Optimizing HIV Treatment:A Global Strategy in Three Acts

Introduction byJosé M. Zuniga, PhD, MPH

Battling Complacency, Advancing Commitment.

Satellite Session at

↑ART COVERAGE FROM 2002-2009

UNAIDS Report on the Global AIDS Epidemic 2010

GLOBAL NUMBER OF ADULTS ≥15 YEARS ELIGIBLE FOR ART IN LMICs, 1990-2009

Stanecki K et al. Sex Transm Infect. 2010;86:ii62-ii66

NUMBER OF ART ELIGIBLE ADULTS ≥15 YEARS IN SUB-SAHARAN AFRICA BY COUNTRY, 2009

Stanecki K et al. Sex Transm Infect. 2010;86:ii62-ii66

BUT HEREIN LIES THE CHALLENGE…23,430 tested for HIV (2 public HIV care systems in central Mozambique)

3,046 CD4 test <30 days after enrollment (77%)

317 adherent to ART for 6 months (83%)

3,049 (43%) not enrolled in HIV care

910 (23%) no CD4 test drawn

1,035 (69%) did not initiate ART

65 (14%) LTFU after ART

7,005 tested HIV positive (30%)

471 initiated ART <90 days after CD4 test (31%)

1,506 eligible for ART Initiation (49%)

3,956 enrolled in HIV care <30 days after test (57%)

Micek MA et al. J Acquir Immune Defic Syndr. 2009;52(3):397-405

AND NOT JUST IN LMICs…(A TRULY GLOBAL CHALLENGE)

Burns DN et al. Clin Infect Dis. 2010; 15;51(6):725-731

HRH CRISIS IN LMICs…

Frenk J et al. Lancet. 2010;376(9756):1923-1958

World maps resized by population, burden of disease, density of medical schools, and density of workforce

IN RESOURCE-RICH COUNTRIES, TOO…

Lack of qualified clinicians

Pay scale/ reimbursement

Lack of clinicians in area

Lack of willingness to work with population

Lack of interest specialty

Workload

Other

0 10 20 30 40

Top Challenge Recruiting HIV Primary Care Providers Reported by Ryan White CARE Act Programs (%)

Hauschild BC et al. Ann Forum Collab HIV Res. 2011;13:1-9

MCT DELIVERY OF INTEGRATED CARE(“HIV MCTs WORK”… AT LEAST IN CHICAGO!)

• METHOD: Retrospective analysis of clinical data sets on 2,647 patients at the CORE Center, Chicago, from 1997-1998

• CONCLUSIONS: Our findings validate the multidisciplinary team model of HIV care, and suggest that health services that are tailored to the express needs of patients lead to better care and improved health outcomes.

Sherer R et al. AIDS Care. 2002;14(Suppl 1):S31-S44

AND IN LIMCs?(IN THIS CASE, SOUTH AFRICA…)

Changes in mean percentage of eligible HIV+ mothers (A) receiving AZT >2 weeks before labor, and (B) on ART at time of delivery in labor ward (p <0.001) showing effects of QI interventions, protocol change, and resource reallocation.

Youngelson MS et al. PLoS One. 5(11):e13891

WHY IS THIS ALL IMPORTANT?

TEST

HIV Positive

Adopt safer behaviors

ENROLL IN CARE

Treat

Maintain viralsuppression

Positive Prevention

Testing

Initiationof ART

Linkage to care

Adherence to ART

Decrease in HIV Transmission

Courtesy of Wafaa El-Sadr (6th International Conference on HIV Treatment and Prevention Adherence)

AGENDA

• Treatment 2.0 – Catalyzing the Next Phase of HIV Treatment, Care, and Support – Craig McClure, Senior Advisor, Treatment 2.0, WHO

• Developing Guidelines to Promote Treatment Adherence, Entry Into, and Retention in Care – Melanie Thompson, MD, Principal Investigator, ARCA

• Treatment Optimization via Multidisciplinary Care Team Delivery of Integrated HIV Services – Joan P. Holloway, MA, Vice President, Global Health Initiatives, IAPAC

• Optimized Multidisciplinary Care Teams Enhance Antiretroviral Therapy Adherence – Michael A. Horberg, MD, Director, HIV/AIDS, Kaiser Permanente