China is a low-prevalence country –according to the 2011 Update on HIV/AIDS Epidemic and Response in China, the HIV prevalence among general population is about 0.058%.– but its population, and thus its population of positive people, is large, there was an estimated number of 780,000 PLWHA by the end of 2011. While the epidemic has historically been concentrated in injecting drug users and in former blood donors and recipients, in 2007 sex overtook needles as the main means of new HIV infection for the first time. Data from the annual case reporting system shows that the portion of identified PLHIV that acquired HIV through sexual contact has been gradually increasing, from 33.1% in 2006 to 76.3% by 2011. 13.7% of sexually acquired HIV was through homosexual contact, an increase from 2.5% in 2006.
In 2003, the Chinese government adopted the “Four Frees and One Care” program, providing free HIV treatment and testing, free schooling for children orphaned by AIDS, and care and economic assistance to affected households. Opportunistic infection treatment and relative laboratory testing are not free, however, and some patients drop off treatment because of the associated costs.
- Population: 1.4 billion
- People living with HIV: 780,000
- Patients in care supported by AHF: About 7,466 (by the end of 2012)
- People receiving ART’s supported by AHF: 5,625 (by the end of 2012)
Statistics from UNAIDS.org, 2011 Update on HIV/AIDS Epidemic and Response in China, unless otherwise stated.
AHF in China
Since the beginning of 2006, AHF started the first cooperation AIDS program in Linfen. At present, total five cities/provinces in China joined AHF China Cares, included Linfen city, Shanxi province, Guangxi Zhuang Autonomous Region, Wolong district, Nanyang city, Henan province, Yunnan province and Chongqing Municipality, China, These five provinces have relatively high HIV prevalence in China with concentrated incidence of AIDS among former blood donors, injecting drug users and sexual transmission. Due to no registration in China, AHF found a national cooperative partner- China Prevention Medicine Association (CPMA) and signed MOU in 2008. CPMA not only provided financial management support, also gave suggestions and technical support in the program development. In order to push forward the strategy of elimination pre-ART, AHF is ongoing to sign a MOU with Beijing Youan hospital to have a long-term cooperation since 2013.
AHF has tried to build up a collaborative working environment by cooperating with government, CDC, hospitals, international organizations, NGOs and PLWHA in national and local level. And AHF tried best to utilize resources from other projects to expand its services. Meanwhile, AHF has paid heavily attention to collaborate with governmental departments, like Ministry of health, NCAIDS, China CDC in national level and Health Bureau, CDC in local level to carry out treatment and testing activities and utilize human resources of local stakeholders.
In order to follow up the principle of AHF– Cutting-edge medicine and advocacy, regardless of ability to pay. And the goal– Establish a scalable, replicable, and sustainable model for the delivery of quality and appropriate prevention, treatment, and care services for people living with HIV/AIDS in the project areas, AHF provides comprehensive medical services involving in providing high quality ART services, including training on ART and OIs for doctors/nurses, skills and capacity building for peer educators, providing OI drugs and laboratory examinations freely for poor HIV/AIDS, supporting WAD campaign and pushing forward to scale up HIV RT testing and condom distribution in community level. In addition, in order to detect HIV positive and linkage to ART service early, AHF conducted some pilot projects, such as using two RT testing to replace WB and linkage to ART immediately, starting ART for patients with CD4 above 350, and scale up HIV blood RT and oral RT to MARPs by internet. These pilot projects will provide good evidence for policy makers to revise relative guideline and paper in the future.
1. ART service
AHF paid heavily attention to push forward ART in China. Three aspects were enhanced in program areas as following:
Firstly, AHF supported local clinic to hold training course for doctor/nurse to improve capacity building. The trainees were medical doctors and nurses from partner hospitals and also county level, township level healthcare providers from project areas. Meanwhile, the trainees included the new and existing doctors/nurses. AHF supported to invite relative outstanding experts to be the trainers from national and international. The content of training included ART service, OI treatment, drug resistance, adverse effect of ARVs, professional prevention, co-infected with TB and HB, psychological support, et.al. The style of training course included lecture presentation, case discussion and clinical round to the patients. Training the new ART guideline to doctors/nurses is the most important for it can improve the quality of ART in the future.
Secondly, AHF provided free OI drugs to poor patients to improve the quality of ART and reduce mortality, a total of 50 kinds and about 70,000USD of OI drugs were provided freely.
Thirdly, AHF supported clinic to conduct relative activities to improve drug adherence and relieve psychological burden of the patients, such as recruited and trained peer educators, conducted community based patient’s workshop and self-support through the cooperation with local key partners, such as local CDCs. All these activities improved the adherence of treatment and the quality of life.
2. HIV testing and condom distribution campaign
In order to increase population’s HIV awareness, accessibility and utilization of testing services, especially the HIV RT testing, and further to promote early diagnosis and treatment, AHF carried out HIV RT testing and condom distribution campaign in project sites and national level. AHF provided free test kits, condom and operational budget to support partners to scale up HIV RT testing, education and condom distribution in community, school and MARPs. All HIV positive were linkage to Clinic Center for medical services immediately.
In order to advocate the strategy of AHF and push forward HIV RT testing and elimination pre-ART, AHF supported partners to conduct propaganda activities in national and community level, such as AHF joined the 12.1 WAD campaign held by MOH in Beijing every year, included the participation of HIV positive and delegates from program sites (included government leader/doctors and PLWHA), media staffs in Beijing and IEC materials.
Meanwhile, AHF also supported local clinic to conduct propaganda quarterly in community level, and utilized mess media to make propaganda for AHF project in local areas.
4. M&E/Quality management/work plan
AHF strengthened the M&E to communicate with local in order to find problems and challenges during the implementation of program. It’s very useful to push forward the implementing of cooperation program. Every year, AHF will travel to local sites to do the clinic centre observation assessment. This assessment helped sites to find some operating problems and laid a good foundation for improving the quality of clinic centre in the future.
5. Pilot project
a) Use two RT testing to replace WB and linkage to ART immediately.
From the beginning of 2013, in order to explore the feasibility and accuracy of replacing western blot (WB) with two HIV rapid tests in the diagnosis of HIV infection in health facilities in China and refer PLHA to ART timely, pilot project for using two HIV RT testing replacing WB and linkage to ART immediately are being implemented in Youan hospital in Beijing, Kunming 3rd hospital and Zhaotong hospital in Yunnan province. These three health facilities respectively represent regions with different HIV prevalence in China and designated ART providers at national, provincial and prefectural levels. Access to services will be available through three channels of linkage, the CDC level, the healthcare facility/hospital, and through community/peer educators – both of the CDC and the community/MSM/peer educators will refer positives identified to the hospital where comprehensive services will be provided. The proposed project aims to implement a ‘one-stop service’ to patients in order to ensure earliest possible initiation on ART as well as access to treatment for TB and OIs. Meanwhile, in order to find the challenges and achievements during and after the implementing, enlarge the influence and distribution of the new-treatment model in national level, AHF contracted with the department of policy research from the National Center on HIV/AIDS and STD Prevention and Control, China CDC to conduct a monitoring and evaluation as an external assessment group. We believe the pilot project will provide evidence to policy makers/health providers for revising relative policy and papers, and push forward to scale up HIV RT testing.
b) Initiative ART for patients with CD4 above 350
To explore the feasibility of providing ART to AIDS patients with CD4>350 in designated health facilities in China, so as to promote the strategy of “Treatment as Prevention” in HIV/AIDS response and the ART guidelines from WHO, AHF begin to push forward elimination pre-ART in the beginning of 2013 in China, especially in Chongqing and Guangxi. AHF encouraged doctors to mobilize patients to accept ART regardless of CD4 result in our project sites. We believe it will be very helpful to make a progress of initiative ART for patients with CD4 above 350 in the future.
c) Scale up HIV RT through internet to MARPs.
Due to the low coverage of HIV testing among MARPs, AHF conducted a pilot project to scale up HIV RT testing through internet. This work collaborated with MSM group in Beijing. Such as during the Dec, 2012, AHF supported MSM group to scale up HIV RT testing among MSM by internet. MSM were selected as seeds to recruit subjects via Internet publicity. Online questionnaire survey was conducted to learn the basic information. The algorithm of two HIV rapid tests (electro selenium kit and colloidal gold kit) was used to perform HIV test for subjects. There have two ways for doing HIV RT testing, one is to deliver the reagents to individuals freely who will do the testing according to the product’s instruction by themselves and the result was took a picture and sent back for us. The other way is to transferring individuals to the testing sites to do test freely by peer educators. Subjects with positive results in both HIV rapid tests were referred to health facilities for WB, CD4 test and viral load test at the same time. Eligible subjects were provided with ART immediately. This work has been proved a low-cost and effective way to find HIV positive MSMs and linkage to hospital for ART services early. This work already was implemented continually by collaboration with MSM groups in Beijing this year.
6. Human resources
In order to push forward all activities in program areas, AHF supported allowance for doctor/nurse, peer educators and data staff as incentive mechanism. It’s necessary and important to implement the strategy of AHF and play a very important role on the stability and sustainability of providing high quality ART services in community clinic.
Country Program Manager:
Dr. Bao Yugang
Room 0812, No.13, South Road of the 3rd Ring East, Chaoyang District,
Huatai Hotel, Beijing, China
Cooperative partners of AHF in China by the end of 2012:
Linfen Infectious Disease Hospital, Linfen city, Shanxi province
Guangxi Center for Disease Prevention and Control, Nanyang city, Guangxi
Wolong district CDC, Nanyang city, Henan province
Yunnan provincial AIDS Clinice Center, Kunming city, Yunan province
Chonqing Public Health and Clinic Center, Chongqing city.
China Prevention Medicine Association (CPMA), Beijing city.
Beiing Youan hospital/ Beijing YouAn Home of Loving Care
MSM group- China Chaoyang AIDS Volunteer Organization