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Virologic outcomes of adult AIDS patients receiving HAART in 24 counties in China

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Beijing: Chinese Center for Disease Control and Prevention; January 2005. Objectives ... Global AIDS Program, U.S. Centers for Disease Control and Prevention ... – PowerPoint PPT presentation

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Title: Virologic outcomes of adult AIDS patients receiving HAART in 24 counties in China


1
Virologic outcomes of adult AIDS patients
receiving HAART in 24 counties in China
  • Ye Ma, Decai Zhao, Lan Yu, Yan Zhao,
  • Zhihui Dou, Fujie Zhang
  • National Center for AIDS/STD Control and
    Prevention,
  • Chinese Center for Disease Control and
    Prevention
  • Beijing, China

2
Background
  • From 2002-2007, 42,126 patients nationwide
    received treatment through National Free ART
    Program (NFAP)
  • Former plasma donation (FPD) 49.7
  • Sexual transmission 23.5
  • IDU 11.3
  • Other/unknown 15.4
  • NFAP based on hospital/community treatment model
  • Recommended first line regimen
    d4T/AZT3TCNVP/EFV
  • Viral loads not routinely done
  • National Free ART database established in 2004 to
    track patient treatment process

China Free ART Manual. Beijing Chinese Center
for Disease Control and Prevention January 2005
3
Objectives
  • To identify proportion of virologic treatment
    failure (defined as 400 copies/ml) among
    patients on first line regimen at varying
    treatment durations
  • To identify the risk factors associated with
    treatment failure
  • To provide a basis for projecting the number of
    patients needing second line ART regimens

4
Study Design
  • Cross sectional study from April-June 2007
  • Inclusion criteria
  • 15 years
  • Previously treatment-naïve
  • Treatment duration 6 months
  • On ART at survey time
  • Sampling method patients from 24 counties in 8
    provinces randomly selected, stratified by
    treatment duration(6-11 months, 12-23 months and
    24 months or more)
  • Patient questionnaire on adherence, signs of
    failure, etc.
  • Viral load tests performed at provincial
    laboratories for all patients sampled

5
Distribution of patients on ART in China
24 counties selected from 8 provinces
11 in central China 4 in the Southwest 9 in the
north
6
(No Transcript)
7
Baseline Characteristics
8
Baseline Characteristics
9
Virological response among patients at different
treatment durations
Treatment failure defined as 400 copies/ml at
6-11, 12-23, and 24-months treatment, observed
failure was 17.9, 27.2, and 33.2, respectively
10
Virological treatment failure adjusted risk
factor analysis
11
Discussion
  • Level of clinical site is one of the risk factors
    for treatment failure, with lowest levels
    associated with higher risks of failure
  • Being treated at village clinic associated with
    23 fold greater risk of failure at 24 months,
    compared to county hospital
  • Major implications for China treatment model,
    which is based on community-level care
  • Rural areas, primarily served by community
    clinics rather than county-level hospitals, have
    critical shortage of experienced health-care
    personnel
  • Must emphasize capacity building for healthcare
    personnel in these regions to improve ART
    quality
  • Establish incentives for increasing ART
    participation from higher-level hospitals and
    doctors

12
Discussion
  • Improper first-line treatment and poor adherence
    were also significant risk factors for treatment
    failure
  • Survival bias in this cross-sectional survey may
    underestimate treatment failure rate
  • Conservative definition of treatment failure
    (400 copies/ml) and no second viral load testing
    may overestimate failure rate
  • 2nd line regimens currently being piloted, with
    national guidelines for usage being developed

13
Acknowledgments
  • Henan, Hubei, Anhui, Shanxi, Shandong, Jilin,
    Guangxi and Yunnan Provincial Centers for Disease
    Control and Prevention, AIDS Care Center of
    Yunnan Province
  • CDC and hospitals from the 24 study counties
    working on site
  • Medical School of Peking University
  • Global AIDS Program, U.S. Centers for Disease
    Control and Prevention
  • National Institute of Allergy and Infectious
    Diseases, U.S. National Institutes of Health
  • Supported by
  • Applied research program on AIDS prevention and
    treatment of the China Ministry of Health
    (WA-2006-03)
  • U.S. Centers for Disease Control and Prevention
    Global AIDS Program
  • U.S. National Institute of Health, ICOHRTA grant
    (U2R TW006918)
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