Metodology for the establishment of regional 2020 targets

1. Metodologyforthe establishment of regional 2020 targets Mónica Alonso González Panamericanhealthorganization PRIMER FORO LATINOAMERICANO Y DEL CARIBE SOBRE EL CONTINUO DE ATENCIÓN DEL VIH Ciudad de México, 26 a 28 de mayo del 2014

2. Outline of the presentation • 1. Why do we need new targets?and why use the framework of the cascade of the continuum of care? • 2. What is the operational definition of each target and the methodology to monitor the targets?

3. Whythe new targets and why use thecascadeframework? • New evidence and new polocies notyetreflected in new targets. • Ambitious targets supportedbyevidence • Regional targets refer to programaticoutcomes and results. • We are usingthecascadeframeowrkbecause : • Guide to immediateactions to be conductedbyprograms • Reinforcesthe concept of interrelatedactions and outcomes • Adoption/adaptation at country level. • Sum of allcountrieswillpermit La suma de todos los países • reaching regional targets. • Process at global and regional level

4. Goal 1. Increasing persons with HIV that know their diagnosis • By 2020, 90% of persons with HIV know their status. • 2013 baseline: • Cumulative HIV cases from HIV case base dsurveillance (source: HIV Surveillancesystem), • Substract HIV deaths (adjustforsubregister) (subregisterbasedon IHME orotherstudy; i.e 30%). • Alternatively, countries can use othermethodswithspecialstudies. Note: Diagnosis in HIV exposedchildrenshouldfollow targets establishedbytheeliminationinitiative (all HIV exposedchildrenshouldhave a definitive diagnosis) 90

5. Goal 2. Decreasing late diagnosis • By 2020, 10% or less of persons have a first CD4 count under 200 cel/mm3. • 2013 Baseline will be the percent of persons with first CD4 < 200 cel/ml in relation to all persons with baseline CD4 that year. • Improvement in availability of data: routine program data. • Alternatively, signs and symptoms indicative of advanced HIV infection at the moment of diagnosis may be used (OI…)

6. Goal 3. Increasing Persons on antiretroviral treatment • By 2020, 90% of the estimated eligible persons for treatment will be on ART.That should represent 81% of estimated PLWH . • 2013 Baseline: Total number of persons on Art in 2013, come from program data. The denominator comes from Spectrum estimates of persons eligible for treatment. Subtarget: By 2020, 90% of children (0 a 14 y.o) eligible for treatment are receiving ART. 90

7. Goal 4. Increasing persons on treatment with undetectable viral load. • By 2020, 90% of persons on ART are virally suppressed (viral load <50 copies/ml). It should represent 73% of estimated PLWH. • 2013 baseline: Persons on ART with undetectable VL, from progra/lab registers in relation to all persons on ART with a VL (last VL) in a specific year (2013). • Alternatively: a special study with a representative sample can produce this information. • If using programatic data: The coverage of yearly VL tests needs to be high in order for the value of the indicator to be acceptable to use. An acceptable coverage value is >70% of patients on ART have a VL in the year. 90

8. Thank you