90-90-90 cascade analysis on reported CLHIV infected by mother-to-child transmission in Guangxi, China: a modeling study

The prevalence of HIV in Guangxi was very high, and there were many children living with HIV (CLHIV) because of larger baseline of pregnant women infected by HIV. It is necessary for children to explore the status of antiretroviral therapy (ART) on different initial CD4 counts in children with HIV infected by mother-to-child transmission (MTCT) in Guangxi and to evaluate the progress towards the 90-90-90 targets proposed by UNAIDS/WHO. Based on a retrospective observational cohort of children with HIV infected from the Guangxi Center for Disease Prevention and Control (CDC), the variables of all patients included viral loads, CD4 counts, laboratory results and WHO clinical staging of HIV/AIDS were collected. Several indicators were defined before analyzed: (1) diagnosis of MTCT: infants born to HIV-positive mothers who tested positive for HIV twice before 18 months; (2) ART initiation: the children who were enrolled in the treatment cohort and were still having HIV monitoring as of 6 months before date censored and (3) viral suppression: a recently viral load measurement that was less than 1000 copies per milliliter. The number of CLHIV in Guangxi was projected by using the estimates of the national HIV/AIDS prevalence from China CDC. An Autoregressive Integrated Moving Average (ARIMA) model and the Holt Exponential Smoothing (ES) model were used to predict the number of CLHIV, the diagnosed CLHIV, the diagnosed CLHIV receiving ART and the number of them achieving viral suppression, in 2019 and 2021, respectively. In this 14-year HIV/AIDS treatment cohort, 807 children who were HIV infected by MTCT were enrolled. The ARIMA and Holt ES models showed that by the end of 2019, 82.71% of all CLHIV in Guangxi knew their HIV status, 84.50% of those diagnosed had initiated ART, and 85.68% of those on ART had durable viral suppression. By the end of 2021, 93.51% of all CLHIV in Guangxi will know their HIV status, 84.28% of those diagnosed will have initiated antiretroviral therapy, and 85.83% of those on ART will have durable viral suppression. Therefore, in 2021, Guangxi fails to achieve the WHO/UNAIDS 90-90-90 targets for CLHIV, and there is still a wide time interval between the first HIV-positive diagnosis and ART initiation. National free antiretroviral treatment program (NFATP) requires strong enforcement to reduce the prevalence of later chronic diseases and complications.