A cluster randomised control trial found that a patient-centred approach to streamlined HIV testing and treatment resulted in improved clinical outcomes for people living with HIV in China.

The approach aims to streamline pathways to HIV treatment in the country, minimising the time and number of hospital or clinic visits between HIV testing and treatment initiation - a major reason why people do not remain in HIV care, and a major contributor to morbidity of people living with HIV in China.

Prior to streamlining, just 43% of patients who had received an initial positive result in some parts of China were later given a confirmatory diagnosis. On top of this, just 57% of people newly diagnosed received a CD4 test within six months of diagnosis. As national health guidelines still require a CD4 count to determine whether a person should start treatment, 80% of people newly identified as HIV-positive did not receive timely antiretroviral treatment.

As such, 478 patients were enrolled in the new trial across 12 hospitals in Guangxi Province in China. Half were randomly assigned the standard package of care offered by the existing health system – the control group – while the other half were given the ‘One4All’ intervention. The intervention is designed to bring the country’s HIV programmes up to speed with World Health Organization guidelines by accelerating diagnosis and staging and to provide immediate ART for eligible patients.

Patients in the test group received rapid, point-of-care HIV testing and immediate CD4 and viral load testing for those who were HIV-positive. Those patients immediately started on antiretroviral treatment, regardless of CD4 count.

The One4All intervention found that people were 20 times more likely to achieve testing completeness by 30 days. As a result, participants had a three times greater chance of starting antiretroviral treatment by 90 days, with a reduction in mortality of 56% at 12 months. Read more via Avert