MONITORING SYSTEM FOR THE ANTIRETROVIRAL THERAPY IN BRAZIL: LESSONS LEARNED AND FUTURE DIRECTIONS

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MONITORING SYSTEM FOR THE ANTIRETROVIRAL THERAPY
IN BRAZIL LESSONS LEARNED AND FUTURE DIRECTIONS

• Marco Vitória, MD
• Brazilian STD/AIDS Programme - MOH
• July 2003

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PATIENTS ON ARV THERAPY IN THE PUBLIC HEALTH
SYSTEM - BRAZIL, 1997 - 2002
140000
120000
100000
80000
60000
125,000
40000
20000
0
jan/97
mai/97
set/97
jan/98
mai/98
set/98
jan/99
mai/99
set/99
jan/00
mai/00
set/00
jan/01
mai/01
set/01
jan/02
mai/02
set/02
Source Ministry of Health
December 2002, estimated data
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BRAZIL EPIDEMIC PROFILE

• CUMULATIVE AIDS CASES (Dec/2002) 257,780
• CUMULATIVE AIDS DEATHS (Dec/2002) 113,840
• ESTIMATED NUMBER OF HIV INDIVIDUALS (2000)
  597,000
• INCIDENCE RATE OF AIDS (2000) 12,4 / 100.000
• PREVALENCE RATE OF HIV (2000) 0,65

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The Brazilian Public Health System (SUS)

• Organized by the Brazilian Constitution of 1988
  Main principles
• - integrality
• - universality
• - equity
• - social control
• Strong catalytic element
• Virtuous circle (AIDS ? Public Health System)

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MAJOR ASPECTS IN BRAZILIAN RESPONSE TO HIV/AIDS

• EARLY GOVERNMENTAL RESPONSE
• STRONG CIVIL SOCIETY PARTICIPATION IN ALL
  DECISION LEVELS
• MULTISECTORIAL MOBILIZATION
• BALANCED PREVENTION TREATMENT APPROACH
• HUMAN RIGHTS PERSPECTIVE IN ALL STRATEGIES AND
  ACTIONS

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BRAZILIAN ARV ACCESS PROGRAM MAJOR ASPECTS

• NATIONAL NETWORK OF PUBLIC ALTERNATIVE CARE
  SERVICES 900 SERVICES
• NATIONAL NETWORK OF VCT FOR HIV 208 SERVICES
• NATIONAL NETWORKS OF LABORATORY SUPPORT
• HIV VIRAL LOAD 78 LABORATORIES
• T-CD4 CELL COUNT 66 LABORATORIES
• HIV RESISTANCE TESTING 14 LABORATORIES
• NATIONAL ARV LOGISTIC CONTROL SYSTEM 480
  DISPENSARY UNITS

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IMPACT OF UNIVERSAL ACCESS TO HAART ON AVERAGE
SURVIVAL AFTER AIDS DIAGNOSIS IN BRAZIL
Chequer et al, 1992 Marins et al. 2002
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Tuberculosis in HIV PatientsCRT DST/AIDS,
São Paulo, Brazil (1994 2002)
Introduction of HAART in Brazil
1997/96 - 53,3 2001/96 - 65,3 2002/96 - 71,8
Source
V.E.CRT
-
DST/Aids (data
until
31/12/02)
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IMPACT OF MOH ARV DRUG POLICY (1996 - 2002)

• Mortality reduction ? 40 - 70
• Morbidity reduction ? 60 - 80
• Occurrence of new AIDS cases ? 58,000 avoided
  cases
• Occurrence of AIDS related deaths ? 90,000
  avoided deaths
• Reduction in Hospitalization needs
• Seven fold reduction
• 358.000 avoided admissions (1997- 2001)

Estimated Savings? U 2.2 billions (Hospital and
Ambulatory Care)
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ARV Drugs Distributed by Ministry of Health -
Brazil (2003)

• ZIDOVUDINE (ZDV)
• DIDANOSINE (ddI)
• LAMIVUDINE (3TC)
• STAVUDINE (d4T)
• ZDV 3TC
• ABACAVIR
• INDINAVIR
• RITONAVIR

• SAQUINAVIR
• NELFINAVIR
• AMPRENAVIR
• NEVIRAPINE
• EFAVIRENZ
• LOPINAVIR / r

() generic version available
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HIVBResNet Study - Genotypic distribution of HIV
primary mutations in ARV naive treated patients
(Brazil,2001)
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Adherence to Antiretroviral Therapy in Brazil
Preliminary Results - 2002
N 1972 patients (from 60 health services)
Nemes et al, 2003 (in press)
Crude rate (CI not available)
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PARTNERSHIPS WITH CIVIL SOCIETY

• Participation and social control
• Guaranteeing human rights for people living with
  HIV and AIDS
• Support for community projects.
• Adherence Groups
• Support Houses

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THE BRAZILIAN EXPERIENCE LESSONS LEARNED AND
FUTURE DIRECTIONS

• Adherence strategies to optimize ARV therapy and
  reduce viral resistance must be always used.
• Universal access to ARV therapy and generic drug
  policy
• Quality with Price Reduction
• Fixed-Dose Combinations.
• Diagnostic and treatment monitoring approach
  using simple clinical and laboratorial tools are
  needed.