Reasons for treatment discontinuation during 1st year of

ART: 2007-2008 data from 12 eastern European

countries

XVIII International conference on AIDS, Vienna, 19 July 2010

Dr Irina Eramova, WHO Regional Office for Europe

Focus of the presentation

Coverage with HIV care by health systems in EE countries

ART interruptions and reasons

Conclusions

Methods (1)

How many PLHIV were seen for care in 2008?

Cumulative number of HIV/AIDS cases as of end 2008 – ECDC/WHO surveillance report on HIV/AIDS– For RUS – presentation from FAC at CIS coordination

body, 03.06.09 Cumulative number of all deaths among PLHIV

– Through WHO country staff and National AIDS Centers Number of PLHIV seen for care in 2008

– WHO EURO questionnaire on health system response– National data from the countries – For RUS – presentation of Dr Onischenko at Suzdal

conference 2009 Some data from EST, LVA, TKM, and UZB were not

available

Methods (2)

How many PLHIV stopped ART within first year?

Health system survey through questionnaire

Global 13 and Regional 19 indicators, including– “Reasons for discontinuation of HAART within

the first 12 months among all patients” Analysis of an average data on HAART

interruption for 2007 and 2008 12 EE countries (excluding RUS, EST, and

TKM)

Number of PLHIV seen for carein 2008 (1)

0200400600800

100012001400160018002000

LIT AZE KGZ ARM GEO TJK

Not seen for care

Seen for care

Number of PLHIV seen for carein 2008 (2)

0

2000

4000

6000

8000

10000

12000

KAZ BLR MDA

Not seen forcare

Seen for care

Number of PLHIV seen for carein 2008 (3)

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

UKR RUS

Not seen forcare

Seen for care

Percent of alive and known to health systems PLHIV seen for care

in 2008

0

10

20

30

40

50

60

70

80

90

100

% PLHIV seen for care in 2008

Lithuania

Azerbaijan

Kyrgyzstan

Moldova

Armenia

Kazakhstan

Russia

Georgia

Ukraine

Tadjilistan

Belarus

ART Discontinuation

How many PLHIV stop ART within 1st year?

21% (671 of 3118 average)

*Lack of data from RUS might affect the percentage of ART

discontinuation

Reasons for ART discontinuation

38% - Death – late presentation

30% - Clinical decision, toxicity or unwillingness to continue ART – inadequate treatment preparedness– poor counselling on ARTand support of

adherene– clinical decision to stop ART because of illicit

drug use– Insufficient clinical management of treatment

side effects 21% - Unknown/other reasons 11% - Lost to follow up

Conclusions

Health systems have to improve their performance in provision of treatment and care for PLHIV– There is a need to develop user-friendly services– There is an urgent need to increase the coverage with

HIV care of those PLHIV already known to the health systems

– There is a need for earlier HIV diagnosis and enrolment into care

– There is a need to improve HIV case management ensuring continuum of care and adherence to ART

– Electronic patient monitoring system should be introduced at clinical level

Acknowledgements

Anne-Marie Rinder Stengaard Carlo Huber WHO country staff National counterparts from EE

countries

Thank you!

http://www.euro.who.int/en