1 / 40

Can the UNAIDS 90-90-90 target be reached? Analysis of national HIV treatment cascades

Code: MOAD01, MOAD0102 Title: 90-90-90: Delivering on the Targets Date: Monday, 20 July 2015 Time: 16:30-18:00 Room: Ballroom C-D. Can the UNAIDS 90-90-90 target be reached? Analysis of national HIV treatment cascades.

wgina
Télécharger la présentation

Can the UNAIDS 90-90-90 target be reached? Analysis of national HIV treatment cascades

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Code: MOAD01, MOAD0102 Title: 90-90-90: Delivering on the Targets Date: Monday, 20 July 2015 Time: 16:30-18:00 Room: Ballroom C-D Can the UNAIDS 90-90-90 target be reached? Analysis of national HIV treatment cascades Jacob Levi1 & Alice Raymond1; Anton Pozniak2; Pietro Vernazza3; Philipp Kohler3; Andrew Hill2 1Imperial College London, Department of Public Health, London, United Kingdom 2St Stephens Centre, Chelsea and Westminster Hospital, London, UK 3Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, Switzerland

  2. UNAIDS 90-90-90: HIV Treatment Targets for 2020 with Global Estimates (2014) Target 3: 90% of people on ART with HIV RNA suppression Target 2: 90% of diagnosed people on ART Target 1: 90% of HIV+ people diagnosed Ref: The Joint United Nations Programme on HIV/AIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014; JC2684 (Numbers as of March 2015) How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 LESSONS OF HOPE FROM THE AIDS RESPONSE July 2015.

  3. Global Estimates (2014-15) vs the Gap to reach 90-90-90 Targets Breakpoint 1: 13.4 million Undiagnosed Breakpoint 2: 14.9 million not treated Breakpoint 3: 15.3 million Not Virally Supressed Ref: On ART = March 2015. How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 LESSONS OF HOPE FROM THE AIDS RESPONSE July 2015. * Average viral suppression% Intention to Treat LMIC rate from a Systematic Review by McMahon J. et al. Viral suppression after 12 months of antiretroviral therapy in low-and middle-income countries: a systematic review." Bulletin of the World Health Organization 91.5 (2013): 377-385.

  4. Methods – Countries and 1 region included • 9 Partial cascades from: • Denmark • Canada (British Columbia) • Rwanda • Belgium • Cuba • Columbia • Ukraine • Kyrgyzstan • Vietnam • (Partial = does not report percentages or numbers for all 3 UNAIDS targets or does not report viral suppression test cut-off used. • 11 full HIV treatment cascades: • Switzerland • Australia • UK • Netherlands • France • Brazil • Average of countries from the Sub-Saharan African Region* • USA • Georgia • Estonia • Russia (Full = reports percentage and number of people for all 3 UNAIDS targets and quotes the viral suppression cut-off used. *Average Sub-Saharan African Region: UNAIDS estimates & percentages from an average from 30 countries - How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 lessons of hope from the AIDS response July 2015. *(Only 15 – 49 yr olds)

  5. Methods - Definitions • Estimates of six stages for each full cascade: • Total number of people living with HIV • Diagnosed as HIV positive • Linked to care • Retention in care • On Antiretroviral Therapy • Viral Suppression <1000 RNA copies/ml • (Undetectable HIV RNA <40-400) • Definitionsvaried for each of the 6 categoriesbetween countries • Breakpoint: >10% drop between successive UNAIDS targets in the cascade • Sources: National reports, UNAIDS Database, Peer-reviewed articles, Conference proceedings.

  6. Cascade of HIV care – Switzerland 2012 Breakpoint 1 Breakpoint 2 Ref: Kohler P, Schmidt JA, Ledergerber B, Vernazza LP. Estimates of HIV prevalence, proportion of diagnosed patients and quality of treatment in Switzerland. 2014.

  7. Cascade of HIV care – Russia 2013 Breakpoint 1 Breakpoint 2 Breakpoint 3 Ref: Pokrovskaya, A., et al The cascade of HIV care in Russia, 2011–2013. Journal of the International AIDS Society 2014;17(4). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224814/pdf/JIAS-17-19506.pdf

  8. Target 1 – Percentage of all HIV+ People Diagnosed - Methodology • Target 1 depends on the approach used to estimate: • The number of all HIV + people living in that country • The number tested and found to be HIV+ • Back-calculation method used to estimate total HIV epidemic size • Heterogeneity of cascade study type: • Cross Sectional or Longitudinal cohorts (or combined approach) • Loss to follow up • Double counting • Expensive • Generalized vs. Focused Epidemics • Varying testing policies (2010 – 2014)

  9. Target 1 – Percentage of all HIV+ People Diagnosed - Results UNAIDS Target 1: 90% of all HIV+ people diagnosed

  10. Target 1 – Percentage of all HIV+ People Diagnosed - Results UNAIDS Target 1: 90% of all HIV+ people diagnosed (*SSA = Regional average From 30 countries)

  11. Target 2 – Percentage of all HIV+ People on ART - Methodology • Estimates of the % on ART were calculated from: • Pharmacy records • Governmental drug purchases • Healthcare dispensary records • Adjusted for PEP & PrEP • Various ART regimens were not differentiated • Linkage and Retention definitions were highly heterogeneous • Neither linkage nor retention categories have UNAIDS 90-90-90 targets • Both are essential for getting people on treatment after diagnosis • May need more attention • Treatment initiation guidelines vary (2010 – 2014) • Now START trial & WHO – test and treat • Eligibility and Adherence sometimes reported

  12. Target 2 – Percentage of all HIV+ People on ART - Results UNAIDS Target 2: 81% of all HIV+ people on ART 29% (*SSA = Regional average From 30 countries)

  13. Target 2 – Percentage of all HIV+ People on ART - Results UNAIDS Target 2: 81% of all HIV+ people on ART 29% (*SSA = Regional average From 30 countries)

  14. Target 3 – Percentage of all HIV+ People with HIV RNA suppression - Methodology • UNAIDS 90-90-90 target = 73% of all HIV+ people achieving “viral suppression” • <1000 RNA copies/ml • Some countries use “undetectable HIV RNA” as their definition or final target • <40 to <500 RNA copies/ml • Various HIV RNA tests used with different “Undetectable” cut offs • This changes the final percentage found to be “successfully treated” • This must be taken into account when comparing cascades • E.g. Brazil • <50 RNA copies/ml = 35% “Undetectable HIV RNA” • <1000 RNA copies/ml = 40% “Suppressed”

  15. Target 3 – Percentage of HIV+ People with HIV RNA suppression - Results UNAIDS Target 3: 73% of all HIV+ people achieving viral suppression (*SSA = Regional average From 30 countries)

  16. Target 3 – Percentage of HIV+ People with HIV RNA suppression - Results UNAIDS Target 3: 73% of all HIV+ people achieving viral suppression (*SSA = Regional average From 30 countries)

  17. Target 1 versus Target 2:Rates of diagnosis and those diagnosed on treatment, by country Make a new version with the T1 and T2 labels removed Make flags smaller (see previous versions – yours are too wide) X and y axis labels are too small. Axes need to be thicker *30 countries with data on GAPRP and DHS data, 2008 - 2014 (How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 lessons of hope from the AIDS response July 2015 Percentage of all HIV + people diagnosed

  18. Target 2 vs Target 3: Percentage of diagnosed people on ART, versus HIV RNA suppression when on ART % of those diagnosed on ART *Average from: Botswana, Burkina Faso, Mali, Cameroon, Cote d’ivoire, Kenya, Senegal, Uganda, Malawi, Mozambigue, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zimbabwe, Zambia.

  19. Conclusions • No country or region analysed so far met the final UNAIDS 90-90-90 coverage target of 73% of HIV positive people achieving undetectable HIV RNA. • Large disparities were identified between countries • All Western European countries achieved viral suppression for over >50% of HIV+ people • All Eastern European countries achieved viral suppression for under <20% of HIV+ people • FAST TRACK: 95%-95%-95% by 2030 • Diagnosis is the largest breakpoint globally - Testing should be focussed on • To facilitate comparisons between countries a standardized reporting method should be implemented • This will allow us to better identify breakpoints and to prioritize resources and inform policy

  20. Thank You Reference for full cascades 1 – Targets: Joint United Nations Programme on HIV/AIDS (UNAIDS). (2014). The gap report. Geneva: UNAIDS. 2014; JC2684 2 – Global Cascade: How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 LESSONS OF HOPE FROM THE AIDS RESPONSE July 2015. *Viral suppression. <1000 copies/mlafter 12 months on Intention To Treat Analysis. McMahon J. et al. Viral suppression after 12 months of antiretroviral therapy in low-and middle-income countries: a systematic review." Figure 2. Bulletin of the World Health Organization 91.5 (2013): 377-385. 3 – Switzerland: Kohler P, Schmidt JA, Ledergerber B, Vernazza LP. Estimates of HIV prevalence, proportion of diagnosed patients and quality of treatment in Switzerland. 2014. 4 – Australia: The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2014 UNSW Sydney: The Kirby Institute for infection and immunity in society 5 – United Kingdom: Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. 2014. 6 – Netherlands: V Sighem A et al. Monitoring Programme report 2014: Human Immunodeficiency Virus (HIV) infection in the Netherland. 2014 7 – France: Supervie V CD. The spectrum of engagement in HIV care in France: strengths and gaps. Atlanta, USA: 20th Conference on Retroviruses and Opportunistic Infections.; March 2013 8 – British Columbia: B Nosyk et al. STOP HIV/AIDS Study Group. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. The Lancet Infectious diseases 2014(1) 40-49 9 – Sub Saharan Africa:How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 lessons of hope from the AIDS response July 2015 10 – USA: H Bradley et al: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV —USA, 2011. 11 - Georgia: Chkhartishvili N, Sharavdze L, Chokoshvili O, DeHovitz J, Del Rio C, Tsertsvadze T. The cascade of care in the Eastern European country of Georgia. HIV medicine 2015;16(1) 62-66. 12 – Estonia: Kaja-Triin Laisaar, et al. Engagement in the Continuum of HIV Care in Estonia. 9th International Conference on HIV Treatment and Prevention Adherence June 2014;Miami page 29. 13 – Russia: Pokrovskaya, A. et al The cascade of HIV care in Russia, 2011–2013. Journal of the International AIDS Society 2014;17(4) References for partial cascades 1 – Rwanda: Sabin Nsanzimana, HIV care continuum in Rwanda: a cross-sectional analysis of the national programme. Lancet HIV 27 March 2015; 2: e208–15 2 – Denmark: M Helleberg et al. HIV Care in the Swedish-Danish HIV Cohort 1995-2010 Closing the Gaps. e72257. PLoS ONE. Report number: 8 (8); Aug 15 2013. 3 – British Columbia: B Nosyk et al. STOP HIV/AIDS Study Group. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. The Lancet Infectious diseases 2014(1) 40-49 4 – Cuba: Ministry of Public Health of Cuba. Computerized HIV/AIDS Registry, 2013. From: Antiretroviral Treatment in the Spotlight: A Public Health Analysis in Latin America and the Caribbean 2013. Page 39. Figure 19. Washington, DC: PAHO, 2013. ISBN 978-92-75-11806-1 5 – Ukraine: Michel Kazatchkine United Nations Switzerland Oral Presentation, HIV Drug Therapy, November 2014 Glasgow, Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, Geneva. Drug use, HIV, HCV and TB: major interlinked challenges in Eastern Europe and Central Asia. Slide 12. Nov 3rd 2014 6 – Columbia: Government of Colombia, Ministry of Health and Social Protection, 2014. 90-90-90 An ambitious treatment target to help end the AIDS epidemic JC2684 October 2014 (UNAIDS). Fig 21, Page 25 7 – Vietnam: WHO/UNAIDS Meeting Report. National HIV/AIDS and STI Programme Managers Meeting of Asian Countries in Western Pacific Region.Feb, 2013, Kunming, China. Page 21, Fig 4. Cascade of HIV diagnosis, care and treatment in Viet Nam (2012) . Estimates by Ministry of Health, Viet Nam, Administration for HIV/AIDS Control (VAAC) 8 – Kyrgyzstan: M Mansfeld, M Ristol and G Likatavicius HIV Programme Review in Kyrgyzstan Evaluation report, December 2012 (WHO Collaborating Centre for HIV and Viral Hepatitis). Figure 1, page 11 9 – Belgium: Van Beckhoven et al. Factors associated with the continuum of care of HIV-infected patients in Belgium. Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Journal of the International AIDS Society November 2nd 2014, 17(Suppl 3):19534. Abstract P002

  21. Cascade of HIV care – Australia 2013 Breakpoint 2 Ref: The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2014 UNSW Sydney: The Kirby Institute for infection and immunity in society.

  22. Cascade of HIV care – United Kingdom 2013 Breakpoint 1 65,928 57,072 Ref: Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377194/2014_PHE_HIV_annual_report_19_11_2014.pdf

  23. Cascade of HIV care – Netherlands 2013 Breakpoint 1 Breakpoint 2 Ref: V Sighem A et al. Monitoring Programme report 2014: Human Immunodefificeny Virus (HIV) infection in the Netherland. 2014 http://www.hiv-monitoring.nl/english/

  24. Cascade of HIV care – France 2010 Breakpoint 1 Breakpoint 2 Breakpoint 3 Ref: Supervie V CD. The spectrum of engagement in HIV care in France: strengths and gaps. Atlanta, USA: 20th Conference on Retroviruses and Opportunistic Infections.; March 2013http://www.sante.gouv.fr/IMG/pdf/Rapport_Morlat_2013_Mise_en_ligne.pdf

  25. Cascade of HIV care – British Columbia (CA 2011) Breakpoint 1 Breakpoint 2 Breakpoint 3 Ref: National HIV Figures (71,300 PLWHIV) applied to the percentages from B Nosyk et al. STOP HIV/AIDS Study Group. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. The Lancet Infectious diseases 2014(1) 40-49.

  26. Cascada del Continuo de Atención y Tratamiento - Brasil Cascade of HIV care – Brazil 2013 Breakpoint 1 Breakpoint 2 <1000 RNA copies 293,000 Breakpoint 3 Ref: Marco Antonio De Avila. Cascade of continuous care in Brazil. Brazilian Ministry of Health, STD/AIDS epidemiological report, Ano III, numero 1, October 2014, Brasilia, Brazil.

  27. Cascade of HIV care – Sub-Saharan Africa 2013 (15 – 45 years old) Breakpoint 1 Breakpoint 2 Breakpoint 3 Reference: How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 lessons of hope from the AIDS response July 2015

  28. Cascade of HIV care – United States 2011 Breakpoint 1 Breakpoint 2 Breakpoint 3 Ref: H Bradley et al: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV —USA, 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a5.htm?s_cid=mm6347a5_w#tab1

  29. Cascade of HIV care – Georgia 2012 Breakpoint 2 Breakpoint 3 Ref: Chkhartishvili N, Sharavdze L, Chokoshvili O, DeHovitz J, Del Rio C, Tsertsvadze T. The cascade of care in the Eastern European country of Georgia. HIV medicine 2015;16(1) 62-66.

  30. Cascade of HIV care – Estonia 2013 Breakpoint 1 Breakpoint2 Breakpoint3 Ref: Kaja-Triin Laisaar, et al. Engagement in the Continuum of HIV Care in Estonia. 9th International Conference on HIV Treatment and Prevention Adherence June 2014;Miami page 29. http://www.euro.who.int/__data/assets/pdf_file/0008/255671/HIVAIDS-treatment-and-care-in-Estonia.pdf

  31. Cascade of HIV care – Rwanda 2013 Breakpoint2 Breakpoint3 Ref: Sabin Nsanzimana, HIV care continuum in Rwanda: a cross-sectional analysis of the national programme. Lancet HIV 27 March 2015; 2: e208–15 & Elul B et al. (2013) High Levels of Adherence and Viral Suppression in a Nationally Representative Sample of HIV-Infected Adults on Antiretroviral Therapy for 6, 12 and 18 Months in Rwanda. PLoS ONE 8(1): e53586. doi:10.1371/ journal.pone.0053586

  32. Cascade of HIV care – Denmark 2010 Breakpoint 1 Breakpoint 2 Ref: Total number of HIV + people estimated from UNAIDS. Diagnosed - M Helleberg et al. HIV Care in the Swedish-Danish HIV Cohort 1995-2010 Closing the Gaps. e72257. PLoS ONE. Report number: 8 (8); Aug 15 2013.

  33. Cascade of HIV care – Belgium 2010 Breakpoint2 Unknown Ref: Van Beckhoven et al. Factors associated with the continuum of care of HIV infected patients in Belgium. Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Journal of the International AIDS Society November 2nd 2014, 17(Suppl 3):19534. Abstract P002

  34. Cascade of HIV care – Cuba 2012 Breakpoint 1 Breakpoint2 Breakpoint3 Ref: Ministry of Public Health of Cuba. Computerized HIV/AIDS Registry, 2013. From: Antiretroviral Treatment in the Spotlight: A Public Health Analysis in Latin America and the Caribbean 2013. Page 39. Figure 19. Washington, DC: PAHO, 2013. ISBN 978-92-75-11806-1

  35. Cascade of HIV care – Columbia 2013 Breakpoint 1 Breakpoint2 Breakpoint3 Ref: Source: Government of Colombia, Ministry of Health and Social Protection, 2014. 90-90-90 An ambitious treatment target to help end the AIDS epidemic JC2684 October 2014 (UNAIDS). Fig 21, Page 25

  36. Cascade of HIV care – Ukraine 2012 Breakpoint 1 Breakpoint2 Breakpoint3 Ref: Michel Kazatchkine United Nations Switzerland Oral Presentation, HIV Drug Therapy, November 2014 Glasgow, Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, Geneva. Drug use, HIV, HCV and TB: major interlinked challenges in Eastern Europe and Central Asia. Slide 12. Nov 3rd 2014

  37. Cascade of HIV care – Kyrgyzstan 2014 Breakpoint 1 Breakpoint2 Ref: M Mansfeld, M Ristol and G Likatavicius HIV Programme Review in Kyrgyzstan Evaluation report, December 2012 (WHO Collaborating Centre for HIV and Viral Hepatitis). Figure 1, page 11

  38. Cascade of HIV care – Vietnam 2012 Breakpoint 1 Breakpoint2 Ref: WHO/UNAIDS Meeting Report. National HIV/AIDS and STI Programme Managers Meeting of Asian Countries in Western Pacific Region.Feb, 2013, Kunming, China. Page 21, Fig 4. Cascade of HIV diagnosis, care and treatment in Viet Nam (2012) . Estimates by Ministry of Health, Viet Nam, Administration for HIV/AIDS Control (VAAC)

  39. Cascade of HIV care – British Columbia (CA 2011) Breakpoint 1 Breakpoint 2 Breakpoint 3 Ref: National HIV Figures (71,300 PLWHIV) applied to the percentages from B Nosyk et al. STOP HIV/AIDS Study Group. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. The Lancet Infectious diseases 2014(1) 40-49.

  40. Cascade Standardization Tools Refs: http://www.aidsdatahub.org/sites/default/files/highlight-reference/document/Metrics_for_monitoring_the_cascade_2014.pdf http://applications.emro.who.int/dsaf/EMROPUB_2014_EN_1639.pdf http://www.unaids.org/sites/default/files/media_asset/JC2702_GARPR2015guidelines_en.pdf

More Related