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Marc Bulterys, MD, PhD CDC Country Director (2008-13) China-US Cooperation 中美合作 - 全球艾滋病项目

Current HIV/AIDS Situation in China UCLA “HIV/AIDS Epidemiology” Course by Prof. Roger Detels November 27, 2013. Marc Bulterys, MD, PhD CDC Country Director (2008-13) China-US Cooperation 中美合作 - 全球艾滋病项目. Overview. Description of the HIV epidemic in China Ongoing challenges

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Marc Bulterys, MD, PhD CDC Country Director (2008-13) China-US Cooperation 中美合作 - 全球艾滋病项目

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  1. Current HIV/AIDS Situation in ChinaUCLA “HIV/AIDS Epidemiology” Course by Prof. Roger DetelsNovember 27, 2013 Marc Bulterys, MD, PhD CDC Country Director (2008-13) China-US Cooperation 中美合作 - 全球艾滋病项目

  2. Overview • Description of the HIV epidemic in China • Ongoing challenges • History of US-China cooperation on HIV/AIDS

  3. National Targets by 2015 • Goals: • The number of people living with HIV/AIDS be controlled to no more than 1,200,000 • New HIV infection 25% • AIDS mortality30% • Measures: • Prevention: 90% coverage for high-risk, 70% HIV testing • ART: >80% • PMTCT: >80%

  4. Leadership commitment

  5. Overview of HIV Epidemic in China • Stable HIV incidence with ~50,000 new HIV infections per year (highest recent estimate in 2007: 70,000) • 800,000-900,000 estimated PLHA (2013) • 260,000 PLHIV eligible for ART at CD4<350 (2012) • 164,000 and 63% eligible on ART; 80% of known (2012) • 28,000 deaths due to HIV (2012) 2012 China AIDS Response Progress Report, China MOH; UNAIDS; NCAIDS (2013); personal communication

  6. HIV Prevalence in Key Populations 2012 China AIDS Response Progress Report, China MOH; from China’s HIV Sentinel Surveillance System

  7. HIV Prevalence Among MSM 2012 China AIDS Response Progress Report, China MOH

  8. Transmission Modes Change Overtime Sexual 83.2% Heterosexual IDU MSM Blood Unknown MTCT

  9. MSM Account for 50% of Newly Reported HIV Cases in Provincial Capital Cities Heterosexual IDU MTCT Blood/products MSM

  10. Methadone Reduces HIV Incidence Among Drug Users 26%

  11. October 29, 2010

  12. Key Populations: Opportunities and Barriers • All: Late treatment initiation, high mortality pre-ART • FSW: • Barriers to accessing care and maintaining ART adherence • Low-fee and rural FSWs have higher HIV/STI rates; in some cities linked with heroin and amphetamine use • MSM: • Increasing HIV transmission, limited intervention coverage in many cities and continuing stigma issues • PWID: • Low ART coverage & treatment retention, high mortality & co-morbidities. Need earlier HIV diagnosis & better ART access • MMT clinics can be platforms for comprehensive HIV services, including DOT ART

  13. National Free ART Program - 1 • National Free ART Program began in 2002 among former plasma donors • Rapidly scaled up to cover entire country

  14. National Free ART Program - 2 • Currently over 200,000 patients from all high-risk groups on ART (AZT/TDF + 3TC + NVP/EFV) • CD4 tests now routine; annual viral load tests recommended in 2009, gradually scaled up • Second-line antiretroviral therapy introduced in 2008; currently >15,000 patients on second-line drugs (usually TDF+3TC+LPV/r)

  15. Five-Year Survival and Mortality Rates Zhang F et al. Annals of Internal Medicine 2009

  16. ART Coverage Increases but Needs Further Expansion Lancet Infectious Disease 2011: ART coverage 78% in FPD, 60% in sexual transmission population and only 39% in PWID

  17. Cascade of HIV Services in China (2012)

  18. Increase in Integrated PMTCT programs, 2003-2010 8 pilot counties in 2003 271 pilot counties in 2007 1156 pilot counties in 2010 (HIV+Syphilis+HBV) 333 pilot counties in 2008

  19. Trends in MTCT of HIV in 15 Selected Counties in China, 2005-2009 Manuscript on trends in mother-to-child transmission of HIV-1 in China, NCWCH (submitted)

  20. Barriers and Challenges • ~50% of PLHA are unaware of their HIV status • Frequent late enrollment in care & ART initiation

  21. Barriers and Challenges • High burden among ethnic minorities: 8% of population but with 38% of HIV cases, often residing in rural and remote areas • Multi-sectorial collaboration to improve linkages between vertical health systems (MCH, CDC, MMT, hospital) • Limited involvement and capacity of civil society • Severe poverty and inequitable financing of basic health care in certain regions

  22. History of US-China Cooperation on HIV/AIDS • CDC assessment mission to China in 2001 • GAP office established in Beijing in Oct 2003 • NIH CIPRA grant ended in 2010 • Transition of USAID HIV/AIDS activities in Guangxi and Yunnan to local government (2011) • Continued emphasis on technical collaboration between US and China CDCs (2013-)

  23. Technical Collaboration Framework • Goal • Strengthen partnership between US CDC and China CDC for HIV/AIDS response within and beyond China • Principles • Integration • Innovation • Evidence-based • Experience sharing • South-to-South cooperation

  24. US-China Cooperation Provinces (2003-2013) Heilongjiang Inner Mongolia Xinjiang Beijing Shandong Ningxia Qinghai Jiangsu Henan Tibet Anhui Focus (high prevalence) TA only (low prevalence, high risk and/or unique epidemics) Previously supported Rural AIDS Clinical Training Centers in Liangshan, Luzhai, and Lixin Guizhou Guangdong Yunnan Guangxi

  25. Support of Epidemiologic Data Analysis and Operational Research to Improve HIV/AIDS Outcomes in China

  26. Increased use of antenatal care and hospital delivery services among minority women in Guangxi PMTCT and Community Mobilization

  27. Rural AIDS Clinical Training Centers in three provinces • Three training centers: • Lixin (利辛) , Anhui (2004) • Luzhai (鹿寨), Guangxi (2010) • Liangshan (凉山), Sichuan (2012) • Transitioned Lixin center to local government in 2011 • Trained 229 rural physicians who are serving >20,000 patients on ART in 16 provinces by 08/31/13

  28. Thank you! • Special thanks to NCAIDS and NCWCH, China CDC 特别感谢国家性艾中心和国家妇幼保健中心 Dr. Wu Zunyou (NCAIDS Director) • WHO, UNICEF and UNAIDS • Staff of the US CDC’s Global AIDS Program in China

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