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Current State of Global HIV Care Continua

Current State of Global HIV Care Continua Reuben Granich 1 , Somya Gupta 1 , Irene Hall 2 , John Aberle-Grasse 2 , Shannon Hader 2 , Jonathan Mermin 2. International Association of Providers of AIDS Care Centers for Disease Control and Prevention. 90-90-90 and Continuum of Care Targets. 90 %.

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Current State of Global HIV Care Continua

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  1. Current State of Global HIV Care Continua Reuben Granich1, Somya Gupta1, Irene Hall2, John Aberle-Grasse2, Shannon Hader2, Jonathan Mermin2 • International Association of Providers of AIDS Care • Centers for Disease Control and Prevention

  2. 90-90-90 and Continuum of Care Targets 90% 90% 90% Know status On treatment Virally suppressed 90% 81% 73%

  3. Methodology • Identification (127) • 31 continuum identified through PubMed search • 96 continuum identified through UNAIDS country reports, WHO reports, PEPFAR* country operational plans, national reports, and conference papers *Over past month the available continua for Africa nearly tripled as a result of PEPFAR open data effort 47 older and/or duplicate continuum excluded Screening (80) 80 recent continuum selected (2010-2016) • 10 continuum were excluded: • 6 continuum reported preliminary/ unconfirmed national figures • 4 continuum were from second hand reports without sources Data analysis (70)* For 70 continuum, data were collected on the 4 key continuum indicators and each indicator was graded on methods 25 continuum that did not have viral suppression estimates and/or had data discrepancies excluded Methods review (45)** 45 continuum graded based on methodology used for indicators *2015 Global HIV burden 82% **2015 Global HIV burden: 54%

  4. People living with HIV diagnosed positive (2010-2016) UNAIDS target 90% 90%-100% 70-89% Below 70% Not available No continuum in public domain Of the 70 countries, data were available for 42 countries for this indicator

  5. People living with HIV on ART (2010-2016) UNAIDS target 81% 81%-100% 60-80% Below 60% Not available No continuum in public domain Of the 70 countries, data were available for 68 countries for this indicator

  6. People living with HIV with viral suppression (2010-2016) UNAIDS target 73% 73%-100% 50-72% Below 50% Not available No continuum in public domain Of the 70 countries, data were available for 45 countries for this indicator

  7. Mapping on ART and viral suppression 90-90-90 targets (45 countries) ART coverage >81% and viral suppression >73% ART coverage 60-80% and viral suppression50-72% ART coverage <60% and viral suppression <50%

  8. Proportion of people living with HIV diagnosed and on ART TARGET UNAIDS target: 81% UNAIDS target: 90% Of 70 countries, data from 42 countries

  9. Proportion of people living with HIV on ART and with viral suppression TARGET UNAIDS target: 73% UNAIDS target: 81% Of 70, data from 45 countries with on ART and viral supression

  10. Countries reporting more than 70% of people living with diagnosed HIV (2010-2016) 90% 20 countries >70%

  11. Countries reporting more than 60% of people living with HIV on ART (2010-2016) 81% 15 countries >60%

  12. Countries reporting more than 50% of people living with HIV with viral suppression (2010-2016) 73% 14 countries >50%

  13. Top 14 countries with >50% viral suppression (2010-2016)

  14. Top 14 countries with >50% viral suppression (2010-2016) 2015 2010 2015 2014 2014 2015 2016

  15. Documenting and grading continua methods

  16. ART CD4 cell count initiation for asymptomatic people (120 countries) 2015 WHO Recommendation : Irrespective of CD4 count <200, <250 or <300 <350 <500 >500 Irrespective of CD4 count Source: www.HIVpolicywatch.org

  17. Availability of Viral Load Recommended and widely available Recommended (availability unknown) Recommended with limited availability Recommended only for monitoring treatment failure Not recommended No recommendation (limited availability) Source: www.HIVpolicywatch.org

  18. Limitations • Limited to most recent care continua available in public domain---some cascades may have been missed • Africa is missing complete continua • Lack of data for people diagnosed and viral load • Data may exist but is missing from public domain • Methods for determining continua are different across countries (apples and oranges) • Continua provide a snapshot but do not capture individual and cohort outcomes well

  19. 90-90-90 glass is half full! • Benchmarking • Continua in public domain from Africa nearly tripled over last six months • Some countries are close to 90-90-90 (and it is only 2016) • 90-90-90 • Policy is changing to test and treat • Countries using 90-90-90 targets • PEPFAR and Global Fund are backing test and treat and 90-90-90 • Viral load access is increasing • Community is embracing earlier treatment

  20. Thank you www.HIVpolicywatch.org www.HIV90-90-90watch.org

  21. ART CD4 cell count initiation criteria in Africa 2015 WHO Recommendation : Irrespective of CD4 count <200 <350 <500 Irrespective of CD4 count Source: published policy

  22. Objectives and methodology: “wiki strategy” Objective: Compare national ART guidelines for 157 countries with WHO 2015 guidelines Recommendation on ART initiation criteria and monitoring for different target population abstracted Search end date: July 2016

  23. ART initiation for asymptomatic people Source: published policy

  24. ART eligibility criteria and proportion of people living with HIV with viral suppression 350 500 Irrespective Data for 45 countries

  25. Merriam-Webster Definition • Feasible • 1:  Capable of being done or carried out <a feasible plan> • Synonym • POSSIBLE, PRACTICABLE, POSSIBLE, ACHIEVABLE

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