Transcript Slides - View the full AIDS 2016 programme

EGPAF experience in scaling up pediatric HIV testing and treatment
Francesca Celletti
Our Contribution to Pediatric ART Coverage
)
1 in 6 children on ART in the countries
where we have C&T programs were
provided treatment by EGPAF
Number of children newly initiated on ART
2,000
7,000
1,800
6,000
1,600
Number of Children
1,200
4,000
1,000
3,000
800
600
Number of Children (Global)
5,000
1,400
2,000
400
1,000
200
0
0
Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015
<1
1-4
5-9
10-14
Global*
Number of children newly initiated on ART has doubled in the last three years.
*Cameroon and Ariel are excluded from this figure
Differentiated models for testing, care and treatment
Differentiation by clinical and VL
suppression
Entry into
care
Care package
stable patients
Care package:
Clinically unstable
patients
On ART
Care package
suppressed
Care package
detectable
Differentiation by demographics (age)
0-5
5-12
12-18
• POC and PITC
• Higher rates of failure and death
• More intensive care (e.g. frequent VL
monitoring)
• PITC, community
• Relatively lower failure rates
• May consider care
simplification/decentralization
• Adolescent friendly HIV testing
• Increased failure – social change, nonadherence
• Focus on social adjuncts to care
POC NAT pipeline
TaqMan® HIV-1 Qual v2.0
Roche
DBS
CE Mark
RealTime Qual HIV-1
Abbott
DBS CE Mark (2011)
Alere™ q HIV-1/2
Detect
Alere
CE Mark
ZIVA™
Cavidi
Under
development
Ustar
Iquum/Roche
SAMBA II EID
DRW
Kenya, Uganda
Xpert® HIV-1 Qual
Cepheid
CE Mark
Lumora
LYNX HIV p24
NWGHF
Micronics
GeneXpert
Omni
Cepheid
SAMBA I Semi-Q EID
DRW
Kenya, Uganda
2014
2015
2016
* Reported November 2015 - timeline and sequence may change
no specific market launch date; DBS assay CE Mark noted for laboratory products
** In addition, open polyvalent platforms are currently available for HIV VL and EID testing
Source: HIV/AIDS Diagnostics Technology Landscape, UNITAID, 2015
QuantumD
x
DFA
EGPAF/UNITAID POC EID project
Goal: to increase the number of
HIV-exposed infants whose HIV
status is known and facilitate early
initiation on treatment.
Scale:
• 9 countries
• 4 years (2015 – 2019)
• $63 million
Targets:
• 320,000 infants
• 13,562 HIV+ (4.2%)
• Results within 2 day
• EID coverage 20%
• ART initiation by 14 days
• Market shaping for POC
Overall testing summary and yield among children and adolescents
supported through EGPAF-Kenya CDC project (Oct 2015-May 2016)
Overall Testing Summary
0-9 Years
10-14 Years
15-19 Years
Tested
86,327
53,223
69,439
Positive
708
317
800
Yield
0.8%
0.6%
1.1%
Yield per testing point / strategy by age group for children and adolescents 0-19 years
16.0%
13.9%
14.0%
12.0%
10.0%
9.3%
9.1%
8.3%
8.0%
6.0%
4.5% 4.7%
3.5%
4.0%
2.0%
0.6% 0.4% 0.8%
0.0%
0.0% 0.0%
3.3%
2.9%
0.0%
0.0%
0.9%
1.7%
0.0%
0.8%
0.0%
OPD
ANC
Labor and Delivery
0-9 Years
MCH & Under 5
Clinic
10-14 Years
TB Clinic
IPD
VCT
15-19 Years
Source: EGPAF, Kenya, Children and Adolescent Testing and Yield Data
7
Neonatal/Infant ART Choices
Liquid formulations:
• 5 NRTIs (3TC and ZDV) liquids
• 1 NNRTI (NVP)
• 1 boosted PI (LPV/rtv) – starting at 14
days of age and 42 weeks gestational
age
Sprinkles and powder:
• 1 Integrase Inhibitor (RAL) powder –
starting at 4 weeks of age
• 1 boosted PI (LPV/rtv) sprinkles – starting at
3 months of age
Decentralization for delivery of pediatric
ART in 5 countries
Primary health facility
Secondary and
tertiary health facility
Lost to
follow-up/
100 PY on
ART
Mortality
rate/100PYs
on ART
Fayorsey et al. Aquir Immune Defic Syndr, 2013
Viral suppression on ART
EGPAF programs, 2015
Adult
Adolescent
Child
100%
91%
90%
86%
82%
80%
67%
70%
60%
59%
64%
55%
68%
58%
50%
40%
30%
20%
10%
0%
Kenya - A PLUS
* Malawi data refer to viral load <1000 c/mL
Kenya - Pamoja
Malawi*
Source: EGPAF Kenya country data review, May 2015
EGPAF Malawi country data review, Oct 2015
Treatment failure and drug resistance
Mozambique Ariel, 2013-14
Vaz P, et al., 7th HIV Pediatric Workshop, 2015,Vancouver, Abs. P- 31
1 or more major drug resistance mutations
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
91%
94%
• 6 facilities in Maputo
• 713 children on ART
for median of 60 mo
• 256 (36%) treatment failure
• Aug 2013-Mar 2014
1%
NRTI
NNRTI
PI
Getting to 1.6M
•
•
•
•
Find the children
Start them on ART early
Continuous investment in R&D
Increased investment
When the story of these times gets
written, we want it to say that we did
all we could, and it was more than
anyone could have imagined