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Scaling up comprehensive HIV treatment for injection drug using populations in Yunnan Province
Y. Wang1, J. Chen2, B. Yu3, D. von Zinkernagel4, T. Cai5, M. Tang3, F. Zhang6, T. Warne5, L. Hsi5, E. Goosby4
1Yunnan Provincial Bureau of Health, Office for HIV/AIDS Prevention and Treatment, Kunming, China, 2Yunnan Provincial Bureau of Health, Office of the Director, Kunming, China, 3Clinton Foundation China Program, Kunming, China, 4Pangaea Global AIDS Foundation, San Francisco, CA, United States, 5Clinton Foundation China Program, Beijing, China, 6National Center for AIDS/STD Prevention and Control, Division of Treatment and Care, Beijing, China
Issues: We report on a promising model in Yunnan Province to enter and retain injection drug users in HIV treatment.
Description: Yunnan has the largest number of HIV cases in China with local IDU-driven epidemics. The Provincial Bureau of Health in partnership with local authorities and Clinton Foundation has implemented HIV treatment in 11 sites in 6 prefectures since July 2005. Cumulatively 2315 patients were on ARVs with 4335 additional persons followed in care by November 2007. An integrated services approach links hospital-based clinics with community outreach/peer support centers that follow patients in clinic and out in their communities. Linkages with methadone maintenance, needle exchanges, and TB control programs extends the net of services to enter and retain IDUs in care. Extension of HIV treatment into enclosed settings has begun to ensure continuity of ARVs and reentry into community-based medical care upon release. A model decentralizing care from hospital clinics to township, village levels has been piloted with lines for consultation, referral and oversight by HIV-trained clinicians. Retention in care, and treatment benefit documented by CD4 and viral load, show good results to date.
Lessons learned: Strong Provincial and local government support have implemented these services and linkages within the existing health infrastructure, resulting in greater numbers of IDUs accessing and receiving ongoing HIV treatment. External partners support rapid expansion of services, cross training physicians, nurses, drug treatment providers and peer educators. Active IDUs can be identified and successfully entered in care when drug treatment and social support systems are available, achieving high rates of retention with rising CD4 counts and undetectable viral loads reflecting high levels of adherence.
Next steps: Expand capacities for patient follow-up at village level and access to care in enclosed settings.
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