Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives XIX International AIDS Conference Washington, DC 22-27 July 2012 Dr. Massimo.

Presentación del tema: "Treatment 2.0 in Latin America and the Caribbean Baseline and perspectives XIX International AIDS Conference Washington, DC 22-27 July 2012 Dr. Massimo."— Transcripción de la presentación:

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

2 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 Objective

3 Patients on ART in LAC 2002–2011 2011 ART coverage in Latin America 70%, 67% in the Caribbean, highest in mid-low income settings WHO. Universal Access progress reports 2010- 2012 Initiations to treatment

4 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 Treatment 2.0

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

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

7 Number of regimens in adults per line of treatment, 2010 7

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

9 ARV Stock-outs Most countries reported > 1 stock out in 2011 9 Country% ART sites with >1ARV stock outs, 2010 Number of ARV stockout episodes, 2010-2011 Antigua and Barbuda 100%--- Argentina5%--- Barbados50%--- Costa Rica100%--- Cuba3%--- Dominica100%--- Ecuador0%--- Granada0%--- Guyana16%--- Haiti0%--- Jamaica87%--- Mexico0%--- Surinam0%--- Trinidad and Tobago67%--- Belize0%--- Chile0%0 Paraguay---0 Peru0%0 Dominican Republic84%0 Brazil100%1 Bolivia0%1 Uruguay0%1 El Salvador0%2 Honduras0%2 Nicaragua19%2 Guatemala82%6 Panamá80%6 Colombia---34 Venezuela---37 PAHO. Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean. 2012.

10 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 Pillar 2. POC and other simplified diagnostic and monitoring tools

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

12 % of patients initiating ART with <200 CD4 2000-2011 12

13 Average VL tests per patient on ART 2010 13 Viral load / patients on ART

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

15 HighMediumLowNo Dependency 75%-100% % external funding of ARV 20%-75% external funding of ARV 5%-20% external funding of ARV 0%-5% % external funding of ARV 2007-2008 Antigua y Barbuda Bolivia Dominica Granada Guyana Haití Jamaica Nicaragua República Dominicana St. Kitts y Nevis St. Vicente y las Granadinas St. Lucia Surinam Anguilla Barbados Cuba Guatemala Islas Vírgenes Británicas Monserrat Ecuador El Salvador Honduras Paraguay Belice Perú Argentina Bahamas Brasil Chile Colombia Costa Rica México Panamá Trinidad y Tabago Uruguay Venezuela 2011-2012 Antigua y Barbuda Bolivia Dominica Granada Guyana Haití Jamaica Nicaragua Republica Dominicana St. Kitts y Nevis St. Vicente y las Granadinas Anguilla, Barbados Cuba Guatemala Monserrat Islas Vírgenes Británicas St. Lucia Ecuador El Salvador Honduras Paraguay Argentina Bahamas Brasil Chile Colombia Costa Rica México Panamá Trinidad Tabago Uruguay Venezuela Belice Perú Surinam Dependence of external sources for ARV 2007/2008 -2011/2012 15 “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 UNAIDS/WHO. Global HIV/AIDS Response country reported data, 2012. Percentage alive and on treatment at 12 months of ART initiation, 2011

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 1.LAC ready for Treatment 2.0, through contextualized country- based approach, operating on several pillars 2.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 3.Ample margins for optimization (regimens, diagnostic algorithms, decentralization of services) and cost reduction. Present “status- quo” unsustainable 4.Building on experience of 1 st wave countries, and heightened joint monitoring of implementation plans, move towards sustainable and expanded ART programmes in line with T 2.0 Conclusions

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