Michael Bartos ([email protected]) UZ-UCSF Annual Research Day 17 April 2015 Fast-track to ending...
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Michael Bartos ([email protected]) UZ-UCSF Annual Research Day 17 April 2015 Fast-track to ending AIDS Fast-track to ending AIDS in Zimbabwe: in Zimbabwe: 90.90.90 opportunities 90.90.90 opportunities
Michael Bartos ([email protected]) UZ-UCSF Annual Research Day 17 April 2015 Fast-track to ending AIDS in Zimbabwe: 90.90.90 opportunities
Michael Bartos ([email protected]) UZ-UCSF Annual Research Day
17 April 2015 Fast-track to ending AIDS in Zimbabwe: 90.90.90
opportunities
Slide 2
1. WHY THE 90.90.90 TARGETS? 2. TESTING SHIFTING TO YIELDS 3.
TREATMENT ACHEIVEMENTS AND CHALLENGES 4. SUSTAINING VIRAL
SUPPRESSION 5. FINANCING THE RESPONSE 6. CONCLUSION Outline
Slide 3
Slide 4
New HIV infections in low- and middle-income countries,
20102030, with achievement of ambitious Fast-Track Targets,
compared to maintaining 2013 coverage
Slide 5
AIDS-related deaths in low- and middle-income countries,
20102030, with achievement of ambitious Fast-Track Targets,
compared to maintaining 2013 coverage
Slide 6
Ending the AIDS epidemic: A working definition Ending the AIDS
epidemic as a public health threat by 2030 is provisionally defined
as reducing new HIV infections, stigma and discrimination
experienced by people living with HIV and key populations, and
AIDS-related deaths by 90% from 2010 levels, such that AIDS no
longer represents a major threat to any population or country
Slide 7
Global targets for ending the AIDS epidemic
Slide 8
Ambitious but achievable treatment target
Slide 9
By 2020 90% of all people living with HIV will know their HIV
status 90% of all people diagnosed with HIV will receive sustained
antiretroviral therapy. 90% of all people receiving antiretroviral
therapy will have durable suppression.
Slide 10
What would ending AIDS targets look like for Zimbabwe 2030
results ? New infections down 13% year on year 100,000 in 2010
currently (2013) 69,000 to 63,000 in 2015 (current projection) to
25,000 in 2020 and 10,000 in 2030 AIDS deaths down from 90,000 in
2010 currently (2013) 64,000 to 27,000 in 2015 (current projection)
to 9,000 in 2030
Slide 11
1. WHY THE 90.90.90 TARGETS? 2. TESTING SHIFTING TO YIELDS 3.
TREATMENT ACHEIVEMENTS AND CHALLENGES 4. SUSTAINING VIRAL
SUPPRESSION 5. FINANCING THE RESPONSE 6. CONCLUSION Outline
Slide 12
Testing: volume or yield? 13m total population 40% under 15
(5.2m) Over 15 infected or at risk (7.8m) Already tested + about 1m
Pool of potential unknowns around 6m Current test volume 2.5m, 2018
target 3m annually
Slide 13
Testing results from the 2013 MICS % of sexually active young
people tested in past 12 months All ever tested Tested past 12
mths
Slide 14
Korenromp and Stover, Democratizing Testing, UNAIDS April
2015
Slide 15
HIVST market intervention Country # Tests Phase 1 # Tests Phase
2 Malawi172,754420,466 South Africa036,000 Zambia200,478404,522
Zimbabwe359,1901,069,810 Total732,4221,930,798
Slide 16
1. WHY THE 90.90.90 TARGETS? 2. TESTING SHIFTING TO YIELDS 3.
TREATMENT ACHEIVEMENTS AND CHALLENGES 4. SUSTAINING VIRAL
SUPPRESSION 5. FINANCING THE RESPONSE 6. CONCLUSION Outline
Slide 17
Slide 18
Ending AIDS 81% coverage target Zimbabwe ART coverage targets
2014-2016
Slide 19
1. WHY THE 90.90.90 TARGETS? 2. TESTING SHIFTING TO YIELDS 3.
TREATMENT ACHEIVEMENTS AND CHALLENGES 4. SUSTAINING VIRAL
SUPPRESSION 5. FINANCING THE RESPONSE 6. CONCLUSION Outline
Slide 20
Retention of Patients Initiating ART During 2007-2009, Zimbabwe
Good retention in care observed in a retrospective cohort study in
a nationally representative sample of patients initiating ART
between 2007 and 2009 69% of patients were continuing ART treatment
at 24 months, whereas 7% had died and 24% were lost to follow-up
(MOHCW, 2012)
Slide 21
90% of those on ART virally suppressed: trade offs? Initiation
vs. retention Routine viral load vs. on demand Maximally effective
regimen vs. maximally forgiving regimen
Slide 22
Community ART refill groups Model self-selecting patient groups
(7-14) one representative picks up ARVs for the group on quarterly
basis group contribute money for transport/ lunch/in kind support
(eg work their fields) Results: 9 months pilot evaluation (n=207)
100% retention, 99% virally suppressed Time saving: normally 45mins
waiting, 50 mins with staff (nurse, counsellor, pharmacist); ART
refill groups: 30 mins to serve 8 patients saving >10
person/hours per day in a busy 3 person clinic Cost savings to
patients from $14 per month to $48 (more remote areas) Secondary
benefits in increased resilience, reduced stigma, more
participation in health governance.
Slide 23
1. WHY THE 90.90.90 TARGETS? 2. TESTING SHIFTING TO YIELDS 3.
TREATMENT ACHEIVEMENTS AND CHALLENGES 4. SUSTAINING VIRAL
SUPPRESSION 5. FINANCING THE RESPONSE 6. CONCLUSION Outline
Slide 24
PEPFAR: The United States Presidents Emergency Plan for AIDS
Relief Sources: UNAIDS estimates, UNAIDSKaiser Family Foundation
reports on financing the response to HIV in low- and middle-income
countries, GARPR 2014, philanthropic resource tracking reports from
Funders Concerned About AIDS, reports from the Global Fund and
UNITAID. Building on past achievements: funds invested in AIDS
programmes in low- and middle-income countries, 19862013
Slide 25
Potential room for expansion: per capita health assistance,
selected countries Zimbabwe
Slide 26
Public resource Availability for AIDS in Zimbabwe, 2009-2016,
US $ million
Slide 27
Resource needs for AIDS 2015-2025 in two different scenarios:
current coverage and enhanced, more efficient coverage
Slide 28
Slide 29
Additional impact: infections averted
Slide 30
Additional impact: deaths averted
Slide 31
CONCLUSION 1.Sustainability will require much more community
delivery 2.Patient-driven diagnostics and regimen switching
3.Testing shift from undifferentiated to targeted yield 4.No one
turned away 5.More money will be needed (also to turn off the
tap)