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

1

Overview

• Description of the HIV epidemic in China• Ongoing challenges• History of US-China cooperation on

HIV/AIDS

2

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%

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4

Leadership commitment

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

Population HIV Prevalence (2011) HIV incidence (2011)

General population 0.1% 48,000

Key populationsFSWMSMPWID

0.5%6.3%6.4%

0.1 per 100 pyrs3-6 per 100 pyrs0.2 per 100 pyrs (MMT); 1-3 per 100 pyrs outside

HIV Prevalence in Key Populations

2012 China AIDS Response Progress Report, China MOH; from China’s HIV Sentinel Surveillance System

HIV Prevalence Among MSM

2012 China AIDS Response Progress Report, China MOH

Transmission Modes Change Overtime

Sexual83.2%

IDU MSM HeterosexualBloodMTCTUnknown

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MSM Account for 50% of Newly Reported HIV Cases in Provincial Capital Cities

IDUMSMHeterosexualBlood/productsMTCT

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Methadone Reduces HIV Incidence Among Drug Users

26%

October 29, 2010

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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

National Free ART Program - 1

• National Free ART Program began in 2002 among former plasma donors

• Rapidly scaled up to cover entire country

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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)

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Five-Year Survival and Mortality Rates

Zhang F et al. Annals of Internal Medicine 200915

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 16

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Cascade of HIV Services in China (2012)

8 pilot counties in 2003

271 pilot counties in 2007

333 pilot counties in 2008

1156 pilot counties in 2010

(HIV+Syphilis+HBV)

Increase in Integrated PMTCT programs, 2003-2010

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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)

Barriers and Challenges

~50% of PLHA are unaware of their HIV status Frequent late enrollment in care & ART initiation

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

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-)

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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

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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

Xinjiang

NingxiaQinghai

Tibet

Yunnan

Guizhou

Guangxi Guangdong

Inner Mongolia

Beijing

Heilongjiang

Shandong

JiangsuHenan

Anhui

US-China Cooperation Provinces (2003-2013)

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Support of Epidemiologic Data Analysis and Operational Research to Improve HIV/AIDS

Outcomes in China

PMTCT and Community Mobilization

Increased use of antenatal care and hospital delivery services among minority women in Guangxi

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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

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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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