hiv care and treatment in china

HIV Care and Treatment in China

2William J. Clinton Foundation HIV/AIDS Initiative

OutlineHIV Care and Treatment in China

Overview of HIV/AIDS in China

China’s Free ART National HIV Treatment and Care Program

–International Cooperation and Support for HIV Control in China

Clinton Foundation HIV/AIDS Initiative’s China Cooperative Programs

–Regional Treatment and Care Scale-Up: Yunnan

–Regional Treatment and Care Scale-Up: Xinjiang

–National Partnerships: Lixin Clinical Training Center, Pediatrics Treatment, Early Infant Diagnosis

HIV/AIDS Situation in China


China in Context: Regional and Domestic Influences on the Development of an HIV Epidemic


1985

1989

1995

1998

Spread of HIV/AIDS epidemic in China

HIV/AIDS Context in China

Estimated 700,000 PLWHAs in 2007.

Primary mode is now sex transmission (41.2%); IVDU (28.4%).

Overall prevalence 0.06%.

Estimated 3% of PLWHAs are children (21,000).

By mid 2008: reported 253,748 HIV/AIDS cases, just over 1/3 of

estimated epidemic.

3/4 of the epidemic concentrated in Yunnan, Henan, Guangxi, Xinjiang

and Guangdong.

Rural vs. urban distribution of epidemic -- 4:1.

Now more than 50,000 patients on ART,

85% increase since 2005.

1,500 children on treatment.

HIV/AIDS Context in China

IVDU Regions

FPD Regions

HIV/AIDS Care and Treatment China’s treatment goals by 2010 include providing:ART/TCM to 80+% of all patients;OI treatment to 90+% patients;PMTCT to 90+% HIV+ pregnant women.


HIV/AIDS Epidemic in China

Drug Users

Sex Workers

Family

ChildrenSource Population

Bridge Population

General Population

China’s “Free ART” HIV Care and Treatment

Program


On December 1st, 2003, Premier Wen Jiabao and Vice Premier Wu Yi went to Beijing

Ditan Hospital to meet AIDS patients, doctors and nurses.

From December 18th to 20th Vice Premier Wu Yi went to Henan province to visit AIDS

patients and their families as well as village health workers.


HIV/AIDS Epidemic and National ART in China

In 2008 there were > 50,000 adult patients and 1,400 pediatric patients enrolled in the National ART program Despite the scale-up of the National ART program, the gap between patients on treatment and patients

needing treatment has widened

Comparison Between Cum. Reported Cases of HIV and Patients on ART


China’s National Free ART Program: Outcomes Analysis

Zhang FJ, et al: Effect of HAART on Mortality in HIV-Infected Former Plasma Donors in China. XVII International AIDS Conference, Mexico City, 2008.


China’s National Free ART Program: Outcomes Analysis

Change over time by mortality and survival following treatment initiation for previously ART-naïve adult AIDS patients

Zhang FJ, et al: Four Year Outcomes of the China National Free Antiretroviral Treatment Program. XVII International AIDS Conference, Mexico City, 2008.


International Cooperation and Support for HIV Control in China

UN Sector

–WHO, UNAIDS, UNICEF, UNDP

Bilaterals

–US CDC, AusAID, DIFD (UK)

NGOs

–Clinton Foundation

–Gates Foundation

–MSF, Project Hope, Others

Coordination under Ministry of Health

Clinton Foundation in China


Clinton HIV/AIDS Initiative (CHAI) China Cooperation Partners

Clinton Foundation

Ministry of Health

Bureau of Disease Control

Department of Comm., M&C Health

Department of Hospital Admin.

Department of Int’l Cooperation

Xinjiang BOH

Yunnan BOH

China CDC

CAMS

NCTB

NCAIDS

NCWCH

ARC

Anhui CDCCMU No.1 Hospital

Ministry of Civil Affairs

Bureau of NGO Management


CHAI Global Structure & Services

Access Services

• Pharmaceuticals• Global Diagnostics

• UNITAID liaison• Malaria• Nutrition

Country Operations

• Africa • Asia

• Latin America & the Caribbean

• Eastern Europe

Programs

• Pediatric Initiative• Rural Initiative

• PMTCT• Special programs• Clinical training

• “Products” that CHAI can offer across all of our

partner countries

• Approach is to apply basic business principles to lower cost and improve quality of

care and treatment – maximizing output per $

• Teams placed on the ground working directly with

Ministries of Health

• Approach is to identify key bottlenecks in the

healthcare system and to fill gaps as required to meet

treatment targets

• Resources and support provided in areas that

require special attention

• Approach is to provide direct support to

accelerate pediatric care, to create replicable

models of rural healthcare, and support specialized in-country

programs

17William J. Clinton Foundation HIV/AIDS Initiative CHAI Regional Meeting 2007

Care & Treatment

Nat’l Policy, Planning & Program Coordination

Provide platform / framework to enable a continuum of C&T

nationwide through: Laws/Protocols/Guidelines

Procurement M&E

Research

Bringing target population into Treatment

Identifying and providing access to C&T for targeted HIV+ populations such as:

Pediatric patients Former/current IVDUs

Women identified as HIV+ during pregnancy TB patients

Plasma donors MSM

CSWs/clients Delivering high-quality care and treatment

Development/establishment of sustainable health systems models for HIV/AIDS, including:

Clinical capacity Reliable laboratory performance

Affordable & accessible drugs & related supplies

Retaining patients in treatment

Development / implementation of models to ensure retention of HIV+

individuals in successful C&T and other interventions, through:

Treatment education Adherence support Family care pilot

Engagement of PLWHAs

Containment

Continuum of C &T: CF China Partner Support Strategy CHAI Cooperative Support Strategy in China


Regional Treatment & Care Partnerships

Target Populations and Regions:

PLWHA without access to HIV treatment and care services•Challenge: Develop new local systems for quality HIV treatment and care

Rural epidemics in rugged border regions of SW and NW China•Challenge: Getting services out in remote areas with dispersed populations

IVDU prevalent epidemic areas, poor and minority PLWHA •Challenge: Patients are hard to identify and reach; many barriers to retention in care

Rising HIV prevalence, at risk for becoming generalized epidemics

•Objective: Develop effective treatment and care services integrated with community outreach, prevention, and harm reduction in order to achieve containment of the epidemic

19William J. Clinton Foundation HIV/AIDS Initiative19

Regional Treatment & Care Partnerships

Approach: Work with government and multisectoral partners to support developing capacity and integrated systems for high quality AIDS treatment

• YUNNAN Province Bureau of Health

• XINJIANG Uyghur Autonomous Region Bureau of Health

• Government is responsible for HIV/AIDS control; CF supports government’s HIV/AIDS treatment and care work

• Integrate with other resources, avoiding overlap with other programs

• Facilitate collaborative linkages with government agencies across sectors (hospitals, CDCs, MCH, DCs, MMT, etc)

• Support partners to pilot new HIV/AIDS treatment and management models in local settings (e.g., integration of ART with MMT, expansion of treatment and care in closed settings)

• Build capacity by working closely with local BOH partners and participatory M&E

20William J. Clinton Foundation HIV/AIDS Initiative20

Background on Regional Treatment & Care Programs

Locations:• Dehong Prefecture (Luxi, Ruili, Yinjiang)• Honghe Prefecture (Kaiyuan, Gejiu, Mile, Jianshui)• Baoshan Prefecture (Baoshan, Tengchong)• Dali City• Lincang Prefecture (Lincang, Cangyuan)• Wenshan County • Pu’er City• Xishuangbanna Prefecture• Total 15 program counties

Supported by: • Norway Government and Pangaea

Locations:

• Urumqi City (5 districts)

• Yili Prefecture (3 counties/cities)

• Kashgar City (4 neighborhoods and 2 counties)

• Kuche County

• Total 16 treatment sites.

Supported by:

• AusAID

XinjiangYunnan

Program Objectives:

•Increase number of patients in care and on ARV treatment

•Maximize number of patients who are successfully treated and retained in care

•Create sustainable replicable models for comprehensive HIV/AIDS treatment and care

Yunnan Province Bureau of Health - Clinton FoundationCooperative HIV / AIDS Treatment and Care Program


HIV / AIDS Epidemic: National Overview2007 estimates indicate that there are 700,000 PLWHA’s in China.Yunnan is among the provinces with the largest number of cases of HIV.

Si chuan

Yunnan

Xi nj i ang

Ti bet

Gansu

Qi nghai

Nei menggu

Guangxi Guangdong

Chongqi ng

Hunan

Gui zhou

Hubei

Henan

J i angxii

Fuj i an

Anhui

Zhej i ang

J i angsu

Shandong

Shaanxi

Shanxi

Hebei

Li aoni ng

J i l i n

Hei l ongj i ang

Bei j i ng

Ti anj i n

Shanghai

Tai wan

Hai nan

Ni ngxi a

40,001-60,000

20,001-30,000

30,001-40,000

101-500

1-100

501-1,000

1,001-5000

5,001-10,000

10,001-20,000

HIV/AIDS Cases

Geographic distribution of cumulative reported HIV cases in China (as of October 2007)

Source: People’s Republic of China Proposal Form, Rolling Continuation Channel (RCC) to the Global Fund, November 2008

IVDU Regions


Yunnan Program Background

Program goals:–The Yunnan BOH – Clinton HIV / AIDS Initiative Cooperative Program was initiated in

2005 to scale-up care and treatment in a comprehensive and standardized way to assure sustained, high-quality care and treatment for as many people with HIV / AIDS as possible;

Objectives (2005-2008):–Put 3,000 patients on ART (including 50 children)–Train 180 physicians and 300 health professionals–Strengthen laboratory capabilities (HIV diagnosis, CD4 and VL testing, and quality

control)

The cooperative program met and surpassed its original objectives by working with local partners to develop and implement an effective model;

New funding support from Government of Norway (MFA) since late-2007 has allowed:–Further development of comprehensive local treatment services which are now

integrated with prevention and harm reduction services for IVDU;–Demonstration of scalability as a province-wide treatment model


Yunnan Program Outcome: EnrollmentWith support from the Government of Norway since late 2007, the program has supported the enrollment of ~4,600 patients on treatment, including 128 children.

No

. of

pat

ien

ts e

nro

lled

on

AR

T

Number of patients enrolled on ARTFigures at YE, 2005 - 2008

487

1,397

2,762

4,657

458

1,254

2,393

3,926

0

1,000

2,000

3,000

4,000

5,000

2005 2006 2007 2008

Cumulative on ART at YE Active on ART at YE

Source: Analysis using SIMCLIN and Patient Information System dataNote: Slight discrepancies in patient enrollment figures (by <1%) may occur between figures displayed here and Aids Care China Reports. This is due to ongoing improvements

in the Patient Information System; patients may be re-classified between analyses.


Yunnan Program Outcome: Site Scale-upOne important focus of the program has been on accessing hard-to-reach patients in closed facilities.

County-level site locations Cumulative 5,345 patients on ART

4,380 active patients on ART– 1,652 new in 2008– 495 newly enrolled in Q1 2009

15 Sites– 4 new in 2008– Comprehensive HIV treatment and care

programs established through the local government at these key rural epidemic sites

Trained– 400 physicians– 200 nurses– 180 lab technicians

ART in 9 closed facilities– 7 detention centers– 1 RETLC– 1 prison

Linked services into integrated system serving IDU-based PLWHA communities

Key achievements By March 31, 2009


Components of the Comprehensive Care and Treatment ModelThe four key components of support:

Clinical Capacity Building

Builds upon existing health system to deliver HIV treatment

Long-term expert clinical support to train and mentor HIV doctors at each site; develop sustainable local clinical leadership

Training workshops for ART physicians and nurses, as well as Methadone and Detention Center health workers

Laboratory Capacity Building

Core technical support to develop capacity and quality system of CD4 and VL labs

VL pilot to demonstrate feasibility and successful treatment outcomes; donation of test reagents

Training and guidelines for Early Infant Diagnosis (EID) pilot with Yunnan CDC and Honghe sites

Peer-Based Community Treatment Support

In partnership with NGO AIDS Care China (ACC)

Red Ribbon Center (RRC) teams support patients in community-based treatment

Electronic patient information system at each site for medical info and case management

RRCs build linkages with networks for prevention, harm reduction and community-based services; patient-centered integration of the comprehensive response

Program Management / Local HIV Care Coordination

Led by YN BOH, support and mentoring for county-level HIV program management builds capacity and assures programmatic efficiency

Targeted patient support encourages ART enrollment and retention, and reduces financial barriers to quality HIV treatment


Yunnan Program Outcome: RetentionPatient retention in the program is remarkable, with lost-to-follow-up rates below 2% across mature sites, and mortality rates at approximately 3.2% across all sites.

Ann

ual L

TF

U r

ate

Impact of the program on lost-to-follow-up rates1

Annual LTFU rate2

4.6%

1.8% 1.6%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

Before program 2007 2008

Impact of the program on mortality rates3

Mortality rate of PLWHA enrolled on ART has declined– 3.24% at YE2008– 5.88% mortality in 2006 when

program in initial stages

In comparison, the nationwide annual mortality rate is approximately 5%

1 ACC Analysis of the 9 sites that had ACC presence for more than one year as of YE 20082 Lost-to-follow-up after program start refers to “patients who cannot be contacted or who exited the program without medical advice and will no longer return to receive

medicine or for check-up”; LTFU before program start follows national guideline definitions of ““lost” if patient has not come in for follow up in 3 months”3 Analysis includes all program sites

These rates demonstrate the efficacy of the comprehensive continuum of care model, with especial emphasis on peer-based community treatment support


Yunnan Treatment Outcome: Viral Load SuppressionViral load suppression among patients who have been on treatment for more than 6 months is 89%, indicating positive treatment outcomes.

Viral load undetectable = successful ART outcome

VL outcomes in Yunnan sites have consistently been ~90%, placing them among the best in nationwide surveys

Pat

ien

ts a

s o

f Y

E20

08

Viral load suppression as indicator for treatment success

202

1,651

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

Pts who have received VLtest in last 6 mo.

Percent of patients who have undetectable VL results in last 6 mo.= 89%

Undetectable

1 Analysis includes adults and children66% of all patients on who have been on treatment for more than 6 months have received a VL test in the last 6 months89% of monitored patients who have been on treatment for more than 6 months have undetectable VL results (Recent defined as w/in last 6 mo.; Undetectable defined as 400

or less)


Yunnan Sustainability Planning: Historical costsAnalysis of historical costs shows that the program focuses on 4 major elements to deliver a comprehensive continuum of care model.

0.2 0.8

1.4

4.7

1.2

1.9

2.9

2.6

-

0.7

1.2

0.1

0.7

1.2

1.8

0.3

0.5

0.6

1.0

-

2.0

4.0

6.0

8.0

10.0

12.0

2005 2006 2007 2008

Program Management

Clinical Treatment and Care

Community Treatment Support

Lab Program

Capacity Building

M RMB

1.8M 3.5M 6.8M 11.3M

Early investments in capacity building was crucial to program success. It will remain significant as the program continues to expand to new sites and enroll more patients.

Xinjiang Uyghur Autonomous Region Bureau of Health – Clinton Foundation Cooperative HIV / AIDS Treatment and Care Program


More photos . . . The end.


HIV / AIDS Epidemic: National Overview2007 estimates indicate that there are 700,000 PLWHA’s in China.Xinjiang is one of the frontline regions, ranked 4th in reported cases, and is estimated to have > 60,000 PLHIV

Si chuan

Yunnan

Xi nj i ang

Ti bet

Gansu

Qi nghai

Nei menggu

Guangxi Guangdong

Chongqi ng

Hunan

Gui zhou

Hubei

Henan

J i angxii

Fuj i an

Anhui

Zhej i ang

J i angsu

Shandong

Shaanxi

Shanxi

Hebei

Li aoni ng

J i l i n

Hei l ongj i ang

Bei j i ng

Ti anj i n

Shanghai

Tai wan

Hai nan

Ni ngxi a

40,001-60,000

20,001-30,000

30,001-40,000

101-500

1-100

501-1,000

1,001-5000

5,001-10,000

10,001-20,000

HIV/AIDS Cases

Geographic distribution of cumulative reported HIV cases in China (as of October 2007)

Source: People’s Republic of China Proposal Form, Rolling Continuation Channel (RCC) to the Global Fund, November 2008

IVDU Regions


Xinjiang Program Background

Context: –By 2006 ART services were still very limited in XJ and most PLHIV had no access to

treatment or HIV care. –AusAID-supported programs with Xinjiang BoH for prevention, harm reduction,

community mobilization and care - but lacked a treatment component–CHAI was engaged by AusAID and MOH to partner with Xinjiang BoH to support

development and scale up of HIV treatment and care services

Goal:–The Xinjiang BOH – CHAI cooperative program was established in 2007 to build

capacity in Xinjiang to treat increasing numbers of HIV/AIDS patients at a high standard of quality, within a continuum of supportive services that retain patients in care.

Objectives:– Increase the number of patients in care and on ARV treatment – Maximize the number of patients who are treated successfully and retained in care – Create sustainable replicable models for comprehensive HIV/AIDS treatment and

care


Xinjiang Program Outcome: EnrollmentSince 2007, the program has supported enrollment ~1760 patients on treatment, and initiated pediatric ART now providing treatment for 62 children.

No

. of

pat

ien

ts e

nro

lled

on

AR

T

Number of active patients enrolled on ART

Source: Xinjiang Regional BoH and CHAI


Xinjiang Program Outcome: Site Scale-upImplementing comprehensive HIV treatment/care services through local BoH management

County-level site locations

1,441 active patients on ART– 798 new in 2008

14 sites– 4 sites at start in Mar 2007 then 6 sites

new at end 2007 (Yili & Urumqi)– 4 new in 2008 (Kashgar & Kuche)

Implemented practice-based training models building treatment capacity

Established local expert teams in program areas for mentoring

Scaled up integrated treatment and care model using peer-based treatment support

Established treatment quality review and Patient Info System

Implemented global budget treatment financing model with good outcomes

Supported training for 73 local doctors at two training centers

Improved CD4 test quality and supported initiation of VL testing in Urumqi

Key achievements by YE 2008

Denotes Current CF Site Location


Components of the Comprehensive Care and Treatment ModelCornerstones of cooperative support

Clinical Capacity Building

Builds upon existing health system to deliver HIV treatment

Long-term expert clinical support to train and mentor HIV doctors at each site for local clinical leadership

Training workshops for ART physicians and nurses, as well as MMT and Prison doctors

Two training centers for Xinjiang HIV clinician base

Laboratory Capacity Building

Core technical support to develop capacity and quality system of CD4 labs

Support Xinjiang CDC in training to develop VL testing capacity and facilitate initiation of VL treatment monitoring in Urumqi

Donation of VL test reagents

Peer-Based Community Treatment Support

Partnership with local BoH/CDC and hospitals:

Peer health workers at clinic sites support patients in enrollment, adherence education and treatment support

Electronic patient information system being implemented for medical record and case management

CDC and peer health workers cooperate in community-based referrals and care coordination

Together they build linkages with networks for prevention, harm reduction and other services, supporting a patient-centered approach

Program Management / Treatment Financing Pilot

Xinjiang BOH mentors local HIV program management to build capacity and assure program efficiency

Targeted patient support facilitates ART enrollment and retention, and reduces financial barriers to quality HIV treatment

Innovative pilot for local global budgets to finance treatment costs encourages early enrollment and cost-effective treatment, managing patients for long-term outcomes.

Participatory M&E with XJ BOH, CHAI and China Health Economics Institute


Integrated Services


Health Workers, Peer Community Workers


Xinjiang Treatment Outcomes: Since the program start in 2007, loss-to-follow-up and mortality rates have improved. In 2009, patient info systems will facilitate better reporting of current-year and treatment response (CD4) outcomes.

Cum

ulat

ive

LTF

U r

ate

Impact of the program on loss-to-follow-up rates1

LTFU rates (cumulative, all sites)Impact of the program on mortality rates2

Mortality rate of PLWHA enrolled on ART has declined– 5.1% cumulatively at YE2008– 7.1% mortality before program

began in March 2007

1 Source: Xinjiang Regional BoH and Local BoH 2 Source: Xinjiang Regional BoH and Local BoH

These outcomes support a preliminary assessment of efficacy for the comprehensive continuum of care model and peer-based community treatment support


Snapshot of Xinjiang Program Highlights- Non-ARV Treatment Cost Financing Pilot

Treatment program costs are funded as global budget, managed by the local BOH:

Total payments to providers are based on agreed targets for :

– new and old patients treated

– per patient costs for outpatient and inpatient services

Standard cost per patient * enrollment = global budget for the district (local BOH)

Funds are intended to be used as “gap” funds after patient self-pay, other programs, and

insurance.

Providers are incentivized to enroll patients early and to manage patients well

– This is to avoid OI episodes (a longitudinal approach to HIV care delivery)

Strong program monitoring and evaluation to ensure providers do not skimp on care.

Financial bonus for good outcomes

Preliminary data on average treatment spend per patient indicate that this approach has allowed localities to manage non-ARV costs well within 850 RMB per patient per year, without sacrificing quality

of enrollment objectives

Budgeted Actual (sample site, 600 patients enrolled)

850 RMBper pt per year

650 RMBper pt per year

County A County B


Continuum of Care ModelCHAI’s approach for supporting comprehensive HIV treatment and care

CARE & TREATMENT

CONTAINMENT

National Policy, Planning & Program Coordination

Provide platform / framework to enable a continuum of C&T nationwide through:

Laws, Protocols, Guidelines Procurement

M&E Research

Bringing Target Population into

Treatment

Identifying and providing access to C&T for HIV+ target populations such as: Pediatric patients IDU HIV+ pregnant women TB patients Incarcerated PLHIV Plasma donors MSMs CSWs

Treatment Infrastructure

Development/establishment of sustainable health systems models for HIV/AIDS, including: Clinical Capacity Reliable Labs Affordable / accessible drugs & lab supplies

Supporting Population

in Treatment

Development / implementation of models to ensure retention of HIV+ individuals in successful C&T and other interventions, including Treatment education IDU adherence pilots Family Care Pilot Engagement of PLWHAs

CHAI China’s National Level Partnerships:

National Pediatric Treatment Program

Lixin Rural HIV Clinical Training Center

HIV Lab Capacity Building

Early Infant Diagnosis and PMTCT Pilots

Increasing Drug Access in Neglected Diseases


Anhui Lixin Rural HIV Clinical Training Center

Scope National Clinical Training Center Patients Impacted by Graduates 15,000

Partners

NCAIDS, US CDC GAP, Anhui CDC Number of Trainees 72

Highlights

• Completed intensive training for 72 rural

clinician leaders since 2004

- Train 18 per year from high prevalence areas

• Work at village, township and county levels to improve local quality care and

strengthen the referral network

• Build local capacity for:

- Dx and treatment of TB / HIV and other OIs

- 2nd line treatment (national pilot site)

• Innovated model for village doctor training to support PLWHA and implemented village doctor training across Anhui Province with

CDC

Program Components

• Clinical leadership for Lixin training center and its network of physicians:

- High quality clinical training approach with

practice-based training in community settings

- Clinical practice in outpt and inpt settings

- Clinical training, TOT and trainee-follow-up

• Provide clinical support to local physicians and improve patient care

• Consultation support for pediatric treatment


Lixin Program - Practice-Based Clinical Training


Lixin Patient Stories


Lixin Training Program

2004-2009•72 Trainees• 4 Fellows


CHAI and China Pediatrics Partnership

The national pediatric ART program was established in January 2005 with CHAI-MoH to supply pediatric ARVs

– CHAI donated drugs for 200 pediatric HIV/AIDS patients urgently needing treatment– Training, mentoring and program support

First treatment site opened in Shangcai, Henan – epicenter of epidemic in China - June 2005 CHAI committed to expanding donations for up to 2000 children in June 2005 Drug supply supported by global UNITAID program from November 2006 Currently, > 1500 children are on treatment across all of China Initiation of 2nd line ART with CHAI and UNITAID supported ARVs started early 2008

Children on Treatment

Year End 2006

Year End 2007

Year End 2005

292

150

996

Year End 2008 1,440

Number of Provinces

10

4

21

24

* Note: CHAI and China NCAIDS estimate that 2,115 children currently need treatment.


Kids


China Pediatrics Overview

Majority of ENROLLED patients are from Henan Province Need significantly more case finding in provinces such as Yunnan and Xinjiang Implementation of Early Infant Diagnosis will lead to higher patient numbers


Main CF Pediatric Program Activities

Pediatrics

Case Finding Procurement/Lab Training & Monitoring

Technical support to draft and conduct training of treatment guidelines

Continuous trainings management support for clinicians at the national,provincial and local levels

Provide regular monitoring and mentoring to local

clinicians

Provide consultations and evaluations at non-CF sites

Patient management for OIs, diagnosis, transportation,

nutrition, etc.

1st line drugs

2nd line drugs

Prophylaxis

Nutrition

Lab support for CD4, drug resistance tests and EID

Community-based case finding activities in IVDU areas

Early infant diagnosis (EID)

hiv care and treatment in china

Documents

hivaids cases

hivaids situation

hiv epidemic

aids patients

national art program

pediatric patients

adult patients

cases of hiv