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Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives

XIX International AIDS Conference. Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives. Dr. Massimo N Ghidinelli Senior Advisor, HIV & STI Project Pan American Health Organization. Washington, DC 22-27 July 2012. Objective.

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Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives

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  1. XIX International AIDS Conference Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives Dr. Massimo N Ghidinelli Senior Advisor, HIV & STI Project Pan American Health Organization Washington, DC 22-27 July 2012

  2. Objective To accelerate the transition to sustainable and expanded treatment programmes in line with Treatment 2.0 • Outline: • Review the pillars of Treatment 2.0 • Analyze the situation in LAC • Discuss main conclusions that stem from this analysis

  3. Patients on ART in LAC2002–2011 2011 ART coverage in Latin America 70%, 67% in the Caribbean, highest in mid-low income settings Initiations to treatment Initiations to treatment WHO. Universal Access progress reports 2010- 2012

  4. Treatment 2.0 Reach and sustain universal access and capitalize on preventive benefit of ART 5 pillars to “re-energize” the HIV response… • Optimize treatment • Provide POC and other simplified diagnostic tools • Reduce costs • Adapt delivery systems • Mobilize communities

  5. Pillar 1. Optimize drug regimens Use of fixed dose combinations Rational use Sequencing strategies Uninterrupted availability of ARVs Simplification Phase out inappropriate regimens Objective: Control HIV infection Increase duration of each regimen

  6. Proportions of adult patients receiving WHO recommended regimens , 2010 1st line 2nd line

  7. Number of regimens in adultsper line of treatment, 2010

  8. Phasing-out obsolete ARVs, 2010 7% patients on ART receiving inappropriate ARVs (2010)

  9. ARV Stock-outsMost countries reported > 1 stock out in 2011 PAHO. Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean. 2012.

  10. Pillar 2. POC and other simplifieddiagnostic and monitoring tools Regional context • Limited decentralization of HIV T&C at the primary health care level with complex algorithms and redundant confirmatory tests • PITC partially implemented mainly in ANC settings • Insufficient impact of HIV testing strategies in key populations: 50% of MSM with an HIV test in past year; in sex workers a median of 69% • Legal policy barriers for HIV testing among adolescents

  11. Untargeted intensity of HIV T&C(2011) UNAIDS/WHO. Global HIV/AIDS Response 2011-2012.

  12. % of patients initiating ART with <200 CD42000-2011

  13. Average VL tests per patient on ART2010 Viral load / patients on ART

  14. Pillar 3. Reduce Costs ARV annual spending per patient(2008-2010), USD Spending per patient on ART (USD)

  15. Dependence of external sources for ARV 2007/2008 -2011/2012 “High dependence” countries represent 20% of PLH in the Region

  16. Pillar 4. Adapt delivery systems • Difficult to characterize service delivery models • Most ART patients concentrate in tertiary level facilities or dedicated centers • Limited decentralization of service provision Percentage alive and on treatment at 12 months of ART initiation, 2011 UNAIDS/WHO. Global HIV/AIDS Response country reported data, 2012.

  17. Pillar 5. Mobilize communities • Strongly organized civil society at national, sub regional and regional levels. (REDLAC+, CIAT, ECW+, REDCA+…) • Successful in mobilizing and achieving policies for access to free ART in all countries, and accessing to patented drugs • CS engaged in T 2.0 but doubts and anxieties about feasibility in LAC, in view of fragility of health systems (i.e stock-outs of ARV and diagnostics) • Interest in supporting improved availability of information, i.e: GIVAR

  18. Conclusions • LAC ready for Treatment 2.0, through contextualized country-based approach, operating on several pillars • Strong partnerships, with active involvement of NAP, civil society, international partners, health service-delivery institutions, professional bodies,…key for transition and to synergize public health principles with individualized approaches • Ample margins for optimization (regimens, diagnostic algorithms, decentralization of services) and cost reduction. Present “status-quo” unsustainable • Building on experience of 1st wave countries, and heightened joint monitoring of implementation plans, move towards sustainable and expanded ART programmes in line with T 2.0

  19. Acknowledgments • Monica Alonso • Pedro Avedillo • Beatriz Garcia • Bertha Gomez • Omar Sued • Freddy Perez • Rafael Mazin • Sonja Caffe • …….y otrosquehancolaborado en el desarrollo de La Lupa………….

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