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Background  The aim of this study was to assess trends in drug resistance and associated clinical and programmatic factors at a national level during the rapid scale up of ART.    Methods  Logistic regression was used to identify the factors associated with HIVDR. Variables associated with drug resistance in multivariable logistic regression were included in the Cochran–Armitage test for trend.    Results  A total of 11,976 patients were enrolled in the study. The prevalence of HIVDR among patients who received ART for 9–24 months during 2003–2008, 2009–2012, and 2013–2015 significantly decreased (15.5%, 6.3%, and 2.3%, respectively,  P  < 0.01). With respect to the class of antiretroviral, there were substantial increases in resistance to both non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) (2003–2008, 2009–2012, and 2013–2015: 49.7%, 58.9%, and 73.0%, respectively,  P  < 0.01). The prevalence of DR to protease inhibitors (PIs) was low, which supported their continued use as second-line therapy in China.    Conclusions  Our results provide evidence for the effectiveness of China’s “Treat All” approach to guide policy makers to improve training for healthcare providers and education on ART adherence among patients.

HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months