Presentation Title Presenter(s ) Centers for Disease Control and Prevention
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Transcript of Presentation Title Presenter(s ) Centers for Disease Control and Prevention
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PEPFAR
Presentation TitlePresenter(s)
Centers for Disease Control and Prevention
AIDS 2012 - Turning the Tide Together
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PEPFAR
World Health Organization (WHO) Global HIV Drug Resistance (HIVDR) Surveillance
• In 2006, WHO established global HIV drug resistance surveillance using early warning indicators (EWIs)
• Eight EWIs were used to monitor factors associated with the emergence of HIVDR
• Countries conduct EWI surveys and report results annually to WHO
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PEPFAR
Methods: Overview
• For this analysis, we analyzed multi-country data reported to WHO in the period 2006 - 2009.
• Countries selected a representative sample of clinics. Different EWIs were surveyed in different clinics, depending on the availability of data.
• The total number of clinics meeting the target in countries and regions in each year was summed and presented as a proportion of total clinics surveyed.
• We selected three EWIs thought to be closely associated with HIVDR.
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PEPFAR
Methods: Early Warning Indicators• EWI-4 monitors antiretroviral drug (ARV) pick-ups on-
time.– Target: > 90% of patients picking up ARVs on-time.
– This EWI was reported by 25 countries.
• EWI-6 monitors ARV drug supply continuity and whether stock-outs occur in clinic pharmacies. – Target: 100% of clinic pharmacies with no stock-
outs. – This EWI was reported by 32 countries.
• EWI-8 monitors HIV RNA (virologic) suppression.– Target: > 70% of patients with viral load < 1000
copies/ml at one year ml at one year after starting ARVs.
– This EWI was reported by 6 countries.
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PEPFAR
EWI 4: Percentage of Clinics with On-Time ARV Pick-Ups, by Region and Year
Target: > 90% of patients picking up ARVs on-time
Africa Latin America and Caribbean Asia 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
10%
85%
0%
26%
0% 0%
15%
0%4%
50% 50%
2006 2007 2008 2009
Year 2006 2007 2008 2009 2006 2007 2008 2009 2006 2007 2008 2009# of clinics 10 123 143 46 13 1 5 2 4 4 N/A 2# of countries 1 7 6 3 4 1 2 1 1 1 N/A 1
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PEPFAR
EWI 6: Percentage of Clinics with ARV Supply Continuity, by Region and Year
Target: 100% of clinic pharmacies with no ARV stock-outs
Africa Latin America and Caribbean Asia0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
77%
46%
89%
61%
45%
86%
57%
74%
92%
48%
22%
2006 2007 2008 2009
Year 2006 2007 2008 2009 2006 2007 2008 2009 2006 2007 2008 2009# of clinics 147 236 125 40 13 33 27 9 18 41 41 N/A# of countries 3 10 8 1 3 5 7 4 1 3 1 N/A
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PEPFAR
EWI 8: Percentage of Clinics with Viral Load (VL) Suppression, by Region and Year
Target: > 70% of patients with VL suppressed one year post-ARV start
Africa Latin America and Caribbean0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
96% 100%100% 100% 45%
2006 2007 2008 2009
No data were reported from Africa in 2006, 2007, or 2008.Only Botswana reported in 2009.
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PEPFAR
Limitations
• Many EWI surveys were conducted while patient-level information systems were in development
• The EWI global surveillance system is young, and still continues to be refined
• Number of countries reporting on specific EWI varies by year
• Sample of clinics may vary by country by year
• May not be same clinics year-to-year in each country
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PEPFAR
Actions Taken by Countries FollowingEWI Results
• Namibia– Migrant workers were seen to be at risk of treatment interruptions– MOHSS has planned an intensification of defaulter tracking systems
and improvements in its electronic record system.
• Malawi– MOH revised electronic medical & pharmacy records to enable
abstraction of EWI 4 (on-time ARV pick-ups)
• China– EWI assessment prompted upgrades to an Internet-based database
to routinely monitor EWI at all ART clinics – Results about on-time ARV pick-ups motivated strategies to address
programmatic weaknesses
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PEPFAR
Conclusions
• Countries across the world are monitoring early warning indicators associated with the emergence of HIVDR
• EWI results identify “on-time ARV pick-up” as a major challenge for clinics and patients.
• Methods to improve on-time ARV pick-ups and ARV supply chains should be prioritized by national ARV programs and individual clinics distributing ARVs.
• National programs have used results to adjust clinic-level information systems and clinic procedures, including adherence counseling and patient-tracking.
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PEPFAR
Acknowledgements
• Drs. Anindya De, Drew Baughman, and Yang Liu of Division of Global HIV/AIDS, CDC performed the SAS analyses.
• Grants from the Bill and Melinda Gates Foundation and from PEPFAR supported EWI surveys in many countries.
• We acknowledge Ministry of Health staff and local CDC staff in many countries who made these analyses possible.
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PEPFAR
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.