Advanced HIV Disease Update UNITED REPUBLIC OF TANZANIA
Advanced HIV Disease Update UNITED REPUBLIC OF TANZANIA Dr. Siraji Shabani National AIDS Control Program Ministry of Health, Community Development, Gender, Elderly and Children July 28 -29, 2020 Dodoma, Tanzania
Outline • HIV perspective in Tanzania • Advanced HIV Disease in Tanzania • Update on CHAI AHD Project • Perspectives from National Network of PLHIV • Challenges • Priorities for 2020 – 2021 The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 2
HIV Prevalence by Regions, age and Sex Group Male Female Total 15 - 49 3. 1 6. 2 4. 7 15 - 24 0. 6 2. 1 1. 4 15 – 19 0. 4 1. 0 0. 7 20 - 24 0. 9 3. 4 2. 2 3
Baseline 90 90 90 (THIS summary report 2016/2017) 2 nd and 3 rd 90 -90 -90 targets nearly attained; testing coverage remains a challenge The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 The CQUIN Learning Network 4
Progress in 90 -90 -90 Progress of first 90 Progress in Second 90 5
HVL Suppression Source: THIS 2016/17 and NACP program data 6
Laboratory Services: CD 4 Testing • Standard of care: • CD 4 testing at baseline and for monitoring of Ro. C on ART with CD 4 count of <350 cell/mm 3 • CD 4 uptake at baseline is still low among PLHIV in care, 40% in 2015 to 12 % in 2018 7
AHD in Tanzania • Prevalence of AHD q. Programmatic data shows that among clients who were initiated ART in 2018. • 21% had WHO clinical 3 or 4 • 31% had CD 4 count of <200 cells/mm 3 (among Ro. C with baseline CD 4 results) • Mortality rates amongst PLHIV q. Number of AIDS related death have been decreasing over a period of time in Country. It is estimated that 24, 000 AIDS related death occurred in Tanzania in 2018 (Source: UNAIDS Estimates 2019). The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 8
AHD in Tanzania Increased coverage from 15 Phase I sites to 201 sites Procurement of Fluconazole and Cr. Ag test kits (Annual supply, expires 2022) Continuous on-site Technical Assistance Sensitization meetings to Health system leaders Inclusion in program priorities through TB/HIV TWG The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 Health care worker capacity building Above site partner to coordinate implementation is MDH under CDC support 9
AHD Coordination and Leadership • AHD services at national level are coordinated by Mo. HCDGEC • At program level services are coordinated by NACP in which: • Two focal person nominated to facilitate nationwide implementation • National AHD task force team for coordination and technical assistance • PLHIV networks are part of AHD coordination and are involved in policy development and guidelines review meetings The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 10
AHD Policies, Guidelines and DSDMs • 2019 National Guidelines for the Management of HIV/AIDS: • Categorization of clients with AHD as late presenter during ART initiation and unstable after ART use with specific interventions • Cr. Ag screening for CD 4<200 or WHO stage 3 or 4 • Pre-emptive treatment dose integrated • Fluconazole monotherapy not recommended for treatment • AHD training materials focusing on TB and CM • The country is in progress of developing a comprehensive AHD training package and reviewing M&E tools to effectively capture AHD implementation The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 11
AHD Essential Package • Essential package of AHD diagnostic and treatment services in Tanzania includes; • Diagnostic - CD 4, routine VL, viral resistance testing, Cr. Ag, TB diagnostics, STI screening, Expedited clinical investigations • Treatment- CM, TB, other OIs management, provision of prophylaxis for common OIs (TPT, CPT) and expedited ART initiation • The services are provided across all the levels of health systems, making use of an existing hub and spoke mode of referral for both patients and samples The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 12
Monitoring & Evaluation Data or The current existing CTC data collection tools and database documentation collect most but not all of the parameters pertaining to AHD. The challenges missing parameters includes standardized Cr. Ag results, phases and completion status of both CM treatment and CPET. . Incomplete and/or delayed documentation in existing M&E tools. However, the country is in the process of collecting the best practices, harmonization of the existing tools and updating the existing CTC tools The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 13
Update on CHAI AHD Project Catalytic procurement S/N Item Quantity Estimated Time of Delivery 1 Crag 50 test/Kit 19, 650 tests 2 Fluconazole 200 mg Capsules 6373 packs of 15 th Sep, 2020 100 Tabs 3 Amphotericin B – 10, 400 vials Liposomal 50 mg for Inj 8 th August, 2020 4 Flucyotosine 500 mg Tablets 8 th August, 2020 400 packs Activities planned 8 th August, 2020 Progress to date Next steps AHD Stakeholder AHD Task force Team Meeting AHD Task force Team Stakeholder meeting Meeting TOT Training Review of AHD Indicators and Data collection tool Ordering of Conduct supportive commodities supervisions and mentorships at AHD sites Support storage and distribution via MSD 14
Perspectives from National Network of PLHIV • NACOPHA’s experience of 5 years Sauti Yetu Project funded by USAID (ended December 9, 2019): • Overall over 87% of identified and individuals linked to HIV testing, tested HIV+ with index testing yield ranged between 57 -67% • Overall 97. 6 % of LFTU were linked back to treatment. • Retention is 100% of all members in the empowerment groups • Over 88% of PLHIV members (in the project area) accessed VL testing; 97% are virally suppressed • Call for a collaborative approach between health staff and stakeholders • There is a need to conduct an intensive needs assessment for people with AHD eg. • Economic empowerment • Interface treatment literacy • Nutritional support and treatment supporters • Need for implementation of the Task Sharing policy to reduce risks of PLHIV presenting AHD, involve trained PLHIV (treatment advocates) • People with advanced HIV disease need targeted interventions in order to reduce mortality and morbidity • Encourage peer visits and follow-up during the early stages of ART 15
Challenges Inadequacy in implementing CD 4+ cell count baseline testing Gaps in clinical data continuum cascade for Cr. Ag screening and management Absence of Systematic and enhanced process to address quality of AHD care and continuous tracking of outcome Lack of an intensive assessment that maps out AHD cases and documents relevant data of basic needs Inadequate commodities for both treatment and other socio-economic needs Fewer partners supporting AHD cases The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 16
Priorities for 2020 – 2021 Provide quality AHD care through sustainable availability of AHD commodities. Invest in robust M&E to enable data driven intervention and setting of AHD targets, AHD Dashboard. Engage CBHS to ensure continuous monitoring of adherence. Systematic and enhanced cohort process. Review existing policies to realize gaps within current policies and guidelines, develop special package of care and mobilize resources for AHD response The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020 17
Acknowledgements • Recipients of Care; represented by the National Council of People Living with HIV (NACOPHA) • PO-RALG, R/CHMTs, National Mentors and HCWs • Implementing Partners The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28 -29, 2020
- Slides: 18