Wuhan: The professionals' perspective

Q&A with UNAIDS' China office, part of the Joint United Nations Program on AIDS and HIV, about the pilot program

Q: How does the Wuhan pilot program relate to Treatment 2.0?

A: Treatment 2.0 is a radically simplified approach to the treatment of HIV, launched by UNAIDS and the World Health Organization in 2010. Treatment 2.0 seeks to simplify the way treatment is provided and increase access by focusing on improved treatment, treatment as prevention, improving service-delivery systems and promoting community mobilization. The Hubei project is not directly related to the global Treatment 2.0 initiative, but seeks to explore new, effective approaches to HIV treatment by incorporating some elements of Treatment 2.0, including optimizing treatment regimes and improving service-delivery mechanisms.

What are your thoughts on China's current treatment policy, particularly the drug regime?

China has achieved immense progress in scaling-up treatment coverage and increased the number of people receiving ART to more than 120,000 people in 2011. While the progress has been impressive, there is room for some optimization of treatment regimens, including the broader utilization of the TDF-based first-line regimen, which generally results in fewer side effects and improved adherence. It is encouraging to see that China has included TDF in its treatment guidelines and looks set to expand coverage of TDF-based first-line regimens in the near future. The Hubei pilot seeks to build experience and capacity around the delivery of these new treatment regimens and to explore optimized models for provision.

Do you think the Wuhan pilot program provides patients with improved treatment and services? Is the 200 yuan service fee justified?

It is impossible to comment on the effectiveness of any particular model before it has been thoroughly tested and evaluated, based on a range of indicators. It is therefore important to explore new approaches and ensure that they are documented thoroughly, allowing for objective assessment of their advantages and disadvantages. It is important to remember that the Wuhan trial is currently operating on a very small scale and is not indicative of any shift in the national treatment program. With regard to the justifiability of the 200 yuan service fee, it is important to remember that people accessing treatment in China are often burdened with a number of ancillary costs for treatment of opportunistic infections, consultations and other items, which can often exceed the 200 yuan charged in the Hubei pilot.

The Global Fund will leave China soon and some people have said that the government will explore the possibility of charging for AIDS treatment with the Wuhan pilot program. What do you think?

UNAIDS cannot comment on the motivations of the government in supporting the Hubei Pilot program, but as far as we know, the government remains fully committed to funding free ART and meeting its commitments under the "Four Frees, One Care" policy.

Does the co-payment model exist in other parts of the world for AIDS treatment? Is it suitable for China, and why?

Private healthcare systems exist in most parts of the world, allowing people to pay extra to receive higher-quality services. It is important to explore a range of approaches to treatment provision, to evaluate which will work best in any particular national context. It is possible that a co-payment model could prove effective in some contexts, but it will be impossible to comment on this until the results of the Hubei trial, and other such trials, become available.

After looking into the pilot program, what concerns do you have for it?

In order to ensure the effectiveness of any trial project, it is important to ensure that the objectives and content are clearly and accurately communicated, and that the trial is thoroughly documented and monitored to allow evaluation of its impact. Furthermore, it is important to ensure that channels are put in place through which concerns and feedback can be voiced.

Do you think the pilot program should be further scaled-up in China?

It is impossible to know whether a particular approach will prove successful and worth scaling up until it has been piloted and its impact has been thoroughly documented and evaluated. We look forward to seeing the results from the Hubei trial, and are supportive of efforts to explore new approaches to providing optimized treatment in a Chinese context.