Factors associated with rapid initiation of combination antiretroviral therapy among people living with HIV from 2016 to 2025 in Wuhan, Hubei, China: a decade-long retrospective cross-sectional study

Rapid initiation of combination antiretroviral therapy (cART) plays a critical role in reducing mortality and improving quality of life among people living with HIV/AIDS (PLWHA). This study aimed to analyze the characteristics and factors associated with rapid cART initiation among PLWHA, and to offer a scientific basis for the development of targeted interventions. A retrospective cross-sectional study was performed among PLWHA reported from 2016 to 2025 in Wuhan, China. Data were collected from the National Disease Prevention and Control Information System. According to the WHO guidelines, rapid cART initiation was defined as initiation within 7 days of HIV confirmation. A chi-square test for trend was applied to assess changes in rapid cART initiation rates over calendar years, and multivariable logistic regression was conducted to identify factors associated with rapid cART initiation. Among 7389 HIV/AIDS patients, the median time from confirmation to initiation of cART was 21 days (interquartile range: 11–41 days). The proportion of patients receiving rapid cART was 15.37%, rising from 2.35% in 2016 to 52.87% in 2025 ( P for trend < 0.001). The multivariable model revealed that patients in 2019–2022 (OR = 4.600, 95% CI: 3.635–5.823) and 2023–2025 (OR = 14.968, 95% CI: 11.813–18.965), age group of 50 years old and above (OR = 1.302, 95% CI: 1.064–1.593), those who were identified through medical institutions (OR = 1.194, 95% CI: 1.020–1.397), and those who were late diagnosed (OR = 1.362, 95% CI: 1.162–1.597) demonstrated a significantly higher odds of rapid antiretroviral therapy initiation. Conversely, unmarried individuals (OR = 0.751, 95% CI: 0.612–0.921), divorced or widowed (OR = 0.773, 95% CI: 0.614–0.972) and those with inter-city mobility (OR = 0.703, 95% CI: 0.611–0.810) had a lower odds of rapid initiation of cART. The proportion of rapid cART initiation in Wuhan increased from 2016 to 2025, but it remained suboptimal. Factors significantly associated with rapid initiation included calendar year, age at diagnosis, marital status, migration status, detection source, and late diagnosis. Targeted interventions for younger, unmarried, divorced or widowed, and migrant patients, along with improved referral systems and enhanced drug accessibility, may further increase the rapid cART initiation rate.