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WHO Early Warning Indicators, EWIs

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The co-discoverers of HIV, Dr. Robert Gallo and Dr. Luc Montagnier and others, ... Scaling up of ARV program to meet the needs of PLHIV in resource limited ... – PowerPoint PPT presentation

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Title: WHO Early Warning Indicators, EWIs


1
??????????????????????????? WHO Early Warning
Indicators, EWIs
  • ??.????? ?????????
  • ???????????????????????????????
  • 18 ????????? 2551

2
  • The co-discoverers of HIV, Dr. Robert Gallo and
    Dr. Luc Montagnier and others, warned that if ART
    scale up to low resource settings including
    Africa was attempted
  • -programs could fail,
  • -ART drug resistance would spread and
  • a new epidemic of resistant virus would spread
    around the world.
  • Others said the cost of expanding the treatment
  • program would be too high.

3
3 by 5 policy
  • WHO and some major donors committed to get 3
    million people on ART by the end of 2005
  • (still only 50 of those thought to be in need)

4
Dr LEE Jong-wook, (1945-2006) Director General
WHO
  • to get "as close as possible to universal access
    to treatment for all those who need it by 2010"

5
?????????????????
  • ??????????????? universal access ????
  • ????
  • ???????????
  • ?????????
  • NAPHA extension

6
(No Transcript)
7
  • Scaling up of ARV program to meet the needs of
    PLHIV in resource limited
  • WHO suggests select single first regimen for
    large scale use

8
HIV Drug Resistance
  • ??????????????????????????????????????????????????
  • -??????????????????????????????
  • -???????????????????????????????????????
  • -Adherence ?????????

9
Adherence to HIV Therapy in the Industrialized
North
  • New York City 57
  • Arnsten CID 2001
  • Philadelphia 79
  • Gross AIDS 2001
  • Hartford 53
  • McNabb CID 2001
  • Los Angeles 63
  • Liu Annals Int Med 2001
  • Pittsburgh 74
  • Paterson Annals Int Med 2000
  • San Francisco 67
  • Bangsberg AIDS 2000

10
The WHO HIV Drug Resistance Strategy
  • Is HIVDR spreading like wildfire?

11
National HIVDR strategy for countries scaling up
ART
  • A. Development of a national HIVDR Strategy
    Working Group,
  • three-to-five year plan and budget
  • B. Regular assessment of HIVDR "early warning"
    indicators from
  • all ART clinics (or representative sentinel
    clinics)
  • C. Sentinel monitoring of HIVDR emerging during
    treatment and
  • related ART program factors
  • D. HIVDR transmission threshold surveys
    geographic areas,
  • populations
  • E. HIVDR database development
  • F. Designation of an in-country or regional
    WHO-accredited
  • HIVDR genotyping laboratory
  • G. HIVDR prevention activities
  • H. Preparation of annual HIVDR report and
    recommendations
  • use of data for ART and prevention planning

12
???????????????????????
  • ????????????????????????????????????????????
    ???????????????? HIV Drug Resistance (HIVDR)
    Working Group (WG) ?????
  • -???????????????????????????????????????
  • -???????????????????????????????????????????????
    ?????????????
  • ??????????????????????????????????????????????????
    ????????????????????????????????????

13
HIV Drug Resistance Early Warning Indicators
  • Prescribing practices
  • Patient retention on first-line ART
  • Percent lost to follow-up
  • On-time ARV Drug pick up
  • ART appointment-keeping
  • Drug Supply Continuity
  • Pill count / adherence (optional)
  • Viral load suppression following 12 months of
    first-line ART(optional)

14
WHO Recommended EWIs (1)
  • 1. Prescribing practices
  • - ???????????.????????????????????????????????????
    ???????????????? ????
  • -???????????.?????????????????????????????????????
    ????????
  • ??????????????? 100
  • -?????????????????????????????????????????????

15
WHO Recommended EWIs (2)
  • 2. Patient retention on first-line ART
  • a.????????.????????????????????????????????? 12
    ??????????????
  • ??????????????? gt 70
  • b.????????.?????????????????????? on ART ????
    1 ?? ????????????????????????????????? 12
    ??????????????
  • ??????????????? 0

16
WHO Recommended EWIs (3)
  • 3. lost to follow-up
  • ????????.??????????????????????????????????????
    ?????? ????????????????????????????? 12
    ????????????????
  • (????????????????????????????? 90
    ???????????????????????????? ?????? 12 ?????
    ???????????????)
  • ??????????????? lt 20

17
WHO Recommended EWIs (4)
  • 4. On-time ARV Drug pick up
  • ????????????????????????????????????
    ??????????????????
  • ( 2 ???????????? )
  • ??????????????? gt 90

18
WHO Recommended EWIs (4)
  • 5. ART appointment-keeping
  • ????????????????????????????????
    ??????????????????
  • ??????????????? gt 80

19
WHO Recommended EWIs (5)
  • 6. Drug Supply Continuity
  • ????????????????????????????? ?????????
    ??????? ????????????????????????
    ??????????????????
  • ??????????????? 0
  • ?????????????????????????????????
  • ??????????????? 100

20
WHO Recommended EWIs (6)
  • 7. Pill count / adherence (optional)
  • ???????????????????????????????????????????????
    (90??????????????)??????????????????????????????
    ????????????????
  • ??????????????? gt 80

21
WHO Recommended EWIs (7)
  • 8. Viral load suppression following 12 months of
    first-line ART
  • ??????????????????????????????? VL lt1000
    copies/ml ??????????????????????? 12 ?????
  • ??????????????? gt 70

22
EWIs
  • ??????????????????????????????????????????????
  • ?????????????????????????????
  • ????????????????????????????????????????
  • ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ???????????????????????

23
EWIs
  • ??????????????????????????????????????????????????
    ???????????????
  • ??????????????????????????????????????
  • ???????????????????????????????????? EWIs
  • ???????????????????????????????????????????????
    ??????????????????????????? ??????????????????????
    ????

24
????????????
  • ??????????????????????????????????????????????????
    ???????????????????????????????
  • ?????????????????????
  • 1.????????????????????????????????????????????????
    ??
  • 2.?????????????????????????????????????????
  • 3.???????????????????????????
  • 4.???????????????????????EWI ?????????????????????
    ????????????????

25
So -how has the HIVDR prevention and assessment
been going?
  • In the first 10 countries where HIVDR
    transmission
  • surveys have been done including Africa, Asia and
    E.
  • Europe all results have been below the 5
    threshold
  • The first surveys of the HIVDR Early Warning
  • Indicators have shown that most sites have good
    to
  • excellent results
  • High rates of retention on first line ART
    including viral suppression indicate ART scale up
    can be safe and
  • effective even in resource poor settings

26
Conclusions 3X5, resistance and resource poor
settings
Resistance is occurring and is
being transmitted at very low levels but it is
not a reason not to continue ART scale up
27
Thank you
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