Implementation of HIV Treatment as Prevention in China Yan Zhao MD National Center for AIDS/STD Control & Prevention Chinese Center for Disease Control & Prevention 24 Jul, 2012

Cumulative reported cases 445,000 (Total Death 93,000 ) Estimated survival cases 780, % heterosexual 17.4% homosexual HIV Epidemic in China

The National Free Antiretroviral Therapy Program in China

Proportion of Patients Newly Enrolled to ART by Transmission Mode Heterosexual Blood donor/recipient IDU homosexual

The Baseline CD4 at Initiation of ART

The Viral Suppression among Patients Taking ARV in 2011 The suppression rate of viremia was 85%*.

Free ARV List in National Program Current ARVs on the Free ARV Program –Domestic production : AZT, D4T, DDI, NVP, IDV, 3TC –Imported drugs: EFV,TDF, LPV/RTV, ABC Recommendation before 2011 First-line Regimen AZT/D4T+3TC+NVP/EFV Second-line Regimen TDF+3TC+LPV/RTV The new recommendation from 2012 First-line Regimen TDF/AZT+3TC+EFV/NVP

Financial Support “Four Frees and One Care” policy The central government pay the cost of ART –Free ARV (8) –Free CD4 2 times/Y and VL 1 time/Y –Medical care workers’ training –DOT –Patients’ transportation support, 50*4=200RMB/Y Local governments are responsible for other costs, including opportunistic infections management

9 The Implementation TasP Strategy in China Background Recent scientific progress on Treatment as prevention Sexual contact is the primary mode of transmission −40%-50% of couple infected when partner first tested. −5.5% HIV Sero-conversion among discordant couples in −Difficulties in using condom due to varied culture, religious, etc. −HIV transmission among MSM increased rapidly.

Sexual Contact is the Primary Mode of Transmission

11 TEST as intervention TREATMENT as Prevention China’s New AIDS Strategy 2011Achieved Detected HIV74,517 Enrolled ART45,843

12 Treatment as Prevention , TasP pilot was launched in some minority groups among sero-discordant couples. Feb 2011, We announced TasP as a nation strategy at Annual National AIDS Meeting Jun 2011, TasP focus on discordant couples, a National workshop May 2012, New free antiretroviral therapy guideline was issued

Treatment Discordant Couples in 2011 ART reduce 55% transmission in ARTNo. couples Person-year observed No. HIV new infections （%）（%） Yes18, No16, Total35,

The updated treatment criteria in China Clinical criteria CD4 levelRecommendation Acute syndromes Any levelRecommend to treat WHO Stage IV/ Ⅲ Any levelTreat Any WHO stage≤350/mm 3 Treat Any WHO stage /mm 3 Any one of the requirements below: 1 higher viral load （ e.g. > copies/ml); 2 rapidly declining CD4 (e.g decrease.> 100/mm 3 /Y); 3 age >65; Any WHO stageAny levelAny one of the requirements below: 1 co-infected with active HBV; 2 HIV associated nephropathy 3 Active TB 4 Pregnancy 5 HIV-positive person in couples or steady sex partners.

15 TasP New Initiatives Target population in priority Serodiscordant couples MSM Sex workers IDUs

Challenges The lack of clear guidelines as to implementation of TasP The lack of acceptance by healthcare workers providing early treatment services The asymptomatic patients’ understanding of the criteria to start ART The limited availability and tolerance of current first-line ARV medicines

Action Plan More education and information for physician and patients Optimize the option of regimen Strengthen community mobilization efforts

Thank you for your attention !