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Background: Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living with HIV (PLHIV) in the "test and treat" era. Multiple psychosocial factors tend to coexist and have a syndemic effect on ART adherence. We aimed to explore factors associated with ART adherence and the syndemic effect of multiple psychosocial factors on ART adherence among PLHIV newly starting ART in Guangdong Province, China. Methods: Newly diagnosed PLHIV from six cities in Guangdong Province were recruited between May 2018 and June 2019, and then followed up from May 2019 to August 2020. Baseline and follow-up data were collected from a questionnaire and the national HIV surveillance system, the follow-up data of which were analyzed in this study. A Center for Adherence Support Evaluation (CASE) index > 10 points was defined as optimal ART adherence, which was measured via participants' self-reported adherence during follow-up survey. Multivariable logistic regression was used to identify factors associated with ART adherence. Exploratory factor analysis (EFA) and multi-order latent variable structural equation modeling (SEM) were performed to explore the syndemic effect of multiple psychosocial factors on ART adherence. Results: A total of 734 (68.53%) follow-up participants were finally included in this study among the 1071 baseline participants, of whom 91.28% (670/734) had self-reported optimal ART adherence. Unemployment (aOR = 1.75, 95%CI: 1.01–3.02), no medication reminder (aOR = 2.28, 95%CI: 1.09–4.74), low medication self-efficacy (aOR = 2.28, 95%CI: 1.27–4.10), low social cohesion (aOR = 1.82, 95%CI: 1.03–3.19), no social participation (aOR = 5.65, 95%CI: 1.71–18.63), and ART side effects (aOR = 0.46, 95%CI: 0.26–0.81) were barriers to optimal ART adherence. The EFA and second-order latent variable SEM showed a linear relationship (standardized coefficient = 0.43, P < 0.001) between ART adherence and the latent psychosocial (syndemic) factor, which consisted of the three latent factors of medication beliefs and self-efficacy (standardized coefficient = 0.65, P < 0.001), supportive environment (standardized coefficient = 0.50, P < 0.001), and negative emotions (standardized coefficient=-0.38, P < 0.01). The latent factors of medication beliefs and self-efficacy, supportive environment, and negative emotions explained 42.3%, 25.3%, and 14.1% of the variance in the latent psychosocial factor, respectively. Conclusions: About nine out of ten PLHIV on ART in Guangdong Province self-reported optimal ART adherence. However, more efforts should be made to address barriers to optimal ART adherence. [ABSTRACT FROM AUTHOR]

Reliable and timely rice distribution information is of great value for real-time, quantitative, and localized control of rice production information. Synthetic aperture radar (SAR) has all-weather and all-day observation capability to monitor rice distribution in tropical and subtropical areas. To improve the physical interpretability and spatial interpretability of the deep learning model for SAR rice field extraction, a new SHapley Additive exPlanation (SHAP) value-guided explanation model (SGEM) for polarimetric SAR (PolSAR) data was proposed. First, a rice sample set was produced based on field survey and optical data, and the physical characteristics were extracted using decomposition of polarimetric scattering. Then a SHAP-based Physical Feature Interpretable Module (SPFIM) combing the long short-term memory (LSTM) model and SHAP values was designed to analyze the importance of physical characteristics, a credible physical interpretation associated with rice phenology was provided, and the weight of physical interpretation was combined with the weight of original PolSAR data. Moreover, a SHAP-guided spatial interpretation network (SSEN) was constructed to internalize the spatial interpretation values into the network layer to optimize the spatial refinement of the extraction results. Shanwei City, Guangdong Province, China, was chosen as the study area. The experimental results showed that the physical explanation provided by the proposed method had a high correlation with the rice phenology, and spatial self-interpretation for finer extraction results. The overall accuracy of the rice mapping results was 95.73%, and the kappa coefficient reached 0.9143. The proposed method has a high interpretability and practical value compared with other methods. [ABSTRACT FROM AUTHOR]