Analysis of factors influencing rapid treatment initiation decisions among people living with HIV: focusing on the role of social support

TL;DR

This study explores how social support influences the quick start of HIV treatment, showing that support from family and peers improves treatment acceptance.

Contribution

The study identifies specific social support factors that facilitate or hinder rapid ART initiation among PLWHA.

Findings

Younger age, cross-district treatment, and disclosure to family were facilitators of rapid ART initiation.

Psychological support from family and peers was most strongly associated with higher rapid ART initiation rates.

PLWHA who received no support had the lowest rapid ART initiation rates.

Abstract

To investigate the impact of social support factors on the acceptance of rapid initiation of antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA), and to provide evidence for developing personalized interventions to improve the rapid ART initiation rate.

A cross-sectional study was conducted among patients visiting Lanzhou Pulmonary Hospital between September 2024 and January 2025. Data were collected via questionnaires. Variable selection was performed using univariable logistic regression; those with a significance level of p < 0.05 were included in a multivariable logistic regression model. Group differences in rapid initiation rates were assessed using the chi-square test.

Among the 530 participants (506 males, 481 Han ethnicity), the highest proportion was in the 31 to <46 age group. Univariable analysis showed that age, education, cross-regional treatment, marital status, monthly income, disclosure to spouses/family, and having infected peers were associated with rapid ART initiation. The multivariable model identified that younger age groups (15- < 31 and 31- < 46), cross-district treatment within the city, monthly income ≥5,000 CNY, disclosure to spouses/family, and having infected peers were facilitators, while being unmarried was a barrier. Rapid initiation rates differed significantly based on spouses’/family members’ attitudes post-disclosure (χ2 = 4.281, p = 0.039) and provision of support (χ2 = 4.281, p = 0.039), but not on peer support provision (p = 0.058). Among the support provided by spouses/family members, psychological support was the most common and was associated with the highest rapid ART initiation rate. The proportions of financial support and material support were similar, and their corresponding rapid initiation rates were also comparable. PLWHA who received no support had the lowest rapid initiation rate, which was significantly lower than rates observed with any form of support. Similar results were observed in the subgroup with infected peers: psychological support had the highest proportion and the greatest rapid ART initiation rate, while the absence of peer support was associated with the lowest proportion and the smallest rapid initiation rate.

Integrating social factors into rapid ART initiation interventions, through a support network connecting families, peers, and healthcare institutions, can enhance treatment willingness and timeliness, ultimately improving outcomes for PLWHA.