Simplified HIV Testing & Treatment in China: Analysis of Mortality Rates Before & After a Structural Intervention

Below:  Cascade of confirmed HIV diagnosis, CD4 testing, ART initiation, and mortality during the pre-intervention 2010, pre-intervention 2011, post-intervention 2012, and post-intervention 2013 phases in Guangxi, China.  (A) For all HIV cases. (B) For individuals with CD4 count ≤ 350 cells/mm3or missing CD4 but reported as AIDS cases.

Methods and Findings

In the “pre-intervention 2010” and “pre-intervention 2011” phases, patients who screened HIV-positive at health care facilities in Zhongshan and Pubei counties in Guangxi, China, followed the standard-of-care process. In the “post-intervention 2012” and “post-intervention 2013” phases, patients who screened HIV-positive at the same facilities were offered a simplified test and treat intervention, i.e., concurrent HIV confirmatory and CD4 testing and immediate initiation of ART, irrespective of CD4 count. 

Participants were followed for 6–18 mo until the end of their study phase period. Mortality rates in the pre-intervention and post-intervention phases were compared for all HIV cases and for treatment-eligible HIV cases. A total of 1,034 HIV-positive participants (281 and 339 in the two pre-intervention phases respectively, and 215 and 199 in the two post-intervention phases respectively) were enrolled. Following the structural intervention, receipt of baseline CD4 testing within 30 d of HIV confirmation increased from 67%/61% (pre-intervention 2010/pre-intervention 2011) to 98%/97% (post-intervention 2012/post-intervention 2013), and the time from HIV confirmation to ART initiation decreased from 53 d. Initiation of ART increased from 27%/49% to 91%/89% among all cases and from 39%/62% to 94%/90% among individuals with CD4 count ≤ 350 cells/mm3 or AIDS. Mortality decreased from 27%/27% to 10%/10% for all cases and from 40%/35% to 13%/13% for cases with CD4 count ≤ 350 cells/mm3 or AIDS. The simplified test and treat intervention was significantly associated with decreased mortality rates compared to pre-intervention 2011. The unit cost of an additional patient receiving ART attributable to the intervention was US$83.80. The unit cost of a death prevented because of the intervention was US$234.52.

Conclusions

Our results demonstrate that the simplified HIV test and treat intervention promoted successful engagement in care and was associated with a 62% reduction in mortality. Our findings support the implementation of integrated HIV testing and immediate access to ART irrespective of CD4 count, in order to optimize the impact of ART.

Read more at:  http://goo.gl/EiU8oj

By: Zunyou Wu, Yan Zhao, Yurong Mao, Cynthia X. Shi, Mingjie Zhang, Xia Jin, Jian Li

National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, et. al.