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Update on global progress in ART outcomes Silvia Bertagnolio HIV Department WHO, Geneva

Update on global progress in ART outcomes Silvia Bertagnolio HIV Department WHO, Geneva. Significant progress towards ending AIDS. WHO/UNAIDS July 2019. Many gaps in service access and quality remain. An ambitious treatment target to help end the AIDS epidemic By 2020. 90-90-90. 90%

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Update on global progress in ART outcomes Silvia Bertagnolio HIV Department WHO, Geneva

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  1. Update on global progress in ART outcomes Silvia Bertagnolio HIV Department WHO, Geneva

  2. Significant progress towards ending AIDS WHO/UNAIDS July 2019

  3. Many gaps in service access and quality remain An ambitious treatment target to help end the AIDS epidemic By 2020 90-90-90 90% of people living with HIV are virologically suppressed 90% of people living with HIV are receiving ART 90% of people living with HIV are diagnosed 79% 62% 53% WHO/UNAIDS July 2019

  4. Quality health service delivery To reach global targets, HIV programmes must establish and maintain systems for ensuring a high level of quality in service delivery This, within the framework of universal health coverage and supported by national quality policies and strategies

  5. NNRTI pretreatment HIV drug resistance (national surveys) 5 in Africa: SA, Uganda, Namibia, Zimbabwe, Eswatini; 5 in Central/South America: Argentina, Honduras, Cuba, Nicaragua, Guatemala; 2 in South East Asia: Nepal, PNG. 2012 WHO HIVDR Report

  6. Cost of No Action IMPACT OF HIV DRUG RESISTANCE (mathematical model) Projected impact in sub-Saharan Africa if NNRTI PDR >10% and NNRTIs continue to be used in first-line Phillips, et al. JID, 2017

  7. HIVDR can be minimized by closing gaps in quality of HIV treatment service delivery • HIVDR is a consequence of suboptimal quality of care. • To preserve the long term durability of DTG, improving the quality of care and qualitymonitoring is critical

  8. WHO, Patient-centred monitoring guidelines, 2017; WHO Consolidated SI guidelines, 2015.

  9. Quality of care indicators associated with HIVDR emergence (2015-2017) aSource: UNAIDSInfo, UNAIDS/WHO Global AIDS Monitoring tool and WHO/AIDS Medicines and Diagnostics Survey on the use of ARV medicines and laboratory technologies and implementation of WHO related Guidelines. c Countries’ datasets were included if comprise ≥70% of people newly initiated on ART; or <70% but reported to be nationally representative e Countries’ datasets were included if viral load testing coverage was ≥70%; or <70% and reported to be nationally representative.

  10. Countries meeting target of the quality of care indicators associated with HIVDR (2016-2018)

  11. Countries meeting target for the quality of care indicators associated with HIVDR (2016-2018)...cont

  12. Proportion of clinics achieving targets of retention on ART at 12 months in 10 countries

  13. Need for a Quality Revolution

  14. Quality improvement approach Quality improvementis a systematicapproach to improvequality by: • DO: • measuringindicators • identyingquality gaps A model: the plan-do-study-act cycle • STUDY: • exploringtheirroot causes • designing & implementingcontextuallyappropriate solutions, informed and supported by the community • ACT: • implementing interventions • assessingtheir impact

  15. Conclusions • Few countries reported nationally representative data, requiring strengthening of record keeping system. • Important quality gaps in ART service delivery identified: suboptimal retention; drug stock outs; VL testing coverage and suppression; suboptimal use of second-line ART. • Monitoring quality of care indicators identifies weaknesses at ART clinic- and programme level associated with population-level emergence of HIVDR and represents our first-line of defence in preventing HIVDR. • Monitoring indicators in isolation, however, is not sufficient, and should be part of a robust national quality strategy and quality improvement approach so that quality gaps are identified and corrective actions triggered. • Heightened vigilance and rapid response to clinic and programme situations favoring HIVDR is urgently required to maximize the quality of ART services and preserve the durability and efficacy of DTG nowand in the future.

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