China Creates Model Treatment and Care Centers

Four sites in three counties will shape a countrywide strategy

April 2004—Last year, antiretroviral therapy became available for the first time to people living with HIV in China. With the launch of China’s Comprehensive AIDS Response (China CARES), the National Center for AIDS Control and Prevention (NCAIDS), a division of the Chinese Centers for Disease Control, began treating 5,000 patients in selected provinces and counties.

This number will increase exponentially in the coming years with the help of a $95 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Before it does, HIV-positive people in four counties of the central provinces will be the first to receive comprehensive treatment and care provided by a partnership of international, regional, and local organizations. Lessons learned from those sites will be used to craft basic operational procedures for the 56 China CARES sites expected to receive support from the Global Fund in 2004.

Treating a burgeoning HIV-positive population in the world’s most populous country is an undertaking that demands the integration of financial and human resources on a massive scale. To meet the challenge a group of international organizations, under the leadership of NCAIDS, developed the pilot project to establish standards of care, train the health care workforce, create strategies for providing treatment effectively, and educate people living with HIV/AIDS.

The plan sprang from a workshop in China, November 4–6, 2003, sponsored in part by TREAT Asia. The workshop was followed by an informal coordination meeting on November 11 organized by NCAIDS and attended by participants from the U.S. Centers for Disease Control and Prevention (CDC), China-UK, Family Health International, Médecins Sans Frontières-Belgium, the World Bank, the World Health Organization (WHO), and TREAT Asia.

Currently, China has in place a drug delivery program through the Chinese CDC, and there is some training of physicians at the provincial, county, and township levels, along with limited HIV testing and laboratory monitoring. The four sites, located in Xincai County in Henan Province, Linquan County in Anhui province, and Suizhou and Xiangfan Counties in Hubei Province, will receive much stronger governmental support and coordinate their efforts with local organizations in order to deliver greatly expanded services.

Participants at the coordination meeting identified key areas that must be strengthened or developed in order to achieve the goal of 95 percent treatment adherence. These include: government leadership at the county level; physician and nurse training; coordination between the Chinese CDC and local hospitals and community-based organizations; laboratory monitoring; greater involvement of people living with HIV/AIDS; a significant reduction in costs to patients; and a system to monitor and evaluate all of these components.

The four sites were chosen based upon their capacity for implementing HIV/AIDS programs, an existing drug distribution program, good infrastructure to support treatment and care, already established regional and international partnerships, and local willingness.

Central to the sites’ success will be the creation of township health centers. These “warm houses” will serve as regional hubs for treatment delivery, coordination among local, regional and international organizations, training for health care workers, provision of financial support to people living with HIV, patient and family education, psychosocial counseling, and voluntary testing. The international partners of the program include WHO, Médecins Sans Frontières-Belgium, the U.S. CDC, and TREAT Asia. TREAT Asia will support treatment education and treatment literacy, the involvement of people living with AIDS, and peer support activities at all four sites.

Each site is expected to report results to NCAIDS based upon the goals outlined above. Their successes and failures will help define a model for an effective countrywide system, establishing the framework for China’s national response to HIV/AIDS.