Abstract

Declining mortality in people with HIV in Hubei province, China, 2002 - 2006: results of an international partnership to train and mentor county, village, and township health care workers

Background: In Central China, improper plasma donation transmitted HIV to 250,000 rural farmers. Rural clinicians were unprepared to manage PLWHIV and use ART in 2002-3.
Objective: To describe trends in mortality and CD4 cell counts in Hubei Province, China from 2002 – 2006.
Methods: Since July 2003, the Hubei Centers for Disease Control (CDC) provided free ART in CDC clinics, and partnered with Project HOPE for training and capacity building. Mortality and treatment outcome data were collected monthly through standardized data forms.


[Mortality by Year of Diagnosis, 2002 - 2006]

Results: From 1/03 to 8/06, 3,063 people with HIV were entered into care, of whom 1,143 started on ART. Of these, 122 (10.6%) died and 13 (1.1%) were lost to F/U. All cause mortality declined by 72%, from 49% in 2003 to 8.8% in 2006. Of ART patients, 848 (77%) remained on ART for mean 18 months. Of 751 patients with baseline CD4 cell counts, a median increase of 137 cells/ml cells was seen after 12-18 months. From 2002-5, 78 senior Chinese “Master Trainers” were trained, and they, with partners, then trained 8,759 health workers, including 2,822 physicians, 1,940 registered nurses, 1,446 laboratory technicians, and 2,551 administrators in 85 trainings.
Conclusions: Rapid scale-up of HIV care and treatment, including ART, has been feasible in Hubei Province. An international partnership, including sustained on-site ex-patriot clinical expertise and the establishment of Chinese Master Trainers in a cascading ´Training of Trainers´ (ToT) methodology has been invaluable. As a result, 8,759 health care workers were trained and a 72% reduction in mortality among people with HIV resulted.