121 Progress, achievements and challenges: a review of China’s free antiretroviral therapy program

In order to respond to the rapid emergence of a large number of AIDS cases and subsequent peak of death in the early 2000’s, Chinese government launched its National Free ART Program in 2002. The initial stage of this program mainly focused on former plasma donors at 6 provinces in central China under the China Comprehensive AIDS Response Program. Since the release of “Four Free and One Care” policy in late 2003, the ART program was quickly scaled up to the whole country and had covered 64% of individuals knows to have AIDS by the end of 2006. As more resources became available, second line drugs, free viral load and free resistance tests became parts of routine services successively between 2007 and 2010, which represented the standardization of China’s ART program. Due to the encouraging findings of ART’s both survival and prevention benefits, China’s ART program stepped into a phase of fast expanding. The sum of newly treated patients in 2011 and 2012 almost equal the accumulative sum of the previous 9 years. By the end of 2015, this program aims to treat 358,600 HIV/AIDS patients in China. With the fast expansion of the program, China successfully decreased the overall mortality of HIV from 39.3 per 100 person-years in 2002 to 14.2 per 100 person-years in 2009. Progress indicators also suggested improvement at implementation. However, there are many challenges remain, which in long run may threaten the sustainability and effectiveness of the program. More attention should be paid to the groundwork of the program and more efforts should be made to improve the overall capacity of the program and its related systems.