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