Strategy to achieve full coverage in the national free antiretroviral therapy program

Abstract

The mode of HIV treatment in China is distinctive compared to the rest of the world-the Government of China is responsible for providing financial support to test and treat people living with HIV and lead the development of strategies to prevent and control the spread of HIV. Early in the epidemic, most people living with HIV were poor and could not afford treatment. In addition, the lack of physicians with experience in antiretroviral therapy (ART) was also a huge challenge before 2000. Numerous HIV infections were reported among former plasma donors infected at blood collection centers in the mid-1990s. Ten years since becoming infected, most people living with HIV developed AIDS and died in 2001-2002 due to lack of timely treatment. In response, the Chinese government piloted an emergency response program in high prevalence villages in Henan to provide free ART beginning in 2002. In 2003, Premier Wen Jiabao announced the " Four Frees and One Care” policy. In 2004, the Department of Treatment and Care at the National Center for AIDS/STD Control and Prevention (NCAIDS) commenced the development of an information system to track ART patients. China’s National Free ART Program (NFATP) has since been quickly scaled up. The eligibility criteria for initiating ART have been adjusted from CD4 cell count less than 200-350 cells/mm3 in 2008, then 500 cells/mm3 in 2014, and finally for all people living with HIV, regardless their CD4 cell count, in 2016. By the end of 2017, the NFATP had enrolled and provided ART for 609,829 people living with HIV (including 5669 pediatric patients), with a coverage of 80.4%. Overall mortality decreased from 18.4% in 2005 to 4.2% in 2015. China has had remarkable success in implementing HIV treatment, but there is still a long way to go to continue improve coverage and effectiveness of treatment.