Clinical Training and Mentoring Program Helps Jump Start HIV/AIDS Treatment in Rural China

Clinton Foundation Doctor in Anhui Province Provides “Treatment Through Training”

Dr. Tom Warne never thought of himself as a teacher, but when he spoke to Pangaea’s Dr. Eric Goosby in San Francisco in early 2005 and heard about the opportunity to be a part of the scale-up of HIV/AIDS treatment in China, he was immediately interested. A little less than a year later, as he is about to begin a new training session with six Chinese doctors in the small town of Lixin in Anhui Province in Eastern Central China, Dr. Warne feels like he has found his calling. “Bringing AIDS treatment to people in need, while helping to bring up the skills of the doctors here, has been tremendously rewarding. We’re helping to build an HIV/AIDS treatment network from the ground up and it’s already making a difference in the lives of poor families throughout the region.”

Anhui, with a population of over 59 million, is an inland province in Southeast China. Lixin County is one of the centers of the so-called “Blood Donor Epidemic”, which was fueled by unsafe blood collection practices in the 1990’s. There are approximately 900 people who have been identified as HIV positive in the immediate area and 400 people are currently under treatment. Over the past year, under the supervision of Dr. Goosby, and with the support of the Anhui Province Bureau of Health, Clinton Foundation HIV/AIDS Initiative (“CHAI”) doctors have completed three intensive clinical training courses in Anhui, with six Chinese doctors in each session. The Chinese doctors, who are from provinces all around China, typically practice in rural areas. They are brought to Lixin to live and work together for three months under Tom’s supervision. The doctors are based in the county hospital, but spend their mornings doing clinics in rural areas. Afternoons are spent in lectures, followed by consultations with patients in the hospital. At the end of the three month training program, the doctors return to their own provinces to bring AIDS patients into treatment and in some cases take a leadership role in the development of local HIV/AIDS services.

Dr. Warne’s career has been shaped by his interest in issues relating to poverty and health. Originally an engineer, he earned a Masters Degree in urban planning and worked for several years as a project director for a Chicago-based non-profit focused on inner city community development. He was also actively involved in HIV issues during this time. In his early 30’s, he decided to go to medical school in order to provide more direct help to people in the community. Dr. Warne is a graduate of the University of Chicago, Pritzker School of Medicine. During his time in medical school he maintained his interest in HIV/AIDS issues, working in South Africa on community and ethical issues in HIV vaccine research. He did a family practice residency through the University of California, Davis, which was based in a county health care system and focused on broad spectrum family practice training and underserved medicine. After completing his residency, he wanted to get involved in global HIV/AIDS treatment and found the CHAI China assignment a perfect fit.

When asked about the success of the training program so far, Dr. Warne notes, “It’s still a little early to tell. We’re starting our fourth class, but the first class graduated less than a year ago. My sense is that the program is very promising – many of the Chinese doctors who have participated are clearly turned on by the training and the idea that they can really make a difference in the lives of their patients – they’re really grabbing on to it. One of the things that we’ve been teaching, aside from clinical knowledge of HIV, is a patient-centered approach to medicine, which is not something that they’re really used to.”

China’s medical system has many layers and while graduates of China’s medical schools receive sophisticated training, rural practitioners often have more rudimentary training and skills. One of Dr. Warne’s students, for example, was a 22-year-old doctor with three years of medical training out of high school and in his first year of clinical work. Providing intensive clinical training practitioners like these, coupled with ongoing support and consultation with a more experienced HIV/AIDS physician offers hope that AIDS treatment can be offered even in the remotest and poorest areas of the country.

Treating HIV/AIDS in Anhui involves bringing entire families into care. According to Dr. Warne, “We find that if we treat one family member and develop trust with that patient, that we then have the family come back with a child or a spouse who is also having problems and may be HIV positive.” The Clinton Foundation has made a special effort to establish a pediatric treatment program in China, including specially formulated drugs and clinical support. Dr. Warne notes, “We’ve been getting kids into care and treating tuberculosis along the way. We’ve identified 20 HIV positive children in the county so far, along with 14 other kids with HIV in other counties in the province. In one family of a migrant worker who had already lost one child to AIDS we were able to start a nine-year-old on treatment. Once he was taken care of, we could turn to his parents. The father is now on ARV’s and the mother, who is being treated for TB, will go on ARV’s soon. It’s been incredibly heartening to see that we can really make a difference in the lives of these people whose lives have been so dramatically affected by the HIV virus.”