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Community, Primary healthcare & hospital responses to advanced HIV & Models of care

Community, Primary healthcare & hospital responses to advanced HIV & Models of care. Amir Shroufi Medical Coordinator MSF South Africa. All deaths in South Africa - 2015. All deaths in South Africa, 15- 49 - 2015. ART Initiations, Eshowe KZN 2010-2015.

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Community, Primary healthcare & hospital responses to advanced HIV & Models of care

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  1. Community, Primary healthcare & hospital responses to advanced HIV & Models of care Amir Shroufi Medical Coordinator MSF South Africa

  2. All deaths in South Africa - 2015

  3. All deaths in South Africa, 15- 49 - 2015

  4. ART Initiations, Eshowe KZN 2010-2015

  5. ART status of PLHIV with CD4 < 200 CD4Epicentre/MSF CHAPS surveys Kenya, Malawi, & South Africa 2012-2013 Courtesy of Menard Chihana & David Maman, Epicentre/UCT, Cape town

  6. Men present later, higher mortality 2013, Eshowe: 1,077 HIV +ve never tested, 2/3 male 2015, SA – 76,000 male HIV deaths, 79,000 female

  7. Missed opportunities • In 4/9 clinics GxP routinely used • IPT use: 37% of eligible • Switch to 2nd line too late • Fluconazole not given 50% • Nurses prescribe fluconazole • 5/9 clinics • Defaulters not systematically traced File review of 9 MSF supported PHC clinics, Eshowe, KZN, SA 2016.

  8. Lesotho: PHC CrAg screening

  9. KZN: more comprehensive strategyall presenting with CD4 < 200

  10. KZN: Enhanced TB screening Blanket screen for all CD<200 Aims to increase detection

  11. Khayelitsha: Dis & re engagement with care One quarter (25.1%) of patients disengaged from ART care at least once from 2013-4 After disengagement, 1,459 patients (16.2%) were hospitalized and 237 (2.6%) died. Contemporary disengagement from antiretroviral therapy in Khayelitsha, South Africa, Samantha Kaplan1 et al, poster # 162, CROI 2017

  12. Failure to switch: need new algorithms

  13. Malawi: Support to Nsanje hospital • MSF has been supporting the HIV programme of the MoH in Nsanje district since 2011 through mentorship • In 2016 a population based survey demonstrated • 77% of people living with HIV know their status, • 90% of people who know their status are on ART • 91% of those on ART are virologically suppressed In 2016, MSF decided to scale up support to Nsanje District hospital

  14. Nsanje: causes of admission vs death Admissions, May – December 2016 Deaths, May – December 2016 29% within first 48 hrs HIV HIV TB HIV / TBV HIV / TBV

  15. Advanced Disease - 2 Kinshasa Hospitals

  16. Summary • Care packages important – nurse driven systems • Screening vs presumptive treatment • Increasing importance retention & suppression • Lower thresholds • To switch – new algorithms needed • To treat

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