Too few take a test
description
Transcript of Too few take a test
![Page 1: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/1.jpg)
Excellent healthcare – locally delivered
Strengthening the treatment cascadeEvidence and practice
Dr Nathan FordTreatment and Care
Department of HIV
![Page 2: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/2.jpg)
![Page 3: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/3.jpg)
Too few take a test
Staveteig et al, DHS Comparative Reports, 2013Global Update on HIV treatment, WHO, 2013
8% - 69% 13% - 76%
37%
Adults
Pregnant women
![Page 4: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/4.jpg)
Substantial attrition between testing and ART initiation
Mugglin et al, Trop Med Int Health 2012
15-30% lost at each step
![Page 5: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/5.jpg)
Still too many people start ART late
The IeDEA and ART cohort collaborations
1 in 4 start ART at CD4<100
![Page 6: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/6.jpg)
Cumulative attrition on ART
Global Update on HIV treatment, WHO, 2013
30% LTF at 3 years
![Page 7: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/7.jpg)
![Page 8: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/8.jpg)
Improving testing and linkage
Suthar et al, Plos Med 2013 [Accepted]Global Update on HIV treatment, WHO, 2013
• Partner and couples testing• Community testing• Self-testing• Combination testing• DBS for early infant diagnosis
![Page 9: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/9.jpg)
![Page 10: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/10.jpg)
Enrollment in pre-ART care
Wynberg et al, 2013 (submitted)Kohler et al, AIDS 2011
Enrollment in pre-ART care
• Earlier initiation• PoC CD4• CTX• Adherence clubs
Wynberg et al, 2013 (submitted)Kohler et al, AIDS 2011
CTX prophylaxis
PoC CD4
Adherence clubs
![Page 11: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/11.jpg)
![Page 12: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/12.jpg)
ART initiation
• Task shifting• Decentralization• Service integration
TB/HIV integration India
Paediatric decentralization in Thailand
PMTCT B+ in MalawiGlobal Update on HIV treatment, WHO, 2013Kredo et al, Cochrane Database of systematic reviews, 2013.
![Page 13: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/13.jpg)
![Page 14: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/14.jpg)
Adherence support
• FDCs• Optimized regimens• Viral load• Adherence support (sms, clubs…)
Fixed-dose combinations
Wilkinson, SAJHIV Med 2013; Ford et al, 2013 (submitted); Butler et al, IAS 2013
![Page 15: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/15.jpg)
Summary
• Successful scale up of ART poses continued challenges to current models of care
• Evidence from research and programmes indicate ways to improve patient care at each step of the cascade
• Future research is needed to identify approaches to enroll people earlier onto ART and support long-term retention in care
![Page 16: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/16.jpg)
WHO’s ongoing workto support ART delivery
• Support to regions for guideline rollout • Future of ART monitoring• Phasing out (d4T) and phasing in (viral load)• Early Infant Diagnosis • Paediatric treatment optimization• Cotrimoxazole prophylaxis• Implementation Science summit
![Page 17: Too few take a test](https://reader035.fdocuments.net/reader035/viewer/2022081503/56815da5550346895dcbd425/html5/thumbnails/17.jpg)
Acknowledgements
Gundo Weiler Eric GoemaereVincent Habiyambere Mathias EggerTxema Garcia-Calleja Andrew BoulleMichel Beusenberg Trevor PeterGottfried Hirnschall Lynne WilkinsonMeg Doherty Hein MaraisCadi Irvine Tony Harries Marco VitoriaBoniface Dongmo NguimfackEyerusalem NegussieRachel BaggaleyNathan Shaffer