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The Brazilian Response Toward Universal Access

The Brazilian Response Toward Universal Access. Department of STD, AIDS and Viral Hepatitis – Ministry of Health of Brazil. HEALTH AS A DEMOCRATIC ACHIEVEMENT. 1988 Constitution: landmark for health The Unified Health System (SUS) UNIVERSALITY – as a fundamental right

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The Brazilian Response Toward Universal Access

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  1. The Brazilian Response Toward Universal Access Department of STD, AIDS and Viral Hepatitis – Ministry of Health of Brazil

  2. HEALTH AS A DEMOCRATIC ACHIEVEMENT • 1988 Constitution: landmark for health • The Unified Health System (SUS) • UNIVERSALITY – as a fundamental right • INTEGRALITY – from prevention to treatment • EQUITY – no distinction with recognition of populations' specificities

  3. HIV CONTINUUM OF CARE (Cascade) Brazil 2012 80% 74% 61% 44% 33%

  4. COMBINATION HIV PREVENTION Classic PreventionStrategies + StructuralInterventions + TASP

  5. CLASSIC PREVENTION STRATEGIES CONDOMS HARM REDUCTION

  6. STRUCTURAL INTERVENTIONS • Focus on Key Populations • 33 supported projects -HIV Screening with Oral Fluid RT technology • Trans • Gays and MSM • PUD • SW

  7. STRUCTURAL INTERVENTIONS 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.”

  8. STRUCTURAL INTERVENTIONS President Dilma Roussef receives the LGBT Movement June, 2013

  9. STRUCTURAL INTERVENTIONS International Drug Simposium: “From Coersion to Cohesion” Keila Simpson, Human Rigths Award, by President Dilma Roussef December, 2013

  10. TREATMENT AS PREVENTION “The results have galvanized efforts to eliminate the global AIDS epidemic” Dr. Bruce Alberts, Science’ Editor

  11. FIRST STEP: NEW TESTING ALGORITHMS • NEW GOVERNMENT DIRECTIVE (DECEMBER 2013) • Introduces 5 new algorithms aimed at increasing access to testing and diagnosis • Algorithms 1 screening + confirmation - > RT finger prick • Algorithms 2- screening RT finger prick + confirmation Oral Fluid • Algorithms 3 screening 3rdgeneration immunoassays + confirmation VIRAL LOAD quantification

  12. FIRST STEP: NEW TESTING ALGORITHMS • Algorithms 4- 4th generation immunoassays as screening + confirmation VIRAL LOAD quantification • Algorithm 5- combines 3rd generation immunoassay screening followed by Western Blot/Imunoblot confirmatory test.

  13. SECOND STEP: NEW TREATMENT PROTOCOL 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

  14. SECOND STEP: NEW TREATMENT PROTOCOL 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.

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

  16. TREATMENT PROTOCOL - 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

  17. WHAT ELSE? • We are customizing the response working in the concept of Hot Spots (two initial Task Forces: RGS and Amazon) ; • Starting a 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); • Has lead the 2014 WHO/WHA resolution on universal treatment for Hepatites.

  18. HIV CONTINUUM OF CARE (Cascade) Brazil 2012 80% 74% 61% 44% 33%

  19. HIV CONTINUUM OF CARE (Cascade) Brazil 2012 578 20

  20. HIV CONTINUUM OF CARE (Cascade) Brazil 2012

  21. HIV CONTINUUM OF CARE (Cascade) Brazil 2012

  22. Community of Portuguese Language Countries - CPLP Thematic Research and Development Networks (Rides CPLP ) are part of the CPLP Strategic Plan in Health, focusing the following themes: • Network in STI - AIDS • Network in Malaria • Network in Tuberculosis

  23. Community of Portuguese Language Countries - CPLP • Brazil was elected to be the executive secretary of the “STI, AIDS Rides/CPLP” for the 2014-2016 period . • Joint Work Plan (STI/AIDS Rides; Rides Mal ; TB Rides): “Elimination of MTCT transmission by 2017”. Implementation of national PMTCT plans under the perspective of the B + Recommendation (WHO). This initiative also includes HIV/TB co-infection diagnosis and treatment, as well as malaria testing and treatment (as a risk factor for HIV transmission during pregnancy).

  24. OBRIGADO! Fabio Mesquita – Director fabio.mesquita@aids.gov.br Marcelo Freitas – Treatment Coordinator marcelo.araujo@aids.gov.br Cristina Raposo – Head of International Cooperation cristina.raposo@aids.gov.br

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