AIDS in Salvador,

Brazil, in times of

COVID-19Carlos Brites

Salvador: HIV EPIDEMIOLOGIC PROFILE

• Salvador is the 4th. largest Brazilian city (~3 million inhabitants)

• It is the 6th. Brazilian city in HIV incidence (4.7 per 1,000), in 2018

17,919,2

25,031,2 33,8 35,6

40,4 45,745,0

2007 2008 2009 2010 2011 2012 2013 2014 2015

Gráfico 1 - Taxa de

incidência(100.000 hab) de aids em

maiores de 13 anos segundo ano de

diagnótico, Salvador - Ba, 2007-

2015.

HIV incidence rate (per 100,000), according to the year

of diagnosis, 2007-2015

HIV incidence rate (per 100,000), according to the

year of diagnosis, 2007-2015

Salvador: HIV RESPONSE- OVERVIEW

• Diagnostic tests (rapid and conventional) are offered at basic health units, free of costs

• Once diagnosed, patients are referred to the nearest referral center (6 main referral centers in town)

• HIV staging is performed (PVL, CD4 count, serological tests for common coinfections, clinical investigation) and ART is started, regardless CD4 count. ART is available at no cost.

• ART is dispensed at intervals of 1-3 months. Every 6 months patients must provide the most recent PVL test at pharmacy, to check treatment effectiveness

• PrEP (currently limited to one center) and PEP available, as well as free distribution of male and female condoms

• In case of virological failure, genotyping is available at no cost.

Salvador : POLICY OVERVIEW

• HIV testing to identify new cases is still a problem: although free of costs testing is available, many at risk populations are not routinely tested

• Current referral centers for care are at their limit to receive new patients

• Need of monthly refill for some ARV drugs

• Social support for patients

Salvador: GAPS AND BARRIERS - 2014

• The first Salvador´s cascade of care showed the main gap were in the first two 90´s: diagnosis and retention

11,960

7,8427,240

6,017

4,3223,824

100% 66% 61% 50% 36% 32%0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Salvador Cascade, 2014

PLHIV Diagnosed Linked Retained on ART Viral suppression

65.567%

55.115%

88.470%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%90-90-90 - Salvador , 2014

% Diagnosed % Linked on ART % Viral suppression

Salvador: GAPS AND BARRIERS - 2015

• The Salvador cascade of care shows the main gap is in the first two 90´: diagnosis and retention

14,774

10,708 10,1078,813

7,783 7,781

100% 72% 68% 60% 53% 53%0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000 Salvador, 2015

PLHIV Diagnosed Linked Retained on ART Viral suppression

68.711%

61.136%

90.289%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

90-90-90 in Salvador, 2015

% Diagnosed % Linked on ART % Viral suppression

Salvador: a current view (2018)

Care Cascade 90-90-90 Targets, Salvador, 2018

95,5%

80.3%

100%

0%

20%

40%

60%

80%

100%

120%

% de diagnosticadas % TARV dos vinculados % CV suprimida dos emTARV

% Linked to care % on ART % Viral

suppression

PLHIV Diagnosed Linked Retained on ART Viral suppression

20320.489

13452.51512851.0

10916.0 10798.0 10798.0

100% 66% 63% 54% 53% 53%0

5,000

10,000

15,000

20,000

25,000

Reamining Gaps - 2018

66% 80% 10%

-24%

-10%

100%

-40%

-20%

0%

20%

40%

60%

80%

100%

120%

% PVHAdiagnosticadas

% TARV dosdiagnosticados

% CV suprimida dosem TARV

GA

P p

ara

met

a 9

0%

Target 90%

66.202%

80.268%

100.00%

0%

20%

40%

60%

80%

100%

120%

% de PVHAdiagnosticadas

% TARV dosdiagnosticados

% CV suprimida dos emTARV

% Diagnosed % On ART % Viral suppression*

% Diagnosed % On ART % Viral suppression*

COVID-19 in Salvador

• First cases diagnosed in March 13th.

• All initial cases imported from European countries

• Current situation (June, 21): 46,279 cases (52% in Salvador), 1,391 deaths (3%)

Impact of COVID-19 on HIV Care in Salvador

• Most of referral centers stopped routine care

• All prescriptions were extended for 3 months for stable patients

• Medical visits postponed

• Pharmacy delivering drugs refill for 3 months, to avoid the need of visits to referral

centers

• Only patients presenting with detectabe HIV viral load / any acute complaints are

attended

Current Situation

• Only 50% of patients coming to scheduled medical visits

• The need of planning the “return to normal”

• Concerns on adherence to therapy and problems with comorbidities

• No data on the specific impact of COVID-19 on HIV patients

How to return to normal?

• Adequacy of facilities to avoid crowded waiting rooms

• Implementation of telemedicine

• Ongoing serosurveillance to SARS-CoV-2 in HIV patients

Thank you!