Project HEART: Expanding Access, Extending Lives

Project HEART: Expanding Access, Extending Lives

Presented by Denis Tindyebwa, MD; EGPAF Regional Director Pediatric Care and

Treatment

Project HEART: Program update• Expanded access

– Geographical coverage– Increased enrollment

• Program outcomes• Increasing focus on children• PMTCT Linkages• Hope for the future

Elizabeth Glaser Pediatric AIDS FoundationMission:

The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent pediatric HIV infection and to eradicate pediatric AIDS

through research, advocacy, and prevention and treatment programs.

Project HEART supports activities in five countries

Côte d’IvoireMozambiqueSouth AfricaTanzaniaZambia

Côte d’Ivoire

Zambia

Tanzania

South Africa

Mozambique

Project HEART Countries

Sites in Project HEART Countries

0

20

40

60

80

100

120

140

160

Quarter

Num

ber o

f site

s

Cote d'Ivoire Mozambique South Africa Tanzania Zambia

Project HEART: Number of care and treatment sites reporting by quarter since the beginning of the program, by country

Doubling expansionevery year

Project HEART: Number of Persons Ever on Care and ART by quarter, over time

1964345329

57256 6781485648

96880116433

138497 138531

176514

204279227017

252263

281117

1923131279

7970696064

117075133485

166136188321

219464

259720 263505

323805

374680

416116

461152

509736

36712150978565

310163

40135

568380

0

100000

200000

300000

400000

500000

600000

2004Q4

2005Q1

2005Q2

2005Q3

2005Q4

2006Q1

2006Q2

2006Q3

2006Q4

2007Q1

2007Q2

2007Q3

2007Q4

2008Q1

2008Q2

2008Q3

2008Q4

2009Q1

Total Cum ART Total Cum Care

Doubling ART Initiation every year

Patients New on ART during the quarter, over time

New on ART during the quarter

0

2000

4000

6000

8000

10000

12000

14000

1600020

04 Q

4

2005

Q1

2005

Q2

2005

Q3

2005

Q4

2006

Q1

2006

Q2

2006

Q3

2006

Q4

2007

Q1

2007

Q2

2007

Q3

2007

Q4

2008

Q1

2008

Q2

2008

Q3

2008

Q4

2009

Q1

Quarter

Cote d'Ivoire

Mozambique

South Africa

Tanzania

Zambia

1. Number of patients living with HIV, ever enrolled in long-term clinical care and support programs.

2. Of those enrolled, number of patients started on ARV therapy.

CUMULATIVE data from March 1, 2004 through March 30, 2009

Project HEARTCumulative Patient Enrollment

Country

HIV Palliative Care1 Antiretroviral Treatment2

Children Adults Total Children Adults Total

Zambia13,641 (7.3%)

172,853

186,494

8,387 (7.0%) 111,109

119,496

Cote d'Ivoire

4,755 (4.5%)

100,447

105,202

1,968 (3.9%) 48,084 50,052

South Africa

13,420 (9.4%)

128,743

142,163

8,926 (10.3%) 77,333 86,259

Tanzania7,862 (9.5%) 75,241 83,103

3,212 (8.5%) 34,757 37,969

Mozambique

3,457 (6.7%) 47,961 51,418

1,149 (7.0%) 15,238 16,387

Total43,135 (7.6%)

525,245

568,380

23,642 (7.6%) 286,521

310,163

Project HEART Cumulative Patient Enrollment: End of Q1 2009

0

100000

200000

300000

400000

500000

600000

Cote d'Ivoire Mozambique South Africa Tanzania Zambia Total

Total Care

Total ART

Project HEART Patients currently in Program

All patients CURRENTLY on care and treatment on March 30, 2009

Country

HIV Palliative Care1 Antiretroviral Therapy2

Children Adults Total Children Adults Total

Zambia6,397

(7.1%) 83,962 90,3594,898 (6.5%) 70,449 75,347

Cote d'Ivoire

1,753 (4.6%) 36,105 37,858

1,317 (3.9%) 32,410 33,727

South Africa

9,137 (10.5%) 78,227 87,364

8,146 (11.1%) 65,421 73,567

Tanzania6,446 (9.7%) 60,093 66,539

2,593 (8.3%) 28,774 31,367

Mozambique

1,900 (7.8%) 22,368 24,268

917 (7.5%) 11,290 12,207

Total25,633 (8.4%)

280,755

306,388

17,871 (7.9%)

208,344

226,215

1. Number of HIV-positive patients who received care anytime January 1- March 30, 2009.

2. Number of patients on ART on March 30th 2009.

Project HEART Patients currently in Program: Q1 2009

0

50000

100000

150000

200000

250000

300000

350000

Cote d'Ivoire Mozambique South Africa Tanzania Zambia Total

Total on Care

Total on ART

13Reasons for Attrition All Patients and Among Adults , Q1 2009

Stopped ART3%

Transferred out25%

Death20%

Lost to follow-up46%

Unknown7%

Adults

Stopped ART2%

Transferred out25%

Death20%


Unknown7%

All Patients

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Cote d`Ivoire Mozambique South Africa Tanzania Zambia Total

Country

Percent of current care who received CTX during quarter, Jan-Mar 09

0-14 15+

Percent of Persons in Care Receiving Cotrimoxazole, Q1 2009

Percentage of patients on ART who are on first line regimens:

End of Q1 2009, by age group

94.2 93.8

100100

98.198.398.8

99.7

96.2

95.1

90

91

92

93

94

95

96

97

98

99

100


Children

Adults

CD4 Cohort Data: Median CD4 at Baseline and 6 Mos, Q1 2009

Cote d'Ivoire Mozambique South Africa Tanzania Zambia0

50

100

150

200

250

300

350

400

450

500

550

600

178156

109152 151

359

298

244

284 284

CD4

coun

t

93.988.0

76.1 74.3

90.1

60.161.9

66.2

61.9

8.6

0

10

20

30

40

50

60

70

80

90

100


Countries

Perc

enta

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f pat

ient

s

Baseline 6-month follow-up

Percentage of Patients in 6-month Cohort with CD4 Counts at Baseline and at the end of the Follow-Up Period, Q1 2009

Number of children currently on ART during Q3 2008, Q4 2008, and Q1 2009

8,146

6,275

626

4,557

2,088

1,165 784

7,300

4,897

2,213

1,270 1,317 917

4,898

2,593

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000


Countries

Num

ber o

f chi

ldre

n

Jul.-Sept. 2008 Oct .-Dec. 2008 Jan.-Mar. 2009

Percentage of patients currently on ART who were children during Q3 2008, Q4 2008, and Q1 2009

6.8 6.96.5

11.5

8.9

6.3

3.9

11.0

6.9

8.4

4.0

11.1

7.58.3

3.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0


Countries

Perc

enta

ge o

f chi

ldre

n

Jul.-Sept. 2008 Oct.-Dec. 2008 Jan.-Mar. 2009

Children newly started on ART during the quarter

Children newly started on ART during the quarter

455594 544 520

718 714

2,149

1,029

1,4071,548

1,109

1,488

1,7031,786 1,749

2,285

2,508

0

500

1000

1500

2000

2500

3000

2005Q1

2005Q2

2005Q3

2005Q4

2006Q1

2006Q2

2006Q3

2006Q4

2007Q1

2007Q2

2007Q3

2007Q4

2008Q1

2008Q2

2008Q3

2008Q4

2009Q1

Num

ber o

f chi

ldre

n ne

wly s

tarted

on

ART

Children started on ART

Stopped ART2%

Transferred out31%

Death20%


Unknown6%

All children (0-14 years)Stopped ART

2% Transferred out16%

Death28%


Unknown3%

Children (0-1 years)

Stopped ART2%

Transferred out32%

Death18%


Unknown6%


Stopped ART2%

Transferred out36%

Death18%


Unknown6%


Reasons for Attrition Among Children by Age Group, Q1 2009

Stopped ART2%

Transferred out31%

Death20%


Unknown6%

All children (0-14 years)

Reasons for Attrition Among Children and Adults, Q1 2009

Stopped ART3%

Transferred out25%

Death20%


Unknown7%

Adults

Percent distribution of children currently on ART end of March 2009, by age group*

12.625.4

8.3 9.3 6.7

29.2

28.0

21.9 24.221.5

58.246.5

69.8 66.4 71.7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cote d`Ivoire Mozambique South Africa Tanzania Zambia

Countries

Perc

etag

e of

chi

ldre

n

0-1 year old 2-4 years old 5-14 years old

*not all sites in Mozambique and South Africa reported pediatric age breakdown information

Infant & Young Child (IYC) Strategy• Target setting – site specific

absolute numbers• Implementation approaches• Indicators for COC – PMTCT/C&T

linkages and integration• Emphasis on PMTCT• More focused monitoring &

feedback

IYC Strategy Indicators (Part 1), Q1 2009

Pregnant women identified as HIV

positive

Pregnant women who received

ARVs

Exposed infants who received

ARVs

Exposed infants who started on

cotrimoxazole at 6 weeks

Exposed infants tested for HIV

Exposed infants with a positive

test result

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000Nu

mbe

r of p

atien

ts

IYC Strategy Indicators (Part 2), Q1 2009

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000Nu

mbe

r of c

hild

ren

0100200

300400500600700800900

1000

Quarter

Num

ber o

f Site

s


1. PMTCT is funded by CDC in CI, SA and Zambia. USAID funds PMTCT in TZ. In Mozambique, PMTCT funding is transitioning from USAID to CDC.

2. The above data is for all five PH countries to give a more thorough picture of services in PH countries

Number of EGPAF PMTCT Sites, Project HEART countries (2004-2009)



0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Eligible Women Counseled Tested Results

Cumulative 2007 2008

PMTCT Cascade A for Five Project HEART Countries (Eligible, counseling, testing, results)



0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

HIV Tested Positive Total HIV Positive Women ARV Infant ARV

Cumulative 2007 2008

PMTCT Cascade B for Five Project HEART Countries (HIV+, Women ARV, Infant ARV)

Hope for the Future

• Greater focus by donors on health system strengthening

• Intensive work toward transition in each Project HEART country including local capacity building

• Increasing funding for increasing access to PMTCT and Improving the PMTCT cascade

• Increasing the identification, enrollment and retention of children in care and treatment

• Improving the quality of care in each supported site

CÔTE D’IVOIRE• Anna Likos and CDC/CI• MOH CI• Joseph Essombo, Anthony

Tanoh, Diby Brou Charles, Joseph Kouakou and the EGPAF/CI team

EGPAF U.S.• Georgette Adjorlolo-

Johnson• Nicole Buono• Elizabeth Flanagan• Nick Hellmann• Trish Karlin• Stephen Lee• Richard Marlink• Rose McCullough• Sara Pacque-Margolis• Mposo Ntumbanzondo• Shobana Ramachandran• Penny Smith• Allison Spensley• Tara Suntoke• Andrea Wahl• Cathy Wilfert• Sue Willard

MOZAMBIQUE• Lisa Nelson and CDC/Moz• MOH Moz• Nancy Fitch, Cathrien

Alons, Esmeralda Karajeanes, Alex Boon, Etelvina Mbalane and the EGPAF/Moz team

SOUTH AFRICA• Thurma Goldman, Celicia

Serenata, and CDC/SA• DOH SA• Kuku Appiah, Marriam

Mangochi, Pumla Lupondwana and the EGPAF/SA team

TANZANIA• John Vertifeuille and

CDC/TZ• MOH TZ• Anja Giphart, Werner

Schimana, Jeroen van Padt Bosch, Aisa Muya and the EGPAF/TZ team

ZAMBIA• Larry Marum and

CDC/Zam• MOH Zambia• Susan Strasser and the

EGPAF/Zambia team• Jeff Stringer, Elizabeth

Stringer, Carolyn Bolton, Stewart Reid and the entire CIDRZ team

PARTNERSBaylor• Mark Kline• Meg Ferris

John Snow International• Andrew Fullem• Lisa Hirschhorn University of CA, San Francisco• Diane Havlir• Royce Lin• Oliver Bacon

CDC• Tedd Ellerbrock• Louise Perry• Diane Flournoy• Bud Bowen• Janna Brooks• CDC Staff in Côte d’Ivoire Mozambique, South Africa Tanzania, Zambia

……..AND ALL OF OUR PATIENTS, PARTNERS, STAFF AND DONORS

Acknowledgements

Documents

Project HEART: Expanding Access, Extending Lives