Challenges Moving from Sciences to Implementation in China
Zunyou Wu
National Center for AIDS/STD Control and PreventionChinese Center for Disease Control and Prevention
Goal
By 2015:– The number of people living with HIV/AIDS be
controlled no more than 1,200,000.
• New HIV infection 25%;
• AIDS Mortality 30%。
To achieve these targets,
We need implementation sciences
Can incidence decline but annual reported HIV cases
continually increase?
HIV AIDS Death
Cases
HIV/AIDS reported in China during 1985-2011
Year
2005 2007 2009 2011 2013 2015
New HIV 70,000 50,000 48,000 48,000 36,000
Further have mortality DROP We need Implementation Sciences
Since ART launch in 2002, AIDS mortality dropped
significantly
• 5
Annual Reported AIDS Mortality
Q1: Why ART , but Mortality ?Q2: When and how to get Mortality ? ???
???
Reported death same year
Reported death previous year
80% Deaths
without ART
Late Diagnosis Still an Issue
year Newly Identified
AIDS at 1st test
Proportion of late( %)
2008 56362 10790 19.1
2009 61626 13433 21.8
2010 64338 16089 25.0
2011 74517 20760 27.6
6
Losses along the Continuum of HIV Care
7
25
20
15
10
5
ScreenedHIV-Positive
ConfirmedHIV-Positive
NotifiedHIV-Positive
ReceivedCD4 Test
ReceivedART
ReceivedVL Test
0
Num
ber o
f ind
ivid
uals
(1
,000
)
22,825(100%)
9,091(40%) 7,754
(34%)4,830(21%) 2,691
(12%) 732(8%)
8
Use New Strategies
• TEST as Prevention
• TREATMENT as Prevention
New vs. existing strategies
Continue Use Traditional ones
Education
Condom promotion
Harm reduction
Counseling
STD management
9
Who Working with?
Prevention by Working with
• HIV Positives
• HIV Negatives
ART vs. PrEP
Population size
Population size
ARTHIV +
PrEPAt risk
11
New strategies
Strategies Implementation
Testing
Treatment as Prevention
PrEP ?
Male circumcision ?
Microbicides ?
12
Conclusion
• Fully Implement Existing Approved Strategies
• Adopt new strategies positively