PROGESS IN STANDARIZATION OF CARE FOR LATIN AMERICA AND CARIBEAN: REGIONAL ANTIRETROVIRAL TREATMENT

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PROGESS IN STANDARIZATION OF CARE FOR LATIN
AMERICA AND CARIBEAN REGIONAL ANTIRETROVIRAL
TREATMENT GUIDELINES

• Mónica Alonso.
• Pan American Health Organization. Washington DC.
• Omar Sued.
• Fundación Huésped. Buenos Aires.

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Presentation overview

• Latin America and the Caribbean context
• How to improve access and quality of treatment
  the Public health approach
• Adaptation of Global guidelines for resource
  constrained countries
• Overview of specificities of the regional
  guidelines
• Conclusions and next steps

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LAC context

• Highest inequity level in the world
• Diverse spectrum in health services and systems
  capacity
• High population mobility
• Lower international investment in HIV / health
• Varied commencement of HAART treatment programs.
• Variable coverage and number of persons under
  treatment
• Inequities in access to care within and among
  countries.
• Need to improve access and quality of care

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Estimated ARV coverage in LAC. 2007
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Public Health ApproachMain Components

• Standardizing regimens with simplified
  formularies
• Simplified clinical decision-making (includes
  monitoring, toxicity and interactions management
  )
• Improved and efficient procurement, and supply
  management
• Collection and analysis of data to track progress
• Monitoring HIV drug resistance at population
  level
• Decentralized, integrated delivery of care,
  task-shifting and specialized support
• Antiretroviral therapy free of charge at the
  point of service delivery

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How to promote access and quality of care
Public Health approach

• Use and dissemination of WHO antiretroviral
  guidelines (Adults, pediatric ARV treatment,
  PMTCT)? adaptation
• Elements that characterize the Region
• Access to technologies (CD4, viral load)
• Regional purchasing mechanisms Strategic Fund
• Countries have national programs and guidelines
• Concentrated epidemics

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Adaptation Methodology

• Regional consultation multidisciplinary group
  from 15 countries, PLWH, intergovernmental
  organizations
• Review of 2006 WHO ARV guidelines
• Identification of potential concepts to be
  adapted
• Consideration of published and unpublished
  evidence (national reports, programmatic
  experiences, etc) supporting changes to be
  included
• Formulation of the initial draft
• Validation through various meetings and review by
  external participants
• Publication and Distribution

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Summary of changes

• Most of the discussions were based on differences
  in access to health care availability and drugs
  prices the requirement of an effective cold
  chain and regional epidemiology of OI.

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Conclusions

• Applicability of a guide can be increased by
  local adaptation
• The adaptation process needs to be
• multidisciplinary,
• comprehensive and,
• with a broader vision of interrelated components
  e.g. linking pediatric, adult and PMTCT
  guidelines
• Uptake of Regional guidelines at the country
  level should be monitored
• Clinical research is needed to further support
  guidance adapted to the region.

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Summary and Conclusions

• Uptake of WHO global guidelines at country level
• Guidelines closer to country context (than DHHS
  or other)
• Inclusion of public health approach at country
  level
• Network of experts
• Harmonization at subregional level
• Orient future needs and negotiation and
  purchasing processes within the Region

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Acknowledgments
WHO UNICEF SLIPE ALAPE REDLA ORAS, CISCA,
CARICOM Washington Alemán. Ecuador Tito
Alvarado. Honduras Héctor Balcacer. Rep.
Dominicana Arelis Batista. Rep.
Dominicana Gustavo Campillo. Colombia José Luis
Castro. Argentina Rolando Cedillos. El
Salvador José Luis Sebastián Mesones. Perú María
Cristina Mogdasy. Uruguay Moraima Molina.
Venezuela Alma Yadira Quezada. El Salvador Luis
Soto Ramírez. México Orival Silva Silveira.
Brasil Jaime Torres. Venezuela Marco Vitoria.
Suiza
Bertha Gómez. Colombia. Greta Miño León.
Ecuador. Carmiña Aliaga. Bolivia. Luis Castaneda.
El Salvador. Lourdes Dueñas. El Salvador. Nora
Girón. Honduras. Rosa Gonzáles.
Honduras. Patricia Jiménez. Perú. Jorge Lattner.
Argentina. Vivian López. Panamá. Mercedes Macias
Parra. México. Greta Miño León. Ecuador. Javier
Nieto. Panamá. Noris Pavía Ruz. México. Jorge A.
Pinto. Brasil. Russell Pierre. Jamaica. Alberto
Reveron Quintana. Venezuela Solange Soto. Rep.
Dominicana. Siobhan Crowley. Suiza. Charlie
Gilks. Suiza.
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