title: Expansion of HIV care and treatment in Yunnan Province, China: treatment outcomes with scale up of combination antiretroviral therapy.
abstract: Effective health care models to scale up combination antiretroviral therapy (ART) are needed in rural southwestern China. We aimed to evaluate the ART treatment outcomes and their associations with patients' demographic characteristics and pre-treatment clinical features in a scaled-up provincial ART program serving eight heavily HIV-affected prefectures in Yunnan Province. We abstracted information from a computerized database for adults initiating ART between July 2007 and September 2008. Survival functions of mortality and treatment failure were calculated by age group, gender, transmission mode, and baseline CD4 count. Multivariable Cox regression analyses were conducted to find independent associations of various demographic and baseline clinical features with outcome variables. Of the 1967 patients in the mortality analysis, there were 110 deaths, of which 16 were coded as accidents or suicides. Adjusted hazard ratios (AHR) associated with mortality were greater for patients with baseline CD4 counts <100 cells/µl vs. patients with CD4 counts ≥200 cells/µl, for male vs. female, for single vs. married, and for those acquired HIV through injection drug use (IDU) vs. other modes of transmission. Successful treatment was 81.3% at six months after treatment started. Immunologic treatment failure was associated with baseline CD4 counts but not with demographic characteristics. Overall loss to follow-up rate was 2.1%. Collaboration between clinics and community networks are distinctive features of Yunnan's model for scaling up ART across a diverse, poor, and rural population. This study finds that the strategy can succeed even if 40% of the patients have a history of IDU.
authors.affiliation: a Yunnan Bureau of Health , Kunming , China.
authors.forename: Juemin
authors.initials: J
authors.lastname: Chen
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Yungshen
authors.initials: Y
authors.lastname: Wang
authors.forename: Michele
authors.initials: M
authors.lastname: Tang
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Hu
authors.forename: Thomas
authors.initials: T
authors.lastname: Cai
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.forename: Deborah
authors.initials: D
authors.lastname: von Zinkernagel
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Harwell
authors.forename: Zhihuan Jennifer
authors.initials: ZJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012424:Rural Population; D015819:Substance Abuse, Intravenous / Q000276:immunology / Q000401:mortality*; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents