Simplified HIV Test and Treat program associated with better coverage and lower mortality
8-Sep-2015 - A "Test and Treat" protocol for HIV/AIDS diagnosis and treatment, implemented in two Guangxi, China counties in 2012, was associated with increased engagement in HIV/AIDS care and a 62% reduction in mortality among participants, according to a study published this week in PLOS Medicine. This before-and-after analysis, conducted by Zunyou Wu from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention in Beijing, and colleagues, suggests that broader implementation of the program may inexpensively improve outcomes for HIV-positive individuals in China.
In many countries including China, barriers to diagnosis, linkage to care, and continuation of care still limit effective HIV/AIDS treatment. Wu and colleagues investigated outcomes associated with a simplified "Test and Treat" intervention incorporating same-visit HIV confirmatory testing, pre-ART CD4 baseline testing, pretreatment counseling, and ART eligibility regardless of CD4 count. A total of 1,034 HIV-positive participants were enrolled, 620 before and 414 after program implementation. Following implementation, the number of people receiving CD4 testing within 30 days of HIV confirmation rose from 64% to 97%, and time to ART initiation decreased from around 50 days to 5 days. The proportion of eligible individuals who initiated ART increased from below 52% to above 91%, and mortality rates among eligible participants fell from about 37% to about 13% (all p < 0.001). Wu and colleagues estimated that the cost of each death prevented by the program was about US$235, mostly incurred during the initial year of the intervention.
The pre-post study design, rather than a controlled trial, may limit the accuracy of these findings; in addition, outcomes may not generalize outside China. Nevertheless, these results suggest that a purely structural change can ensure that fewer patients are lost along the continuum of HIV testing and treatment. The authors state, "Our findings provide program-based evidence to support widespread implementation of this intervention in China and to support similar test and treat strategies elsewhere."
Funding: It was supported by China National AIDS Program from the National Health and Family Planning Commission of the People's Republic of China (grant number: 131-14-000-105-01; 2012ZX10001007) and by the AbbVie. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: All authors other than JM declare no competing interests exist. JM is supported, with grants paid to his institution, by the British Columbia Ministry of Health. He has also received financial support from the US National Institutes of Health, International AIDS Society, United Nations AIDS Program, World Health Organization, France Recherche Nord & Sud SIDA HIV Hépatites (ANRS), International Association of Providers of AIDS Care (IAPAC), UNICEF, MAC AIDS Fund, and Open Society Foundation. He has received grants from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.
Citation: Wu Z, Zhao Y, Ge X, Mao Y, Tang Z, Shi CX, et al. (2015) Simplified HIV Testing and Treatment in China: Analysis of Mortality Rates Before and After a Structural Intervention. PLoS Med 12(9): e1001874. doi:10.1371/journal.pmed.1001874
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
Guangxi Bureau of HIV/AIDS, Guangxi Health Department, Nanning, China
Guangxi Center for Disease Control and Prevention, Nanning, China
Guangxi Antiretroviral Treatment Center, Liuzhou, China
Zhongshan County Health Bureau, Zhongshan, China
Zhongshan County Center for Disease Control and Prevention, Zhongshan, China
Zhongshan County General Hospital, Zhongshan, China
Pubei County Health Bureau, Pubei, China
Pubei County Center for Disease Control and Prevention, Pubei, China
Pubei County General Hospital, Pubei, China
Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, United States of America
Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, United States of America
BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, British Columbia, Canada
Chinese Center for Disease Control and Prevention, Beijing, China
Simplified HIV Testing and Treatment in China: Analysis of Mortality Rates Before and After a Structural Intervention
Dr Zunyou Wu
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