Impact of Comprehensive Strategy on Mortality in Heterosexually Transmitted HIV-Infected Individuals - Liangshan Prefecture, Sichuan Province, China, 2008-2024.

Abstract

A comprehensive strategy integrating universal human immunodeficiency virus (HIV) testing, real-time patient tracking, and enhanced antiretroviral therapy (ART) within a poverty-alleviation framework was implemented to curb the HIV epidemic in Liangshan Prefecture. This study aimed to quantify its impact on HIV treatment coverage and mortality among heterosexually transmitted HIV-infected individuals. Data on heterosexually transmitted HIV infections in Liangshan from 2008 to 2024 were extracted from China's HIV/acquired immunodeficiency syndrome (AIDS) Comprehensive Response Information Management System (CRIMS) database. Cox proportional hazards models were used to estimate the effectiveness of the comprehensive strategy on mortality. Interrupted time series analysis examined trends and changes in treatment coverage and mortality before and after implementation. Subgroup analysis investigated outcomes variations across different populations. Among 37,034 eligible HIV-infected individuals, 7,302 deaths occurred. Not receiving ART was the strongest risk factor for mortality [hazard ratio (HR): 17.74]. The comprehensive strategy led to a 21.62% immediate increase and a 1.48% annual increase in treatment coverage, accompanied by a 0.47% decline in mortality per year [95% confidence interval (CI): -0.73, -0.21]. By 2024, the mortality rate was 4.89% lower than the expected level (95% CI: -8.02, -1.75), representing an 81.2% reduction. Reductions were greatest among males, residents of key counties, and patients at the HIV infection stage. The comprehensive strategy in Liangshan significantly improved treatment coverage and reduced mortality among heterosexually infected individuals. Further efforts are needed to promote early diagnosis, rapid ART initiation, and tailored care support for advanced disease. This comprehensive model offers an adaptable template for high-burden, resource-limited settings.