Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 19, 2022
Open Peer Review Period: Oct 19, 2022 - Nov 2, 2022
Date Accepted: Jan 11, 2023
(closed for review but you can still tweet)
Peer-led community-based support services and HIV treatment outcomes among people living with HIV in Wuxi, China: a propensity-score matched analysis of surveillance data 2006-2021
ABSTRACT
Background:
Community-based organizations (CBOs) deliver peer-led support services to people living with HIV (PLHIV). Systematic reviews have found peer-led community-based support services can improve HIV treatment outcomes, however few studies have been implemented to evaluate impact on mortality using long-term follow-up data.
Objective:
We aimed to evaluate associations between receipt of peer-led community-based support services and HIV treatment outcomes and survival among PLHIV in Wuxi, China.
Methods:
We performed a propensity score matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for PLHIV in Wuxi, China between 2006-2021. PLHIV who received adjunctive peer-led community-based support for at least 6 months from a local CBO (exposure group) were matched to PLHIV who only received routine clinic-based HIV care (control group). We compared differences in HIV treatment outcomes and survival between these two groups using Kaplan-Meier curves. We used competing risk and cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported sub-distribution hazard ratios (SHR) and hazard ratios (HR) with 95% confidence intervals (CIs).
Results:
A total of 860 PLHIV were included (430 in exposure group, 430 in control group). Exposure group was more likely to adhere to antiretroviral therapy (ART) (92.1% vs. 83.7%, P<.001), remain retained in care 12 months after ART initiation (93.5% vs. 76.1%, P<.001), and achieve viral suppression 9-24 months after ART initiation (93.7% vs. 89.3%, P=0048) compared to control group. Exposure group had significantly lower ARM (1.8 vs. 7.0 per 1000 person-years, P=0.01) and all-cause mortality (2.3 vs. 9.3 per 1000 person-years, P=.002), and significantly higher cumulative survival rates (P=.002). Exposure group had a 72% reduction in AMR (SHR=0.28, 95%CI: 0.09-0.95) and a 70% reduction in all-cause mortality (HR=0.30, 95%CI: 0.11-0.82). The non-randomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups.
Conclusions:
Receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among PLHIV in a middle-income country in Asia. The 15-year follow up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
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