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The Brazilian Response Toward Universal Access

The Brazilian Response Toward Universal Access. Cristina Raposo Head of International Cooperation Department of STD, AIDS and Viral Hepatitis – Ministry of Health Brazil. SUS – uma conquista democrática.

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The Brazilian Response Toward Universal Access

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  1. The Brazilian Response Toward Universal Access • Cristina Raposo • Head of International Cooperation • Department of STD, AIDS and Viral Hepatitis – Ministry of Health • Brazil

  2. SUS – uma conquista democrática • Constituição de 1988: marco na política de saúde no Brasil. A criação do Sistema Único de Saúde (SUS) realiza o ideal democrático: • conceito de saúde como um direito social, superando o limite da questão previdenciária • relevância pública dos serviços e ações de saúde • descentralização da gestão em saúde, com participação da sociedade e das três esferas de governo • assegura o atendimento integral de todos os brasileiros

  3. Saúde é um direito Art. 196 “Saúde é direito de todos e dever do Estado, garantido mediante políticas sociais e econômicas que visem à redução do risco de doença e de outros agravos e ao acesso universal e igualitário às ações e serviços para sua promoção, proteção e recuperação”. Art. 198 ..... e constituem um sistema único, organizado de acordo com as seguintes diretrizes: I - descentralização, com direção única em cada esfera de governo; II - atendimento integral, com prioridade para as atividades preventivas, sem prejuízo dos serviços assistenciais; III - Participação Social.

  4. Princípios do SUS – Lei 8080/90 Art. 7º ... são desenvolvidos de acordo com as diretrizes previstas no art. 198 da Constituição Federal, obedecendo ainda aos seguintes princípios: I - universalidade de acesso aos serviços de saúde em todos os níveis de assistência; II - integralidade de assistência, entendida como conjunto articulado e contínuo das ações e serviços preventivos e curativos, individuais e coletivos, exigidos para cada caso em todos os níveis de complexidade do sistema; III - preservação da autonomia das pessoas na defesa de sua integridade física e moral; IV – Equidade da assistência à saúde, sem preconceitos ou privilégios de qualquer espécie; V - direito à informação, às pessoas assistidas, sobre sua saúde; ...

  5. Resposta sustentável • Sistema Único de Saúde • Orçamento • Recursos Humanos • Atores • Financiamento descentralizado • Aporte Recursos locais – estados e municípios

  6. HIV/aids no Brasil • Nacionalmente estável e concentrada em populações chave • Casos acumulados de aids (até jun/2013): 686.478 • Média dos novos casos de aids/ano (2002-2012): 37.000 • Prevalência do HIV na população geral (2011): 0,4% • Prevalência do HIV em populações chave (RDS, 2009/10): HSH=10.5%; PUD=5.9%; PS=4.9% • Prevalência de HIV entre usuários de crack (TLS, 2013): 5,0% • Número estimado de PVHA (2012): 718.000 • Taxa de detecção de aids (2012): 20,2/100.000

  7. Indicadores • Gestantes HIV positivas que recebem antirretrovirais para reduzir o risco da transmissão vertical: 64% • Taxa de transmissão vertical (modelagem): 3,6% • Cobertura de testagem de HIV no pré-natal: 84%

  8. Combined Prevention: • Classic Strategies + • StructuralInterventions + • TASP

  9. Classic Prevention Strategies Condoms Harm Reduction

  10. FOCUS on a ConcentratedEpidemic

  11. NGO Training on Rapid Oral Test • 4 Workshops on TASP, 40 supported projects, • Trans • Gays e MSM • PUD • SW

  12. Structural Interventions

  13. Politics for Transgender Social Name Transgender and Transsexuals, you deserve a friendly service You can be served in public health system with the name you chose. Order SUS card with your name that you decide to use and exercise your right.

  14. President Dilma Russef receives the LGBT Movement in her Palace June, 2013

  15. Keila Simpson, Human Rigths Award, by President Dilma Russef December, 2013

  16. Treatment is also Prevention “The results have galvanized efforts to eliminate the global AIDS epidemic” Dr. Bruce Alberts, Science’ Editor

  17. First Step: the new Brazilian algorithm for HIV • NEW GOVERNMENT DIRECTIVE (DECEMBER 2013) • Regulates HIV-1 diagnosis in adults in Brazil • Introduces 5 new algorithms aimed at increasing access to testing and diagnosis • First time of Oral Fluid tests based algorithms used in Brazil • Algorithms 1 and 2- to screen and confirm using finger prick or Oral Fluid  • Algorithms 3 and 4- combine 3rd and 4th generation immunoassays as screening and VIRAL LOAD quantification for confirming results  • Algorithm 5- combines 3rd generation immunoassay screening followed by Western Blot/Imunoblot confirmatory test.

  18. New HIV Algorithm • THE ADVANTAGES • (1 and 2) Innovative approach enhances testing accessibility and reduces biological risk • (1 and 2) Requires no labinfrastructure • (1) Pilot tests already underway with key populations • (1) Likely to contribute substantially to helping individuals to learn their serological status. Near future: self test in pharmacies. • (3 and 4) Combines 4th generation Elisa and the latest molecular biology tests-Verycosteffective

  19. THE NEW CLINICAL PROTOCOL AND THERAPEUTIC GUIDELINES - CPTG The new Clinical Protocol and Therapeutic Guidelines (CPTG) for Treatment of HIV Infection in Adults was discussed with an Advisory Board of experts, submitted to a public consultation for 30 days, and published in a Government Directive no. 27, of November 29, 2013. * SVS: Health Surveillance Secretariat Both the complete document (in Portuguese) and the Quick Consultation Guide are available in PDF and in an on-line version at www.aids.gov.br/pcdt

  20. THE NEW CLINICAL PROTOCOL AND THERAPEUTIC GUIDELINES - CPTG A highlight among the main new items of the CPTG is the recommendation to start antiretroviral therapy for all HIV positive people, regardless CD4, based on the possible impact on morbidity and mortality, but also in the reduction of HIV transmission. A Public Health Approach.

  21. THE NEW CLINICAL PROTOCOL AND THERAPEUTIC GUIDELINES - CPTG In addition, clear ART therapeutic lines were established. The first line being Tenofovir + Lamivudine + Efavirenz. This recommendation does not apply to patients who are already receiving initial therapy; it refers to patient who will begin ART from now on.

  22. THE NEW CLINICAL PROTOCOL AND THERAPEUTIC GUIDELINES - CPTG The second line of treatment refers to the introduction of protease inhibitors (PI/r) into the antiretroviral regimen, with the preferred PI being Lopinavir with a Ritonavir booster (LPV).

  23. NATIONAL GUIDELINES - APP • IOS (Apple) and Android platforms • Smartphones and Tablets • Free of charge • Offline access to national guidelines • Updates – downloadable new contents and modifications • New functionalities will be added: ie: interactions of ARV and other drugs. PCDT HIV

  24. Optimize drug regimens POC and other simplified monitoring Mobilize communities TREATMENT 2.0 Adapt delivery systems Reduce costs Tratamento 2.0

  25. What Else? • We are customizing the response working in the concept of Hot Spots (two initial Task Forces: RGS and Amazon ; • Starting a big National Study on PREP in Public Health Services in 4 different sites (2 SP, 1RJ and 1 RGS); • Intensifying PEP at least in the hot spots; • Enhancing the universal and free of charge access to Hepatites B and C Treatment (including triple therapy with first generation of antivirals); • Leading a resolution to the WHA 2014 on universal treatment for Hepatites.

  26. HIV CONTINUUM CARE (Cascade) - Brazil2012 80% 74% 61% 44% 33%

  27. HIV CONTINUUM CARE (Cascade) - Brazil2012

  28. HIV CONTINUUM of CARE (Cascade) - Brazil 2012

  29. HIV CONTINUUM of CARE (Cascade) - Brazil 2012

  30. THANK YOU! Fabio Mesquita – Director fabio.mesquita@aids.gov.br Cristina Raposo – Head International Cooperation Cristina.raposo@aids.gov.br

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