The association between disclosure and antiretroviral therapy among adults living with HIV in China: A systematic review and meta-analysis

BACKGROUND: Antiretroviral therapy (ART) and ART adherence are crucial for preventing HIV transmission and prolonging the lifespan of people living with HIV (PLWH). Serostatus disclosure is a significant factor influencing both ART initiation and ART adherence. However, studies evaluating the impact of disclosure on ART initiation and ART adherence in mainland China have yielded inconsistent findings. This systematic review and meta-analysis aim to examine the associations between disclosure and both ART initiation and adherence. METHODS: We systematically reviewed English databases (MEDLINE, Embase, Web of Science and the Cochrane Library) and Chinese databases (CNKI, WanFang, CQVIP, and SinoMed) to identify literature on factors that influence ART initiation and ART adherence from inception to Sep 24, 2024. Microsoft Excel 2019 sheet was used for data extraction. The data extraction sheet included information on the author’s names, publication year of the study, study design, study population, sample size, definition of adherence to ART, and study quality score. The Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies was employed to assess the quality of the selected articles. Data were analyzed using STATA 17.0, and a random effects model was utilized to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Sensitivity analyses were conducted through the sequential exclusion of studies. Publication bias was assessed using Begg’s test and Egger’s test. RESULTS: Our search yielded 517 results, of which 21 were eligible and included in the final meta-analysis. The analysis found that PLWH who disclosed their HIV serostatus were 2.59 times more likely to initiate ART compared to those who did not disclose (ORƒ_%=ƒ_%2.59, 95%CI: 1.92-3.49). However, we found no statistically significant association between HIV serostatus disclosure and ART adherence (ORƒ_%=ƒ_%1.21, 95%CI: 0.89-1.65). Additionally, no significant associations were identified between HIV serostatus disclosure and ART adherence in any subgroup analyses based on the subjects of disclosure, participants, or adjusted effect estimates for confounding factors. CONCLUSIONS: We found evidence that serostatus disclosure is likely to positively associated with ART initiation, but not with ART adherence. Encouraging serostatus disclosure among PLWH, while simultaneously increasing public awareness about HIV and fostering a supportive environment for disclosure, may enhance ART adherence

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Social support
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment