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Too few take a test

Strengthening the treatment cascade Evidence and practice Dr Nathan Ford Treatment and Care Department of HIV. Too few take a test. 8% - 69%. 13% - 76%. 37%. Adults. Pregnant women. Staveteig et al, DHS Comparative Reports, 2013 Global Update on HIV treatment, WHO, 2013.

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Too few take a test

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  1. Strengthening the treatment cascadeEvidence and practiceDr Nathan FordTreatment and Care Departmentof HIV

  2. Too few take a test 8% - 69% 13% - 76% 37% Adults Pregnant women Staveteiget al, DHS Comparative Reports, 2013 Global Update on HIV treatment, WHO, 2013

  3. Substantial attrition between testing and ART initiation 15-30% lost at each step Mugglinet al, Trop Med Int Health 2012

  4. Still too many people start ART late 1 in 4 start ART at CD4<100 The IeDEA and ART cohort collaborations

  5. Cumulative attrition on ART 30% LTF at 3 years Global Update on HIV treatment, WHO, 2013

  6. Improving testing and linkage • Partner and couples testing • Community testing • Self-testing • Combination testing • DBS for early infant diagnosis Suthar et al, Plos Med 2013 [Accepted] Global Update on HIV treatment, WHO, 2013

  7. Enrollment in pre-ART care Enrollment in pre-ART care Adherence clubs • Earlier initiation • PoC CD4 • CTX • Adherence clubs CTX prophylaxis PoC CD4 Wynberg et al, 2013 (submitted) Kohler et al, AIDS 2011 Wynberg et al, 2013 (submitted) Kohler et al, AIDS 2011

  8. ART initiation Paediatric decentralization in Thailand • Task shifting • Decentralization • Service integration TB/HIV integration India Global Update on HIV treatment, WHO, 2013 Kredo et al, Cochrane Database of systematic reviews, 2013. PMTCT B+ in Malawi

  9. Adherence support Fixed-dose combinations • FDCs • Optimized regimens • Viral load • Adherence support (sms, clubs…) Wilkinson, SAJHIV Med 2013; Ford et al, 2013 (submitted); Butler et al, IAS 2013

  10. Summary • Successful scale up of ART poses continued challenges to current models of care • Evidence from research and programmes indicate ways to improve patient care at each step of the cascade • Future research is needed to identify approaches to enroll people earlier onto ART and support long-term retention in care

  11. WHO’s ongoing workto support ART delivery • Support to regions for guideline rollout • Future of ART monitoring • Phasing out (d4T) and phasing in (viral load) • Early Infant Diagnosis • Paediatric treatment optimization • Cotrimoxazole prophylaxis • Implementation Science summit

  12. Acknowledgements Gundo Weiler Eric Goemaere Vincent Habiyambere Mathias Egger Txema Garcia-Calleja Andrew Boulle Michel Beusenberg Trevor Peter Gottfried Hirnschall Lynne Wilkinson Meg Doherty Hein Marais Cadi Irvine Tony Harries Marco Vitoria Boniface DongmoNguimfack Eyerusalem Negussie Rachel Baggaley Nathan Shaffer

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