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Total Control of the Epidemic Project in Butuo County, Sichuan Province

Source:Humana People to People ChinaDate:2014-10-29 00:00:00Click:1224
Project Background
Sichuan’s Liangshan Yi ethnic minority Autonomous Prefecture in the high altitude Hengduan mountains at the east edge of the Qinghai-Tibetan Plateau, is one of three central government supported HIV/AIDS hot spots in China with a very high HIV/AIDS infection rate due to trafficking of drugs from the golden triangle to China’s inland and coastal areas followed by drug use and sharing needles.
Butuo County is one of the agricultural counties in cold and mountain areas. Most of the residents are Yi ethnic minority. It is a key county of national level for poverty alleviation and development and one of the key counties with the highest HIV epidemics. Butuo County is 114 km away from the capital city Xichang. There are 13 ethnic minorities including Yi, Han and Miao. Yi ethnic minority accounts for 94% and agricultural population accounts for 93% of the total population across the county. 80% of the population is low income people, with 30% of population under the national poverty line of RMB2300/year/person. In Butuo County the general population HIV infection rate was 5.7% at the end of 2013 (Butuo County Health Bureau).

Project Inception
Since 2010 HPP was invited by Ministry of Health and CDC to conduct AIDS prevention and control in Butuo. In 2012, the HPP TCE project started the community-based home testing program. Our project donors were China-MSD HIV/AIDS Partnership (CMAP), China-US Cooperation - Global AIDS Program (GAP), New Zealand Embassy in China and Liangshan Prefecture Association of HIV/AIDS Prevention and Control.
Every day, Field Officers go house-to-house in each remote village to conduct one-to-one HIV/AIDS prevention education to activate their self-protection potential. They are mobilized to understand that “Only people themselves can liberate themselves from HIV/AIDS – The Epidemic”. Through education people’s HIV/AIDS knowledge has been improved, their awareness of protecting themselves and their families has also been improved.
Project mobilizes people for HIV counseling and testing, which can facilitate behavior change. The figure shows that 68% of people change their behavior after being tested, regardless of testing negative or positive.
Project Activities
1.Recruitment and training of local staff
Project recruits and trains field officers in each village. They can be local doctors, cadres of Women’s Federation, and also be activists. 
The project plans to organize two meetings each month, which are facilitated by project manager. During the meeting, weekly reports are submitted, experience is shared, financial statement is reported, work plan and priorities for next month are developed. At the mean time, project manager will also provide training to field officers based on practical situation to improve quality of the work and their capacity. 

Recruiting field officers 

Training field officers
2.Home visit and face to face education
Home visit and health education are field officers’ main work. Home visit day is from Monday to Friday. The time will be decided at villagers’ convenience. It takes 1.5 hours in average for each home visit. Home visit tools: Home Visit Register, informed consent form, Register for test, HIV rapid test equipment, IEC materials and condoms.  

Health education includes providing HIV/ADIS knowledge to villagers, mobilizing pregnant women for prenatal care and hospital delivery, providing condoms and explaining condom use to HIV single-infection couples and key population.

From the five year project implementation experience, face to face education during home visit is the most effective and direct way. It is acceptable to villagers. Most villagers have low education level and many of them can’t speak Mandarin. Therefore, it is easy for them to forget what they are educated. Through home visit education, villagers can grasp HIV/ADIS knowledge. 


3.HIV rapid test
As Butuo is a very remote and spread out mountainous area with inconvenient traffic, it can take villagers 1-5 hours to walk to the township clinic for HIV test and many villagers never took the time and transport money to do it. But when our CDC trained and certified TCE Field Officers brought the voluntary counseling and rapid test to the people’s homes, about ½ of all households utilized this service. This project innovation plays a major role in preventing new HIV infected people and blocking HIV transmission. HIV home test can reach the areas that routine test can’t reach. The project is also the first community-based home test project in China. 
After health education, field officers start to mobilize family members to accept HIV rapid test. They first receive pre-test counseling. If they agree to get test, informed consent form need to be signed. 
If the test shows positive, the field officer will refer him/her to the township clinic. The township clinic keeps record and informs the result. If tested negative, the field officer will provide further education (post-test counseling). Test equipments need to be taken back after use.
Hukou and ID must be checked before test. The basic information of the villagers who have been visited and tested is recorded for the sake of revisit and data statistics. Field officers should keep the record of information collected from home visit as the original data to be reported on weekly meeting. 

4.Different kinds of trainings and education
Provide knowledge on HIV/ADIS through different forms such as Women’s Club, night school, bazaar and entertainment programs during festivals. Awareness of women in villages of Butuo county on HIV/AIDS knowledge, prevention and treatment, as well as risk prevention during non-commercial sex is improved. Comprehensive harm reduction methods are used in cooperation with other organizations at the project sites. Condom use is effectively promoted among women. High risk behavior incidence and HIV transmission among high risk and vulnerable population is reduced. The project has had significant impacts on behavior change among target population.
From interview, evaluation staff learnt that before project was implemented, many local people did not realize the severity and potential risk of HIV. Most of them took it for granted that it was not a big issue. Things are improved significantly after project implementation. Now most people have learnt the harm and risk of HIV and they seek to get counseling on HIV prevention and test.  



5.Drug users are referred to MMT clinic
Drug users can be met from home visit and training of villagers. They can also be introduced by village leaders and other villagers. Field officer need to mobilize drug users at project sites and refer them to MMT center for treatment.  

Project News
HIV health education is really needed—An Observation by TCE field visit
TCE Butuo Launch conference and field officer training session