Each China CARES site was required to establish an AIDS working committee to lead the local response, formulate local policies, define roles and responsibilities, mobilize and support of civil society and monitor and evaluate programme implementation. The committee was chaired by a chief government official with members from various government sectors such as Health, Publicity, Education, Civil Affairs, Public Security, Justice, Finance and the Women’s Federation. Non-government organizations (NGOs) and community-based organizations (CBOs) were supported to deliver services to most at-risk populations and people living with HIV/AIDS (PLWHA) in all programme sites.
A four-tier programme management system was established at the national, provincial, prefecture and county levels. Corresponding working teams were established at these levels and extended through each county, township and rural village. To ensure a strong programme management system, the National Program Management Office (NPMO) developed the China CARES Program Working Manual 24 and established a resource panel in HIV/AIDS-related technical areas. Each resource group had the responsibility to develop and regularly update the technical guidance, operational manual and training models. Five expert groups were established according to geographic areas to provide specialized technical assistance to the 127 programme sites. Each expert group was responsible for five to six provinces. To respond to diverse needs, a group of professionals with various expertise attended biannual site visits to provide technical support in prevention, treatment, care and management, to ensure the planned activities were running properly and to ensure problems were addressed in a timely manner. provides an overview of the organization of the China CARES programme.
Overview of the management structure of the China CARES, 2003–08
Given wide disparities and diversity in socio-economic, cultural and ethnic backgrounds, as well as diverse HIV disease burdens and transmission modes, project sites were encouraged to design and develop intervention activities with targeted goals taking the local situation into consideration. For instance, in Yunnan province and Xinjiang Autonomous Region in southwest and northwest of China, project sites particularly focused on intervention for drug users, where as in Henan province in central china, intervention focused on ART and care. Gradually, a set of strategies was formed and classified into five main categories based on the most common transmission routes as listed in .24
As part of an integrated and comprehensive response, the other transmission modes were also addressed as needed. In total, there were 85 national experts providing regular technical support to the 127 project sites.
Activities implemented in each site were tailored to local circumstances using multi-sectoral collaboration. Each sector was encouraged to contribute and share responsibilities. For instance, Health, Public Security and Food and Drug Administration jointly supported implementation of the MMT programme. Health and other sectors jointly supported condom promotion programmes. Women’s Federation mobilized housewives to conduct face-to-face HIV/AIDS information dissemination. Ministry of Publicity mobilized media outlets to air prime-time public service announcements. Local NGOs helped increase adherence to the ARV treatment and promote support groups. Micro-credit programmes assisted PLWHA to live on their own. Civil affairs sectors helped PLWHA access social security benefits. Youth league, Red Cross Society and Education sectors mobilized student volunteers to participate in HIV prevention information dissemination and promotion of safer sex.
China CARES made use of the available primary health-care system to promote patient follow-up and increase adherence to ARV treatment.4,10,11,25
Village doctors dispensed ARV drugs, provided directly observed therapy (DOT), and reminded patients to routinely have CD4 (and later an annual viral load) tests, which were conducted at facilities at the township, county or provincial level. Since county-level doctors provided technical support to township- and village-level doctors as the treatment team head, the three-tier health system increased patients’ adherence to ART through the DOT programme.4,11
To disseminate programme experiences and lessons learned, a China CARES Newsletter
was compiled and published regularly. A China CARES homepage was established on the Chinese Centre for Disease Control and Prevention (China CDC)’s website.25
The Journal of China STD and AIDS
issued a special volume about China CARES, as well as four editions of China CARES best practices, to facilitate local and regional experience sharing.26
National dissemination meetings were conducted by the State Council AIDS working committee and Ministry of Health (MOH) twice during the programme period. At the provincial level and below, collections of programme briefings and lessons learned were developed regularly and shared among programme sites to provide updates on progress and experiences to government leaders and related stakeholders.