Transcript WHO's Contribution to Universal Access to HIV/AIDS

Round 6
WHO's Contribution
to Universal Access to
HIV/AIDS Prevention, Care
and Treatment
Department of HIV/AIDS
May 2006
WHO's Strategic Directions for 2006-2010
rrEMENDER
1. Enabling individuals to know their HIV status through HIV testing
and counselling
2. Accelerating the momentum of HIV/AIDS treatment and care
scale-up
3. Maximizing the health sector's contribution to HIV prevention
4. Investing in strategic information to guide a more effective
HIV/AIDS response
5. Taking urgent action to strengthen and expand health systems
May 2006
Goal
Description
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Objectives
Indicators
Description
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Target/bene
ficiaries
Services
Indicators
Description
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Coverage
Indicators
Main Activities
Description
Milestones
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#3
#4
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#3
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#2
#3
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#2
#3
#4
#2
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May 2006
#2
Goals, Objectives and Service Deliveries(1)
Care & ART
•
Major goals : Example
1. Reduced HIV related mortality and morbidity
2. Reduced HIV transmission
•
Major impact indicators:
1. % of HIV+ individuals alive after ART (6, 12 & 24
months)
2. Incidence of TB among HIV+ persons using ART
3. % of HIV-infected children born to HIV+ mothers
May 2006
Priority Interventions (2)
Strategic Direction :
Objective
Priority Interventions:
Service delivery aeras
Accelerating the scale-up
of ARV treatment and care
- Antiretroviral treatment
- Care including nutrition, palliative
care and end of life care
- Prevention for persons living with
HIV/AIDS
- Prevention and management of
opportunistic infections
- TB/HIV
May 2006
ARV Treatment & Monitoring:
Major Activities
 Define national ART protocol
 Define national minimum standards of care in all health
levels
 Accreditation of Health Services
 Use of the "4 Ss" approach with focus in district level
 Adherence support services (community involvement)
 Laboratory support/complexity accordingly health care
levels
 Monitor ARV resistance at population level
 Operational research
May 2006
Priority Interventions (1)
Strategic Direction :
Objective
Priority Interventions
Service delivery aeras
Enabling individuals to
know their HIV status
through HIV testing and
counselling
- Voluntary testing and counselling
- Provider initiated testing and
counselling
May 2006
Priority Interventions (3)
Strategic Direction :
Objective
Priority Interventions:
Service delivery aeras
Maximizing the health
sector's contribution to
HIV prevention
- Prevention of mother to child
transmission (PMTCT)
- Prevention of sexual transmission
- Prevention of HIV transmission
through injecting drug use (harm
reduction)
- Prevention of HIV transmission in
the health care setting
- Research on new prevention
technology
May 2006
PMTCT: Major Activities
 Development/update of MTCT policies, guidelines, plans and protocols
(linkages with ART services)
 Development of communication strategy
 Staff recruitment & training
 Procurement and management of supplies and equipments (HIV test kits
and drugs)
 Simplified ANC approach
 ARV prophylaxis (PMTCT WHO guidelines)
 Infant feeding counselling & support
 Integral family approach: care and treatment of women and their children
 linkage with other services and referral mechanisms
 Family planning & counselling
 Community mobilization
 M&E system and operational research
May 2006
Major activities reduction of transmission
• Development of guidelines for
VCT/PMTCT/STI
• Development/adaptation /diffusion of tools
• Social marketing
• Training
• Services
• Purchase drugs and diagnostic kits
May 2006
Priority Interventions (4)
Strategic Direction :
Objective
Priority Interventions:
Service delivery aeras
Investing in strategic
information to guide a
more effective response
- Epidemiology and surveillance of
HIV/AIDS and STIs
- HIV drug resistance surveillance
and monitoring in ART programs
- Monitoring and evaluation of the
health sector's progress towards
universal access
- Operational research
May 2006
Priority Interventions (5)
Strategic Direction:
Objective
Priority Interventions:
Service delivery aeras
Taking urgent action to
strengthen and expand
health systems
- National strategic planning and
management
- Procurement and supply
management
- Laboratory strengthening
- Human resource management
- Strategies for sustainable financing
May 2006
Operationalizing WHO's contribution
to achieving universal access
For more information, please visit
The WHO Universal Access website:
http://www.who.int/hiv/universalaccess2010/
May 2006
§4.4.2 epidemiological data
• Prevalence;incidence;pattern of the
epidemic
• In high risk groups: need for surveys
• Number of HIV patients in need of
treatment
• %TB/HIV
• Information on pharmaco-resistance
May 2006
§ 4.4.4HSS-feasibility/§ 4.6.6
• pattern of the epidemic/availability of services
and staff/ needs (patient repartition; sex ratio)
• Try to identify the constraints : B): HR
(quantity,quality);IT;procurement;structures;QA;
free access
May 2006
Basics in ARV Forecasting (1)
• Number of patients to be treated:
–
–
–
–
15-20% of estimated number of HIV+ individuals will need treatment
Consider 3by 5 target (40-50% of the total estimated number)
Establish country targets
Establish the scaling up progression (20-25% in 1st year; 75%-80% in
2nd year; stabilization or deceleration after)
• Patient profiles (1st year of treatment):
– 80-90% with body weight < 60 Kg (can varies among countries)
– 3-5% of HIV+ women become pregnant
– 5-10% TB/HIV will start immediate ART (should be more higher in very
high prevalent countries with integrated TB-HIV services)
– 10-15% d4T intolerance/toxicity (should be higher in 2nd year)
– 10-15% NVP toxicity/intolerance (maybe higher in 1st 6 months)
– 3-5% severe ZDV toxicity/intolerance
– 3-5% severe EFV toxicity/intolerance
– 3-4% of total NVP used in NVP based regimens will be ½ NVP dose
(lead in dose schedule)
May 2006
Basics in ARV Forecasting (2)
• 1st line: 97-99% (1st year)
– Preferential regimen: 70-75% (d4T/3TC/NVP)
– Alternative regimen: 25-30%
• Regimen 2: 10-15% (d4T/3TC + EFV)
• Regimen 3: 5-10% (ZDV/3TC + NVP)
• Regimen 4: 5-10% (ZDV/3TC + EFV)
NVP 200 mg (lead in dose): 3.5% of total NVP
d4T/3TC (lead in dose): 3.5% of total d4T/3TC
d4T 30 mg (< 60 Kg): 80%of total d4T
• 2nd line: 1-3% (1st year)
– Preferential regimen: 90% (TDF or ABC + ddI + boosted PI- LPV/r or SQV/r)
– Alternative regimen: 10% (TDF or ABC + ddI + unboosted PI – NFV or ATV)
OBS: 2nd line proportion probably will
increase progressively particularly
after 2nd or 3rd year.
ABC syrup (children): 5% of total 2nd line
ABC tablet (TDF toxicity): 2.5% of total alternative regimen in 2 nd line
May 2006