《100% Condom Use Programme: Experience from China(2001-2004)》
China has been challenged by the HIV/AIDS pandemic in ways that are both similar to and unique from experiences in other countries. China’s large and ethnically diverse population, its geographic expanse, rapid economic growth, institutional transition from a planned to an open economy and evolution of social norms have shaped its growing HIV/AIDS epidemic. China’s well-organized civil administration, trained professional cadres and far-reaching public health infrastructure have, on the other hand, proved to be a valuable resource in mobilizing a response to HIV/AIDS. As a part of that response, China embarked on an effort between 2001 and 2004 to
evaluate a unique preventive health strategy—the 100% Condom Use Programme (100% CUP)— to determine whether it could be replicated and achieve results in Chinese communities.
The 100% CUP strategy was originally developed in Thailand where it proved to be remarkably effective in assuring condom use in entertainment establishments, and in reducing the prevalence of STI and HIV/AIDS among sex workers and their clients, as well as the general population. 100% CUP is now being implemented in other Asian countries, with similarly positive
results in reducing the threat of STI and HIV/AIDS. In 2001, the Chinese Ministry of Health and the World Health Organization (WHO) worked together to launch the 100% CUP in two locations: Wuhan City in Hubei province, Jingjiang County in Jiangsu province, and one year later in 2002, another two sites in Danzhou City in Hainan province, and Lixian County in Hunan province. In 2003 with the support of the United Nations Population Fund (UNFPA), the China Family Planning Association launched another 100% CUP pilot project in Liuzhou City, Guangxi Zhuang Autonomous Region.
The overall findings of the Chinese pilot projects are that the 100% CUP strategy can be effective in China, that Chinese local governments can organize multisectoral support for the 100% CUP, and that these programmes can achieve notable increases in condom use and a reduction in STI among workers in entertainment establishments.
The four WHO-sponsored pilot sites witnessed dramatic increases in condom use among entertainment establishment workers at each site, ranging from approximately 50% increase over the course of piloting in Hubei province, to a more than 500% increase in the pilot in Hainan province. While the pilots had very low HIV infection rates to start with, even at zero cases in
some provinces (Jingjiang, Huangpi and Danzhou), the pilots did witness decreases in Chlamydia infections ranging from about 34% in the Hubei province pilot, to 88% reduction in rate in the Hainan province pilot.
Essential elements of the 100% CUP strategy were successfully implemented in each of the pilot communities, using a variety of tactics to organize a programme appropriate for local circumstances. Multisectoral “leading groups” which implemented the programmes in each pilot community have included members from various agencies relevant to the local response. The
critical relationship between the bureaus of Public Health and Public Security has been accomplished effectively through a variety of techniques, and methods for monitoring and enforcing condom use among entertainment establishment workers have been adapted to local circumstances. The documented success and utility of the 100% CUP strategy has inspired
district and provincial authorities to scale up and launch new programmes in other communities, including province-wide scale-ups in Hubei and Hunan, which are currently underway.
Important lessons have been learnt through the pilot projects about the challenges of establishing a 100% CUP and the methods for overcoming them. Other communities planning to implement the strategy can benefit greatly by drawing upon the experiences of these pilot projects and the lessons they provide.
Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China
Yin Wang, Weiwei Jiang, Qi He, Cheng Wang, Baoju Wang, Pan Zhou, Nianguo Dong, Qiaoxia Tong
Background: Severe patients with 2019 novel coronavirus (2019-nCoV) pneumonia progressed rapidly to acute respiratory failure. We aimed to evaluate the definite efficacy and safety of corticosteroid in the treatment of severe COVID-19 pneumonia. Methods: Forty-six hospitalized patients with severe COVID-19 pneumonia hospitalized at Wuhan Union Hospital from January 20 to February 25, 2020, were retrospectively reviewed. The patients were divided into two groups based on whether they received corticosteroid treatment. The clinical symptoms and chest computed tomography(CT) results were compared. Results: A total of 26 patients received intravenous administration of methylprednisolone with a dosage of 1-2mg/kg/d for 5-7 days, while the remaining patients not. There was no significant difference in age, sex, comorbidities, clinical or laboratory parameters between the two groups on admission. The average number of days for body temperature back to the normal range was significantly shorter in patients with administration of methylprednisolone when compared to those without administration of methylprednisolone (2.06 ± 0.28 vs. 5.29 ± 0.70, P=0.010). The patients with administration of methylprednisolone had a faster improvement of SpO2, while patients without administration of methylprednisolone had a significantly longer interval of using supplemental oxygen therapy (8.2days[IQR 7.0-10.3] vs. 13.5days(IQR 10.3-16); P<0.001). In terms of chest CT, the absorption degree of the focus was significantly better in patients with administration of methylprednisolone. Conclusion: Our data indicate that in patients with severe COVID-19 pneumonia, early, low-dose and short-term application of corticosteroid was associated with a faster improvement of clinical symptoms and absorption of lung focus.