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Exploring the impact of ART adherence on the transmission of drug resistance could provide insights in controlling the HIV epidemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We proposed a dynamic transmission model incorporating the CD4 cell count-dependent rates of diagnosis, treatment and adherence with transmitted drug resistance (TDR) and acquired drug resistance. This model was calibrated and validated by 2008\u20132018 HIV\/AIDS surveillance data and prevalence of TDR among newly diagnosed treatment-naive individuals from Guangxi, China, respectively. We aimed to identify the impact of adherence on drug resistance and deaths during expanding ART.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the base case (ART at 90% adherence and 79% coverage), we projected the cumulative total new infections, new drug-resistant infections, and HIV-related deaths between 2022 and 2050 would be 420\u200a539, 34\u200a751 and 321\u200a671. Increasing coverage to 95% would reduce the above total new infections (deaths) by 18.85% (15.75%). Reducing adherence to below 57.08% (40.84%) would offset these benefits of increasing coverage to 95% in reducing infections (deaths). Every 10% decrease in adherence would need 5.07% (3.62%) increase in coverage to avoid an increase in infections (deaths). Increasing coverage to 95% with 90% (80%) adherence would increase the above drug-resistant infections by 11.66% (32.98%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A decrease in adherence might offset the benefits of ART expansion and exacerbate the transmission of drug resistance. Ensuring treated patients\u2019 adherence might be as important as expanding ART to untreated individuals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkad186","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T21:28:19Z","timestamp":1686691699000},"page":"1934-1943","source":"Crossref","is-referenced-by-count":8,"title":["Modelling the impact of treatment adherence on the transmission of HIV drug resistance"],"prefix":"10.1093","volume":"78","author":[{"given":"Hao","family":"Lai","sequence":"first","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center , Xi\u2019an, Shaanxi 710061 , P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center , Xi\u2019an, Shaanxi 710061 , P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zengbin","family":"Li","sequence":"additional","affiliation":[{"name":"China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Center , Xi\u2019an, Shaanxi 710061 , P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoming","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Stomatology, Xi\u2019an Jiaotong University , Xi\u2019an, Shaanxi 710004 , P.R. China"},{"name":"Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi\u2019an Jiaotong University , Xi\u2019an, Shaanxi 710004 , P.R. China"},{"name":"School of Public Health, Xi\u2019an Jiaotong University Health Science Center , Xi\u2019an, Shaanxi 710061 , P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Xi\u2019an Jiaotong University Health Science Center , Xi\u2019an, Shaanxi 710061 , P.R. 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