WHO's Contribution to Universal Access to HIV/AIDS
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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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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