View
0
Download
0
Category
Preview:
Citation preview
Key Consideration for Ensuring Access to HIV Diagnostics: FORECASTING Presented by: Lama Suleiman 30 September 2014 Contracts Manager , Malaria Prevention and diagnostics Unit ,Health Technology Center - Supply Division
Geneva – Switzerland AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
1
ACKNOWLEDGMENT
UNICEF Programme Division
• Dr Chewe Luo
• Ravikiran Bhairavabhotla
UNICEF Supply Division
• Helene Moller
• Ludo Scheerlinck
• Bibiana Zambrano
• Etleva Kadilli
• Lama Suleiman
• Irene Iyako
• Ignacio Gimenez
AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting 2
Global Burden of Disease, treatment and diagnostic needs
Key considerations to estimate demands
Conclusion
Presentation outline
3
AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
4 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
Global Burden of HIV Disease
Number of people living with HIV in 2013
> Total 35,000,000
> Adults 31,800,000
> Pregnant women 1,450,000 (4%)
> Children 3,200,000 (9%)
People newly infected with HIV in 2013
> Total 2,100,000
> Adults 1,900,000
> Children 240,000 (12.6%)
HIV Diagnostic Testing, Staging and Monitoring
Viral Load
Infant testing CD4
HIV Rapid Testing
6 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
CD4≤200
Recommended since 2003
CD4≤350
Recommended since 2010
CD4≤350
+ TB/HIV
+TB/HBV
CD4≤500
+TB/HIV
+TB/HBP
ART regardless of CD4 count:
* Serodiagnosis
* Pregnant women
* Children <5 years
All HIV+
Test and Treat
11 m
15 m
17.6 m
28.6 m 34 m
Population in need of treatment has expanded as WHO guidelines have emerged
UNAIDS new 2020 targets for ending AIDS
epidemic by 2030
Gaps in access using 2013 data
7 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
90%
Diagnosed
90%
On treatment
90%
Virally suppressed
Source: Adapted from Nkengasong, CDC at UNAIDS DAI meeting, Sept 2014
90%
90%
90%
50%
43%
37%
24%
38%
25%
Target
Adults
Children*
Pregnant women
*43% refers % of children tested
Considerations for diagnostics forecasting
procurement and product development
8 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
1. Aligning country policy guidelines with changing
WHO Recommendations
TARGET POPULATION (ARV-NAIVE)
2010 ART GUIDELINES 2013 ART GUIDELINES
HIV+ ASYMPTOMATIC CD4 ≤350 cells/mm3 CD4 ≤500 cells/mm3 (CD4 ≤ 350 cells/mm3 as a priority)
HIV+ SYMPTOMATIC WHO clinical stage 3 or 4 regardless of CD4 cell count
No change
PREGNANT AND BREASTFEEDING WOMEN WITH HIV
CD4 ≤350 cells/mm3 or WHO clinical stage 3 or 4
Regardless of CD4 cell count or WHO clinical stage
HIV/TB CO-INFECTION Presence of active TB disease, regardless of CD4 cell count
No change
HIV/HBV CO-INFECTION
Evidence of chronic active HBV disease, regardless of CD4 cell count
Evidence of severe chronic HBV liver disease, regardless of CD4 cell count
HIV+ PARTNERS IN SD COUPLE No recommendation established Regardless of CD4 cell count or WHO clinical stage
9 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
Source: Doherty, WHO 2013
10 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
* Aligning to reality on the ground: Current uptake 2013 ARV guidelines increases
40%
48%
45%
39%
52%
0% 20% 40% 60% 80% 100%
ART in liver disease
ART in SD couples
PMTCT Option B+
Paediatic ART <5 years
Adult initiation <CD 500
Percentage of 58 WHO HIV Focal Countries with confirmed adoption of select WHO 2013 ARV recommendations, June 2014
* or 75% of 22 EMTCT Global Plan countries
*
Source: WHO HIV Country Intelligence Database, June 2014
11 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
* Aligning to realities on the ground:
Adoption of option B/B+ in the 22 priority countries
2. Aligning diagnostic needs to programme needs along the
treatment Cascade
12 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
Cascade Pathway Related laboratory services
HIV testing and diagnosis HIV serology for adults and p24, DNA PCR for children
Staging to initiate of antiretroviral treatment
CD4 count
Chemistry, hematology & Testing opportunistic
infections
Monitoring of HIV disease and treatment
Viral load suppression Viral load and HIV drug Resistance testing
Source: adapted from John Nkengason, CDC
13 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
National hospitals and reference labs (high capacity service points and labs) HIV diagnostic (Ab, virologic) CD4, VL,
Regional or district level facilities (Near POC/POC, regional high volume labs) Medium capacity ART, PMTCT, Paediatric treatment HCT, TB/HIV services HIV diagnostic (Ab, virologic) CD4, VL
Primary facility and health posts (POC) HCT settings Facility and home based AB testing and self testing and ?POC CD4 and EID
3. Forecasting: Optimizing use of diagnostic technologies in national programmes in relation to capacity and population size at different
levels
14 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
4. Understanding Access Bottlenecks relative to population size: Estimated infant early infant HIV diagnosis need vs. demand
South Africa 20%
Nigeria 15%
Uganda 9%
Tanzania [PERCENTAGE]
Mozambique 8%
Kenya 6%
Zambia 6%
Zimbabwe 6%
Malawi 5%
Cameroon 3%
Ethiopia 3%
DRC [PERCENTAGE]
Cote dIvoire
2%
Angola 1%
Lesotho 1%
Ghana 1%
Chad 1% Botswana
1%
Namibia 1%
Swaziland 1% [CATEGORY
NAME] <1%
Estimated number of HIV-exposed infants, 2013 (Estimated Need)
South Africa 41%
Zambia 9%
Uganda 9%
Mozambique 7%
Zimbabwe 7%
Kenya 7%
Tanzania [PERCENTAGE]
Swaziland 2%
Cameroon 2%
Malawi 2%
Nigeria 2%
Ethiopia 1% Botswana
1%
Namibia 1%
Lesotho 1%
Ghana 1% Cote
dIvoire 1%
Angola 1%
DRC [PERCENTAGE]
[CATEGORY NAME]
<1%
[CATEGORY NAME]
<1%
Reported number of HIV-exposed infants receiving EID, 2013 (Current Demand)
Source: UNAIDS 2013 HIV and AIDS estimates, July 2014. Estimated number of pregnant women living with HIV delivering used as a proxy for HIV-exposed infants.
Source: UNAIDS, WHO, UNICEF 2014 Global AIDS Response Progress Reporting (GARPR), 2014.
15 AIDS Medicines and diagnostics (AMDS) Annual stakeholders & Partners meeting
© UNICEF/ZIMA2011-00003/Pirozzi
Conclusion • Changing demand profile
• Population size • Evolution of WHO guidance • Decentralisation of services to
reach more people
• For more efficient and effective
programmes and use of resources: • Enhance supply management
support in countries • Increase investment in and
regular reporting of country data on need and consumption
Thank you
Recommended