Attrition rate of antiretroviral therapy and its influencing factors among Chinese people living with HIV/AIDS: A meta-analysis and system review

OBJECTIVE: To systematically evaluate the attrition rate of PWH undergoing ART and its influencing factors. METHODS: We systematically searched Embase, PubMed, Web of Science, The Cochrane Library, VIP, WanFang, CNKI, and the Chinese Biomedical Literature Database for studies on the attrition rate and/or influencing factors of ART in PWH. The search period covered from database inception to January 2025. Two researchers independently screened the literature, extracted data, and appraised the quality of the included studies. Data analyses were performed using RevMan 5.3 and Stata 16.0 software. RESULTS: A total of 19 studies were ultimately included, of which 11 were cohort studies, 4 were case-control studies, and 4 were cross-sectional studies. The meta-analysis showed that the attrition rate among PWH receiving ART was 4.0 per 100 person-years (95% CI: 2.0-5.0 per 100 person-years). Factors identified as influencing attrition among PWH included age(ORƒ_%=ƒ_%1.51, 95%CI:1.46,1.64), male gender(ORƒ_%=ƒ_%1.30, 95%CI:1.17,1.44), unmarried or living alone(ORƒ_%=ƒ_%1.43, 95%CI:1.30,1.59), alcohol consumption(ORƒ_%=ƒ_%8.48, 95%CI:1.33,53.74), infection via intravenous drug use(ORƒ_%=ƒ_%2.15, 95%CI:1.89,2.46), initial treatment regimen including protease inhibitors (PI) (ORƒ_%=ƒ_%1.58, 95%CI:1.34,1.86), baseline CD4ƒ_§ T lymphocyte countƒ_%>ƒ_%350/AæL(ORƒ_%=ƒ_%1.84, 95%CI:1.11,3.05), adverse drug reactions(ORƒ_%=ƒ_%1.71, 95%CI:1.26,2.34), inconvenient access to medication(ORƒ_%=ƒ_%5.38, 95%CI:1.79,16.18), low family support(ORƒ_%=ƒ_%4.81, 95%CI:1.86,12.44), passive acceptance of treatment(ORƒ_%=ƒ_%16.04, 95%CI:1.72,149.42), interval from diagnosis to ART initiationƒ_%>ƒ_%1 year(ORƒ_%=ƒ_%1.20, 95%CI:1.10,1.53), and ART initiation year in 2016 or later(ORƒ_%=ƒ_%1.57, 95%CI:1.28,1.93). (Pƒ_%<ƒ_%0.05). For some factors(alcohol consumption, inconvenient access to medication, low family support, passive acceptance of treatment), the small number of included studies and/or substantial heterogeneity limits the certainty of the evidence and the stability of the findings; therefore, they should be interpreted with caution. CONCLUSION: Our meta-analysis indicates that ART attrition among PWH in China is relatively high and influenced by multiple factors. Accelerating ART initiation, optimizing medication access and adverse-event management, and strengthening social and family support may reduce attrition and improve treatment outcomes. Trial registration This study has been registered in PROSPERO under the registration number CRD420251023033

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Social support
  • Health services
  • Other
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Substance Use
  • Alcohol
• Health Systems
  • Governance arrangements
  • Delivery arrangements