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Future challenges for HIV prevention & treatment in high-risk populations

Future challenges for HIV prevention & treatment in high-risk populations. Professor Anna Mia Ekström HIV/AIDS & Global Health Research Group. People living with HIV: 35.3 (32.2-38.8) million. 40 000 000. 35 000 000. 30 000 000. 25 000 000. 20 000 000. 15 000 000. 10 000 000.

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Future challenges for HIV prevention & treatment in high-risk populations

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  1. Future challenges forHIV prevention & treatment in high-risk populations Professor Anna Mia Ekström HIV/AIDS & Global Health Research Group

  2. People living with HIV: 35.3 (32.2-38.8) million 40 000 000 35 000 000 30 000 000 25 000 000 20 000 000 15 000 000 10 000 000 5 000 000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 People living with HIV in the world Anna Mia Ekström Source: UNAIDS 2011

  3. Anna Mia Ekström, HIV& AIDS Research Group

  4. New HIV infections and AIDS-related deaths 4 000 000 People 2.3 (1.9-2.7) million 3 500 000 3 000 000 2 500 000 2 000 000 1 500 000 1.6 (1.4-1.9) million 1 000 000 500 000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 New HIV infections AIDS-related deaths Anna Mia Ekström Source: UNAIDS 2011

  5. Anna Mia Ekström, HIV& AIDS Research Group

  6. Methods for hiv-prevention • Malecircumcision • Preventmothertochild transmission (PMTCT) • Antiretroviraltreatment • Safer sex (partners, condoms) • HIV-testing Anna Mia Ekström, HIV& AIDS Research Group

  7. Real-life effectiveness?Male circumcision reduced by 60% (?) Anna Mia Ekström, HIV& AIDS Research Group

  8. Prevention of mother to child transmission (PMTCT)  risk down from 33% to<5%. Anna Mia Ekström, HIV& AIDS Research Group

  9. ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINES CONDOMS CONTRACEPTIVES MEDICAL SUPPLIES GOVERNMENT BILATERAL DONOR MULTILATERAL DONOR NGO/PRIVATE GLOBAL FUND C S S C S I D A N O R A D C I D A H A V A R D P E P F A R A X I O S P F I Z E R J ICA C D C G A V I C U A M M U N I C E F U S A I D W B UN I TA I D CL I NTON GOVERNMENT C O L U M B I A A B B O T T W H O Source Of Funds Procurement Agent/Body C L I N T O N H A V A R D E G P A F A X I O S U N I C E F A B B O T T C U A M M C O L U M B I A U S A I D TEC & CCT MEDICAL STORE C R S S C M S MOH & SW J I C A G A V I CROWN AGENTS T M A P C D C Point of 1st warehousing TEC &CCT HOSPITAL CRS IMA MEDICAL STORE AXIOS COLUMBIA CUAMM HEALTH FACILITY HOSPITAL Point of 2nd warehousing TEC &CCT ZONAL MEDICAL STORE HEALTH FACILITY HOSPITAL REGIONAL/DISTRICT VACCINE STORE TEC &CCT Point of Distribution ZONAL BLOOD SAFETY CENTRE DISTRICT STORE HEALTH FACILITY PRIMARY HEALTH CARE FACILITY HOSPITAL PATIENT Weak health systems prevent effective implementation (ARVMAC, KI coordinated EU project) Source: MOHSW & WHO. Courtesy of Don de Savigny Anna Mia Ekström, HIV& AIDS Research Group

  10. PMTCT in reality: only 1/10 complete the full program Anna Mia Ekström, HIV& AIDS Research Group

  11. Antiretroviral treatment: miracle drugs! Saves lives! Reduce viral load, strenghten the immune defense, reduces risk of transmission by 96% ….but expensive, demans monitoring structures/staff, livlife long adherence due to high drug resistsnce risk and potentially serious side effects Anna Mia Ekström, HIV& AIDS Research Group

  12. Anna Mia Ekström, HIV& AIDS Research Group

  13. Access to ART up by 60% last 24 months in low and middle income countries Now: 8 million on ART (dec 2012) Anna Mia Ekström, HIV& AIDS Research Group

  14. Safer sex? HIV transmission in sexual networks Man ”Bank book” ”Girl friends” ”Weekend get-away” Anna Mia Ekström, HIV& AIDS Research Group

  15. Vision Research Group • To contribute to evidence-based HIV prevention, treatment and care in resource-poor contexts with high HIV prevalence and among marginalized groups at high risk Anna Mia Ekström, HIV& AIDS Research Group

  16. Research in populations with high HIV prevalance and in marginalized groups at high risk Anna Mia Ekström, HIV& AIDS Research Group

  17. Who? • 40 senior & affiliated researchers, postdocs, PhD students • Strong international network: universities, public & private partners How? • Innovative, Interdisciplinary, Implementable! • Virology- clinic-epidemiology-policy • Population-baseradeepidemiologiska studies HDSS, RDS, health systems, qualitative methods, clinical cohorts collaboration with Karolinska University Hospital and multiple clinics and hospitals abroad • Capacity building& international PhD exchange ERA evaluation? • Excellent Research group activities in brief

  18. For more information, please see:Research group “HIV/AIDS and Global Health”http://ki.se/research/ekstromthorsonanna.mia.ekstrom@ki.se AND TODAY: Asli Kulane/Mohamad Farah: Visuals in health education for Somali immigrants Keshab Debua: HIV in Nepal: surveillance among marginalized youth Hanani Tabana: couple testing in South Africa Rolling ppt on ARVMAC: results from EU project on ART scale-up (plan 8) Anna Thorson/Susanne Strömdahl: Poster on HIV among MSM (ECDC)

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