Optimizing HIV Treatment: A Global Strategy in Three Acts Satellite Session at Introduction by José M. Zuniga, Ph. D, MPH Battling Complacency, Advancing Commitment.
↑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: ii 62 -ii 66
NUMBER OF ART ELIGIBLE ADULTS ≥ 15 YEARS IN SUB-SAHARAN AFRICA BY COUNTRY, 2009 Stanecki K et al. Sex Transm Infect. 2010; 86: ii 62 -ii 66
BUT HEREIN LIES THE CHALLENGE… 23, 430 tested for HIV (2 public HIV care systems in central Mozambique) 7, 005 tested HIV positive (30%) 3, 956 enrolled in HIV care <30 days after test (57%) 3, 049 (43%) not enrolled in HIV care 910 (23%) no CD 4 test drawn 3, 046 CD 4 test <30 days after enrollment (77%) 1, 506 eligible for ART Initiation (49%) 1, 035 (69%) did not initiate ART 471 initiated ART <90 days after CD 4 test (31%) 65 (14%) LTFU after ART 317 adherent to ART for 6 months (83%) 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… World maps resized by population, burden of disease, density of medical schools, and density of workforce Frenk J et al. Lancet. 2010; 376(9756): 1923 -1958
IN RESOURCE-RICH COUNTRIES, TOO… Top Challenge Recruiting HIV Primary Care Providers Reported by Ryan White CARE Act Programs (%) Other Workload Lack of interest specialty Lack of willingness to work with population Lack of clinicians in area Pay scale/ reimbursement Lack of qualified clinicians 0 10 20 30 40 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): S 31 -S 44
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. PLo. S One. 5(11): e 13891
WHY IS THIS ALL IMPORTANT? ENROLL IN CARE TEST Initiation of ART Testing Treat HIV Positive Linkage to care Adopt safer behaviors Prevention Adherence to ART Maintain viral suppression Decrease in HIV Transmission Courtesy of Wafaa El-Sadr (6 th International Conference on HIV Treatment and Prevention Adherence)
AGENDA • Treatment 2. 0 – Catalyzing the Next Phase of HIV Treatment, Care, and Support – Craig Mc. Clure, 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
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