Round 6 WHO's Contribution to Universal Access to HIV/AIDS Prevention, Care and Treatment Department of HIV/AIDS

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Round 6 WHO's Contribution to Universal Access
to HIV/AIDS Prevention, Care and
TreatmentDepartment of HIV/AIDS
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WHO's Strategic Directions for 2006-2010
rrEMENDER

1. Enabling individuals to know their HIV status
   through HIV testing and counselling
2. Accelerating the momentum of HIV/AIDS treatment
   and care scale-up
3. Maximizing the health sector's contribution to
   HIV prevention
4. Investing in strategic information to guide a
   more effective HIV/AIDS response
5. Taking urgent action to strengthen and expand
   health systems

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Goal Goal Objectives Objectives Objectives Services Services Main Activities Main Activities
Description Indicators Description Target/beneficiaries Indicators Description Coverage Indicators Description Milestones
1   1     1   1  
1   1     1   2  
1   1     1   3  
1   1     1   4  
1   1     2   1  
1   1     2   2  
1   1     2   3  
1   2     1   1  
1   2     1   2  
1   2     2   1  
1   2     2   2  
1   3     1   1  
1   3     1   2  
1   3     1   3  
1   3     1   4  
2   1     1   1  
2   1     1   2  
2   1     2   1  
2   1     2   2  
2   1     2   3  
2   2     1   1  
2   2     1   2  
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Goals, Objectives and Service Deliveries(1)
Care ART

• Major goals Example
• Reduced HIV related mortality and morbidity
• 2. Reduced HIV transmission
• Major impact indicators
• of HIV individuals alive after ART (6, 12 24
  months)
• Incidence of TB among HIV persons using ART
• of HIV-infected children born to HIV mothers

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Priority Interventions (2)
Strategic Direction Objective Priority Interventions Service delivery aeras
Accelerating the scale-up of ARV treatment and care - Antiretroviral treatment Care including nutrition, palliative care and end of life care Prevention for persons living with HIV/AIDS Prevention and management of opportunistic infections - TB/HIV
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ARV Treatment MonitoringMajor Activities

• Define national ART protocol
• Define national minimum standards of care in all
  health levels
• Accreditation of Health Services
• Use of the "4 Ss" approach with focus in district
  level
• Adherence support services (community
  involvement)
• Laboratory support/complexity accordingly health
  care levels
• Monitor ARV resistance at population level
• Operational research

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Priority Interventions (1)
Strategic Direction Objective Priority Interventions Service delivery aeras
Enabling individuals to know their HIV status through HIV testing and counselling - Voluntary testing and counselling Provider initiated testing and counselling
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Priority Interventions (3)
Strategic Direction Objective Priority Interventions Service delivery aeras
Maximizing the health sector's contribution to HIV prevention - Prevention of mother to child transmission (PMTCT) Prevention of sexual transmission - Prevention of HIV transmission through injecting drug use (harm reduction) Prevention of HIV transmission in the health care setting Research on new prevention technology
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PMTCT Major Activities

• Development/update of MTCT policies, guidelines,
  plans and protocols (linkages with ART services)
• Development of communication strategy
• Staff recruitment training
• Procurement and management of supplies and
  equipments (HIV test kits and drugs)
• Simplified ANC approach
• ARV prophylaxis (PMTCT WHO guidelines)
• Infant feeding counselling support
• Integral family approach care and treatment of
  women and their children
• linkage with other services and referral
  mechanisms
• Family planning counselling
• Community mobilization
• ME system and operational research

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Major activities reduction of transmission

• Development of guidelines for VCT/PMTCT/STI
• Development/adaptation /diffusion of tools
• Social marketing
• Training
• Services
• Purchase drugs and diagnostic kits

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Priority Interventions (4)
Strategic Direction Objective Priority Interventions Service delivery aeras
Investing in strategic information to guide a more effective response - Epidemiology and surveillance of HIV/AIDS and STIs - HIV drug resistance surveillance and monitoring in ART programs Monitoring and evaluation of the health sector's progress towards universal access Operational research
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Priority Interventions (5)
Strategic Direction Objective Priority Interventions Service delivery aeras
Taking urgent action to strengthen and expand health systems - National strategic planning and management - Procurement and supply management - Laboratory strengthening - Human resource management - Strategies for sustainable financing
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Operationalizing WHO's contribution to achieving
universal access

• For more information, please visit
• The WHO Universal Access website
• http//www.who.int/hiv/universalaccess2010/

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4.4.2 epidemiological data

• Prevalenceincidencepattern of the epidemic
• In high risk groups need for surveys
• Number of HIV patients in need of treatment
• TB/HIV
• Information on pharmaco-resistance

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4.4.4HSS-feasibility/ 4.6.6

• pattern of the epidemic/availability of services
  and staff/ needs (patient repartition sex ratio)
• Try to identify the constraints B) HR
  (quantity,quality)ITprocurementstructuresQA
• free access

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Basics in ARV Forecasting (1)

• Number of patients to be treated
• 15-20 of estimated number of HIV individuals
  will need treatment
• Consider 3by 5 target (40-50 of the total
  estimated number)
• Establish country targets
• Establish the scaling up progression (20-25 in
  1st year 75-80 in 2nd year stabilization or
  deceleration after)
• Patient profiles (1st year of treatment)
• 80-90 with body weight lt 60 Kg (can varies among
  countries)
• 3-5 of HIV women become pregnant
• 5-10 TB/HIV will start immediate ART (should be
  more higher in very high prevalent countries with
  integrated TB-HIV services)
• 10-15 d4T intolerance/toxicity (should be higher
  in 2nd year)
• 10-15 NVP toxicity/intolerance (maybe higher in
  1st 6 months)
• 3-5 severe ZDV toxicity/intolerance
• 3-5 severe EFV toxicity/intolerance
• 3-4 of total NVP used in NVP based regimens
  will be ½ NVP dose (lead in dose schedule)

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Basics in ARV Forecasting (2)

• 1st line 97-99 (1st year)
• Preferential regimen 70-75 (d4T/3TC/NVP)
• Alternative regimen 25-30
• Regimen 2 10-15 (d4T/3TC EFV)
• Regimen 3 5-10 (ZDV/3TC NVP)
• Regimen 4 5-10 (ZDV/3TC EFV)
• NVP 200 mg (lead in dose) 3.5 of total NVP
• d4T/3TC (lead in dose) 3.5 of total d4T/3TC
• d4T 30 mg (lt 60 Kg) 80of total d4T
• 2nd line 1-3 (1st year)
• Preferential regimen 90 (TDF or ABC ddI
  boosted PI- LPV/r or SQV/r)
• Alternative regimen 10 (TDF or ABC ddI
  unboosted PI NFV or ATV)
• ABC syrup (children) 5 of total 2nd line
• ABC tablet (TDF toxicity) 2.5 of total
  alternative regimen in 2nd line

OBS 2nd line proportion probably will increase
progressively particularly after 2nd or 3rd year.