National ART program in China may be successful in viral suppression

More than 70% of patients receiving antiretroviral therapy from a national program in China may have achieved viral suppression, according to results of a recent study.

Ye Ma, MD, of the Division of Treatment and Care at the National Center for STD/AIDS Prevention and Control at the CDC in China, and colleagues conducted the study.

"When China first began its National Free ART Program in 2003, patients did not have access to the best first line ART drugs, experienced doctors were in extreme shortage and the medical service capacities in rural areas were poor," Ma said.

Prior to this study, data from national studies examining virologic outcomes of patients receiving treatment from the national program were limited.

The researchers conducted a multi-stage cluster design study in which they randomly selected patients from eight provinces who had been receiving first-line therapy for at least six months.

The participants were stratified into three groups based on treatment duration.

The researchers tested patients for viral load and held interviews. Findings from these procedures were linked with a national database.

Multivariate models were created to analyze for associations between treatment and viral suppression. A threshold of less than 400 copies/mL was set as the mark for adequate viral suppression.

Analysis was conducted for 1,153 patients. Adequate suppression was observed in the following ratios:

72% overall
82% among patients receiving ART for 6-11 months
73% among patients receiving ART for 12-23 months
67% among patients receiving ART for >24 months

Multivariate models indicated that patients receiving treatment at locations other than county-level hospitals were less likely to reach viral suppression goals and that the odds for inadequate viral response were greater among patients being treated at village clinics (OR, 5.4; 95% CI, 1.7-5.6). Patients receiving treatment at township health centers (OR, 3.1; 95% CI, 1.7-5.6) and public health clinics (OR, 3.1; 95% CI, 1.7-5.6) also had a greater risk for inadequate virologic response.

"When such an ART program is scaled-up in resource limited areas, achieving a satisfactory virologic response is feasible," Ma said. "However, in addition to a patient's ART regimen, adherence, age and gender, we found that the level of the medical institution was a risk factor."

Ma acknowledged that treatment given at locations other than county-level hospitals was less likely to achieve viral suppression. "This finding reflects the effect of the doctors' medical competency on treatment results, which may be unique to developing countries," he said. "This is an important public health problem that can be solved by either improving the abilities of HIV doctors or transferring patients to more standardized medical facilities."

Other results indicated that the OR for failure to meet virologic goals was 3.9 (95% CI, 2.7-5.7) among patients being administered didanosine-based regimens compared with those receiving lamivudine-based regimens.

"Owing in part to the results of this study, free annual viral load testing is now provided nationwide in China," Ma said. "Both the central and local governments have made great efforts to mobilize various resources in order to provide as many services as possible for HIV/AIDS patients."

Ma Y et al. Clin Infect Dis. 2010;50:264-271.