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

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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
  

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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
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Baseline Characteristics
8
Baseline Characteristics
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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
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Virological treatment failure adjusted risk
factor analysis
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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
  

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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
  

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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)