HIVAIDS in China by Zunyou Wu

Author:Zunyou Wu
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

6.2 The Rocky Road to Treatment

A positive HIV screening test is just the first of several steps towards HIV treatment. Though antiretroviral treatment was also provided free from 2004 under the “Four Frees and One Care” programme, patients had to find money to pay for up to 11 other laboratory tests before they could qualify for free treatment. The costs varied a great deal by region: one study measured them at less than US&30 in some sites and over US&150 in others [3]. National protocols required any patient with a positive result on their screening test to come back later and give blood for further testing. About a third of patients never bothered to come back [4]. Blood samples for those who did come back were sent for another screening test at a higher-level laboratory; if that test was positive, the result was confirmed by a test known as a Western blot, which is expensive and complicated to perform. It could take up to a month to go through all the steps required just to get a confirmed HIV diagnosis; in that time health staff sometimes lost contact with patients even before they could be referred to the next stage, the CD4 test. Here was another opportunity for potential patients to be lost to the system. In 2006, at the start of the treatment scale-up, just 20% of those with confirmed HIV diagnoses (and only 13% of those who had initially screened HIV positive) went on to get a CD4 count within six months. In that time, their immune systems suffered further damage, which diminished the prospect for successful treatment. A careful analysis of the national database showed that 9% of people newly diagnosed with HIV between 2006 and 2012 died within 6 months. Seven out of ten of them never got a CD4 test, so they couldn’t access the medicines that might have saved their lives [5]. Figure 10.​11 in the Chap. 10 shows how dramatically that has changed.

CD4 tests are important because they give doctors a good indication of how well a patient’s immune system is functioning. CD4 cells are an important part of a healthy immune system, defending the body from other infections. A healthy adult will normally have somewhere between 500 and 1200 CD4 cells per millilitre of blood. But HIV attacks those cells, so that over time there are fewer and fewer left, and the body is therefore less and less able to defend itself against disease. When the CD4 cell count falls below 200 or so, people begin to suffer from things that would normally be fought off by the immune system. In the context of HIV infection, these are known as opportunistic infections: they are one of the defining characteristics of the syndrome known as AIDS. An analysis of treatment and survival among those diagnosed in the earlier years of the expansion of China’s treatment programme (until 2009) found that CD4 count at diagnosis was exceptionally important in explaining who lived and who died.

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