namibia cop 2018 stakeholder meeting · 2018-02-15 · pepfar presentation outline i. program...
TRANSCRIPT
PEPFAR N
Namibia
COP 2018 Stakeholder Meeting HIV Treatment :
“Treat All” Policy, Differentiated
Service Models
January 31, 2018
PEPFAR
Presentation Outline
I. Program Overview Update of Test and Treat Policy
PEPFAR Country Specific COP18 Guidance :Highlights on Treatment
II. Update on Outcomes for PEPFAR Namibia FY17
– TX New and Tx Curr Results
– Adherence and Retention Outcomes
– Viral Load Suppression Outcomes
III. Differentiated Models of Care
– Updates on implementation during FY17
• Ongoing Evaluations
– Community-Based ART
– Community Adherence Clubs
IV. Questions and Discussion
2
PEPFAR
Status Treat-All Policy and Transitioning from
EFV-based to Dolutegravir-based 1st line regimen
• Treat All Policy in Full Implementation in All Districts since early 2017
• New DTG Formulations – Technical Advisory Committee (TAC) meeting convened
by MoHSS after the IAS2017 to deliberate technical considerations: • Concerns raised regarding missing data for sub-populations (e.g.
Pregnant women, TB patients on Rifampicin)
– TAC considered: • Current ARVs Stock-on-hand as well as Stock already –on-order • Lead times for ordering ARVs
– MOHSS working on a transition plan with the ultimate objective of transitioning patients to new; safer DTG-based regimens in due course
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COP 2018 COUNTRY SPECIFIC POLICY DIRECTIVES AND TECHNICAL APPROACHES
Same Day Initiation - There are still many districts where same day initiation of ART has not been adequate, including in the capital of Windhoek. PEPFAR Namibia should continue monitoring time to initiation and ensure that implementing partners have plans that utilize efficient linkage methods, following up where progress remains inadequate.
Community Based ART – CBART has proven to be a successful method of treatment provision in Namibia. PEPFAR Namibia should continue to scale up CBART and begin cost/impact analysis of the multiple models; determine which models may be most sustainable with different populations.
TLD Optimization: Submission of a draft TLD transition and supply plan for FY 2019 is required for the Regional Planning Meeting. These plans must be developed in close consultation with host countries and in collaboration with GF and other key stakeholders.
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PEPFAR
UPDATE ON OUTCOMES FOR
PEPFAR NAMIBIA FY17
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6
Trends in Total Current on ART (Tx Curr) and New ART initiation (Tx new):
Namibia FY15-FY17
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Rapid Increase in patients Current on ART in districts supported by PEPFAR: (1) During the period FY15-FY17 –Tx Curr number more than tripled the number current on ART. This reflects the highly successful major
pivot (from a Technical Assistance program to Direct Service Delivery Support Model ) implemented by PEPFAR Namibia beginning in FY15
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Day 0 7 Days 30 days 90 Days
43% 47%
52%
61% 60% 63%
68%
78% 82% 81%
83%
89% 90% 89% 90% 93%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 7 days 30 days 90 days
FY17Q1
FY17Q2
FY17Q3
FY17Q4
FY17Q1
FY17Q2
FY17Q3
FY17Q4
FY17Q1
FY17Q2
FY17Q3
FY17Q4
FY17Q1
FY17Q2
FY17Q3
FY17Q4
Cu
mu
lati
ve (
%)
Star
ted
on
AR
T
Namibia: FY17 :Time from HIV Diagnosis to ART initiation,FY17 Q1 –Q4
The proportion of patients initiating ART on Same Day (Day 0) has increased from 43% in FY17 Q1
to 61% by FY17 Q4
APR 2017: PMTCT _ ART and Infants <1 Linked to ART
9122 8092
205
11967 11691
194 188 0
2000
4000
6000
8000
10000
12000
14000
HIV + pregnantwomen Target
HIV + pregnantwomen
receiving ARTtarget
HIV infectedinfants
identified by 12months of age
(target)
HIV infectedinfants New on
ART
PMTCT APR 17: Targets and Achievements
Target Achieved
0%
20%
40%
60%
80%
100%
PMTCT_ART Coverage by District
PMTCT_ART coverage
• FY17 PMTCT targets were achieved except for new HIV infected infants identified
• PMTCT-ART coverage was 98%. Ranging from 84% to 100%
• 188 (96%) of identified HIV infected infants were linked to ART
Challenges
• Shortage and periodic rotations of trained staff affecting service delivery
• Inadequate re-testing of pregnant and breastfeeding women
• Data reporting issues
• Lower target set for PMTCT_ ART (adjusted for FY2018)
• 15 districts had higher ART linkage and 8 districts had lower ART linkage than HIV infected infants identified • Some infants were initiated on ART in clinics
other than where diagnosis was made.
Challenges
• Paeds. ART not decentralized to some clinics • Inadequate re-testing of breastfeeding women and
HEIs beyond 6 weeks , 9months and 18 months • Data reporting issues
0%
100%
200%
300%
400%
500%
600%
0
5
10
15
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25
30
35
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# o
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IV p
osi
tive
Axis Title
HIV infected infants identified HIV Infected infants new on ART (<1yr)
% HIV infected infants new on ART (<1yr)
HIV infected infants identified and linked to ART by
District
Adherence Estimates based on Pharmacy Pill Count July to September 2017
MOHSS, (November, 2017). Quarterly ART PMIS Feedback Report for the Period July to September 2017. Windhoek: MoHSS –Division: Pharmaceutical Services.
Aggregate national rates for Adults and Pediatrics patients with >75% adherence are 63% and
50% respectively for the period of July to September 2017
63%
50%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% w
ith
>7
5%
Ad
he
ren
ce
Region
#>75% Adherence Adults #>75% Adherence Paeds Sum of National %
77%
91% 91%
83%
74%
84% 84%
79% 78% 78%
87%
81%
87% 86%
81%
86% 87% 87%
81%
86% 89%
74%
91% 89%
84%
90%
84% 84% 83%
90%
81%
87%
95%
87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Namibia Viral Load Suppression Oct16 to Sep 17 (N=191,239)
Source: Laboratory Data from the Namibia Institute of Pathology; MEDITECH
74%
80%
72%
64%
89%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<5 Y 5-9Y 10-14Y 15-19Y >20
% V
L Su
pp
ress
ion
Age group
Namibia VLS by Age Group, October 2016 to Sep 2017 : (N=158,632)
N=8,052 N=6,844 N=137,326
N=4,534
N=1,876
Source: Laboratory Data from the Namibia Institute of Pathology; MEDITECH
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Kat
ima
Mu
lilo
Nan
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Nya
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na
Ru
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Wal
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k
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Nam
ibia
12
Mo
nth
Ret
en
tio
n (
%)
District
Retention by District Namibia ,October 2016 to October 2017
PEPFAR
DIFFERENTIATED MODELS OF
CARE
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Community Based ART Model & Description
Districts (Est. no. of patients-December 2017)
Community based ART Delivery (CBARTs)- provider managed
Oshakati (300); Engela; Eenhana (800); Outapi (270); Tsandi (250); and Okahao (250)
Community Adherence Clubs (CACs)- patient-self managed with support from CHWs and HEWs
Oshakati (280); Katima Mulilo (90) Windhoek, Andara , and Nyangana(still forming)
Community-Based ART Management
National ART guideline revised and Community based ART delivery models included in the 2016
ART Curriculum revised and include Community based ART models, Training conducted PEPFAR facilitated exchange learning visits & best practices sharing (Omusati,
Ohangwena, Oshana, Kavango West and East and Zambezi region) Used project ECHO platform to share best practices SOPs and reporting tools developed and used in demonstration project- to be adapted
Number of CACS and Patients in CACs by Region: December 2017
17
200 175
37
412
25 29 5
59
0
50
100
150
200
250
300
350
400
450
Oshana Zambezi Khomas Total
Nu
mb
er
of
Pati
ents
Region
Districts (Est. no. of patients) Number of Clubs
Draft COP18 Proposed Activities
Facility-Based Community Adherence Clubs targeting Urban Facilities
Further Expansion of Community-Adherence Clubs
Standardization of Teen Clubs and expansion of use
Support for continued ART decentralization especially for Pediatric access
Use of Technology for Teen Adherence Clubs and others1
1New app helps treatment adherence for people living with HIV http://www.unaids.org/en/resources/presscentre/featurestories/2017/october/20171030_life4me
PEPFAR
QUESTIONS AND DISCUSSION