIV infections and ART. This study utilized real-world data to evaluate the community-level effectiveness of ART in reducing new HIV infections.Methods: Ecological study was designed to establish the relationship between ART quality and new HIV infections. New HIV infections were identified through an expanded testing system in 2018– 2023; ART quality was evaluated based on ART-treated clients in 2016– 2023, and non-probabilistic sampling was performed. Generalized linear models was employed to assess associations between metrics of ART effectiveness and new HIV infections. Statistical significance was set at α = 0.05 with 95% confidence intervals.Results: A total of 3836 new HIV infections were identified, yielding an overall incidence of 2.1%. Treatment coverage for the entire population was 80.8%, and the proportion of clients with an increased CD4 count was 61.0% of the entire population. In the generalized linear modeling, four key factors were associated with reduced new HIV infections: a greater number of clients undergoing treatment, a higher proportion of clients demonstrated CD4 count improvement, higher level of CD4 in baseline, and a reduction in reported cases (β = − 0.04, − 0.03, − 0.01, 0.17 respectively).Conclusion: This ecological study verified that expanding treatment coverage, optimizing the effectiveness of antiretroviral treatment and elevating baseline CD4 counts could curb community-level new HIV infections. Early detection, prompt treatment, and effective ART are crucial for curbing HIV transmission in regions mainly driven by sexual transmission and with high cumulative incidence rates.Keywords: HIV, ART, new infections, ecological study