HMI and partners combat HIV/AIDS epidemic in China

Today almost a million people are infected with HIV in China, and the epidemic is on the move in both urban and rural communities, and among both wealthy and poor. The Chinese Ministry of Health has warned that the number of infected could rise to 10 million by the end of the decade if urgent action is not taken. In contrast with the Indian sub-continent and sub-Saharan Africa, where unprotected sex is the major factor in the spread of the virus, in China intravenous drug use and illegal blood donation figure in a large majority of new cases. However, regardless of what passes the virus from one person to another, the resulting challenge is the same for health care leaders in China and their counterparts in other parts of the world: how to reduce the spread of the disease by building the capacity of frontline providers to deal with it.

In May, a team of faculty from HMI helped lead a training program in Xi’an, in the province of Shannxi, designed to bring the most updated knowledge in HIV/AIDS diagnosis and treatment to Chinese health care providers. The two-day program was a collaboration of HMI, the China Medical Tribune, AIDS Clinical Care, and the New England Journal of Medicine. Dr. Harvey Makadon, HMI vice president of health systems, co-directed the course with Dr. Cao Yun-zhen, a member of the Chinese Academy of Medicine who has been an instrumental figure in China’s efforts to combat the HIV/AIDS epidemic. The program curriculum combined lectures, small-group workshops, and case discussions to provide a comprehensive body of knowledge and tactics that frontline providers in China can put into practice in their own communities.

The program’s participants included physicians and head nurses from infectious disease departments in county and prefecture hospitals, as well as large and medium-sized hospitals in Xi’an. The majority had not previously received training in the diagnosis and management of HIV/AIDS.

From left to right: Matthew O'Rourke, executive editor of AIDS Clinical Care; Dr. He Yun, a program participant who provides care to children with HIV/AIDS; Dr. Keith Henry, a faculty member; Dr. Getu Zhaori, editor-in-chief of the China Medical Tribune; Wei Fei-li, a technician in the AIDS center of Dr. Cao Yun-zhen; and Dr. Chen Yan, vice editor-in-chief of the China Medical Tribune.

Knowledge and practice
Dr. Getu Zhaori, editor-in-chief of the China Medical Tribune, said that the depth of the lectures, as well as the practical experience of the faculty from both China and the United States, contributed to a valuable program. “The HIV/AIDS education program was successful and useful, first because we chose the right target population for the education and training,” he said. “Since some of the faculty are very experienced in the clinical management of HIV/AIDS patients, the participants learned a lot through the lectures as well as by asking questions during and after the lectures.”

Dr. Getu Zhaori: “The HIV/AIDS education program was successful and useful, first because we chose the right target population for the education and training.”

As with other HIV/AIDS education programs with which HMI has been involved, the organizers of the Xi’an program hope that the its benefits extend exponentially. “Some of the participants have already accomplished their task of training 10 physicians or nurses in their area,” said Zhaori. The ultimate goal is to reach 550 trainees in the Shannxi area.

The program addressed the full spectrum of HIV/AIDS-related issues, exploring the epidemiological impact at both the global and country level, as well as presenting the latest knowledge in the clinical areas, including the principles of antiretroviral therapy, treatment of AIDS complications, and HIV virology and its pathogenesis.

Among the faculty were Dr. Howard Libman and Dr. Raymond Powrie, both regular participants in HMI’s HIV/AIDS education efforts. Libman, an associate professor of medicine at Harvard Medical School and the director of HIV services at Beth Israel Deaconess Medical Center, lectured on HIV counseling and testing. He noted that most of the estimated 42 million people worldwide who are infected with HIV have not been diagnosed. Libman detailed the different types of HIV, the risk indicators, and the variety of tests that are now available, and offered insight into the appropriateness of certain tests in specific situations. “HIV testing should be recommended to persons who have an increased risk of infection based on history or clinical manifestations,” he said.

Powrie, associate professor of medicine at the Brown School of Medicine, lectured on preventing mother-to-child HIV transmission, which continues to result in a high death rate among children in resource-poor countries. He pointed out that HIV infection does not affect obstetrical outcomes, and that conversely, pregnancy has no effect on the course of HIV. Ideally, he said, an HIV-infected pregnant woman would receive prenatal care from a multidisciplinary team that would maximize antiretroviral and prophylactic therapies while observing her closely to find any evidence of disease progression. “All women of child-bearing age should be encouraged to be tested for HIV,” he said. He noted that mother-to-child transmission of HIV can occur at any stage of gestation, but most commonly happened during labor and delivery due to direct contact of the infant with maternal blood and cervical secretions. “In the absence of effective antiretroviral treatment in the mother, there is about a 25 percent risk of transmission to the newborn.”

Infrastructure, education, encouragement
“This is a critical juncture for the Chinese health care community, but I believe that the story of HIV in the West provides some useful lessons,” said Makadon, who lectured on the role of primary care in preventing and treating HIV/AIDS. “The earliest prevention efforts in the U.S. were hampered by discrimination and fear, and this delayed the development of the infrastructure to care for HIV-infected patients. The leadership of China cannot allow this to happen.”

Makadon emphasized the need in China to create a “continuum of care” for the prevention and treatment of HIV/AIDS—an infrastructure supported by synergies between primary care networks, public health efforts, and community-based programs. “These health care leaders must create an environment that encourages people to be open about risk, that encourages people at risk to learn about their HIV status, and that makes resources about prevention and treatment available,” he said. “Counseling and education in the primary care setting is important, but there is a limit to what can be done there. This must be combined with public health and community involvement behind a consistent message.”

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