Simplified HIV testing and treatment reduces mortality rate by over 60% in a trial in China

In a recent article in PLoS Medicine (2015; 12:e1001874), Zunyou Wu of the Chinese Center for Disease Control and Prevention and colleagues presented the results of an intervention to simplify HIV diagnosis and treatment in two Chinese counties. Wu explains that the study was motivated by the high number of patients in some areas who were being diagnosed at an advanced stage of disease and dying in the same year; the goal was to intervene in the months between diagnosis and death. In the target counties, patients who screened positive for HIV infection received rapid testing, and antiretroviral therapy (ART) was initiated immediately upon receiving a positive result, irrespective of CD4+ cell count. This reduced the average time from HIV confirmation to ART initiation from around 50 to 5 days and increased the percentage of patients who initiated ART from below 36% to above 90%. Most importantly, this intervention reduced mortality rates by 62%. Wu says the lesson to draw from this dramatic improvement is to ‘look at AIDS as a reality and pragmatically analyze how to provide simplified services for patients’. Brian Williams, of the Wits Reproductive Health and HIV Institute in South Africa, says that these results are ‘what I would have expected and hoped for, so I am not at all surprised. But I am delighted that they have managed to demonstrate the impact so directly’. He notes that these findings join those from other successful simplified/immediate treatment programmes in places such as Vancouver, British Columbia; San Francisco; and Uganda. Mirjam Kretzschmar of the UMC Utrecht Julius Center says that the takeaway from this research is ‘We don’t necessarily have to invent new interventions; we should make sure that the ones we have are set up in an effective way … If [patients] have to come back 3 or 4 times to draw blood before they even get a diagnosis, they will drop out. Also it is important to reduce time delays as much as possible. Every time delay will result in people losing interest and forgetting. These kinds of improvements are potentially very effective in improving the impact of ART in resource-limited countries’. As for the future of this simplified testing and treatment strategy in China, Wu explains that the model was expanded to another 12 high-priority counties in a second phase, where it reduced mortality by nearly 50%, and has been expanded to a total of 50 counties in a third phase. Currently, he and colleagues are considering scaling-up the model nationwide and are working on revising national treatment guidelines to advise initiating ART for all individuals diagnosed with HIV, regardless of CD4+ cell count. Acknowledgements Conflicts of interest There are no conflicts of interest.

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