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.
33 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)
4Dr 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
8HIV Drug Resistance
- ??????????????????????????????????????????????????
- -??????????????????????????????
- -???????????????????????????????????????
- -Adherence ?????????
9Adherence 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
10The WHO HIV Drug Resistance Strategy
- Is HIVDR spreading like wildfire?
11National 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) ????? - -???????????????????????????????????????
- -???????????????????????????????????????????????
????????????? - ??????????????????????????????????????????????????
????????????????????????????????????
13HIV 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)
14WHO Recommended EWIs (1)
- 1. Prescribing practices
- - ???????????.????????????????????????????????????
???????????????? ???? - -???????????.?????????????????????????????????????
???????? - ??????????????? 100
- -?????????????????????????????????????????????
15WHO Recommended EWIs (2)
- 2. Patient retention on first-line ART
- a.????????.????????????????????????????????? 12
?????????????? - ??????????????? gt 70
- b.????????.?????????????????????? on ART ????
1 ?? ????????????????????????????????? 12
?????????????? - ??????????????? 0
16WHO Recommended EWIs (3)
- 3. lost to follow-up
- ????????.??????????????????????????????????????
?????? ????????????????????????????? 12
???????????????? - (????????????????????????????? 90
???????????????????????????? ?????? 12 ?????
???????????????) - ??????????????? lt 20
17WHO Recommended EWIs (4)
- 4. On-time ARV Drug pick up
- ????????????????????????????????????
?????????????????? - ( 2 ???????????? )
- ??????????????? gt 90
18WHO Recommended EWIs (4)
- 5. ART appointment-keeping
- ????????????????????????????????
?????????????????? - ??????????????? gt 80
19WHO Recommended EWIs (5)
- 6. Drug Supply Continuity
- ????????????????????????????? ?????????
??????? ????????????????????????
?????????????????? - ??????????????? 0
- ?????????????????????????????????
- ??????????????? 100
20WHO Recommended EWIs (6)
- 7. Pill count / adherence (optional)
- ???????????????????????????????????????????????
(90??????????????)??????????????????????????????
???????????????? - ??????????????? gt 80
21WHO Recommended EWIs (7)
- 8. Viral load suppression following 12 months of
first-line ART - ??????????????????????????????? VL lt1000
copies/ml ??????????????????????? 12 ????? - ??????????????? gt 70
-
22EWIs
- ??????????????????????????????????????????????
- ?????????????????????????????
- ????????????????????????????????????????
- ??????????????????????????????????????????????????
??????????????????????????????????????????????????
???????????????????????
23EWIs
- ??????????????????????????????????????????????????
??????????????? - ??????????????????????????????????????
- ???????????????????????????????????? EWIs
- ???????????????????????????????????????????????
??????????????????????????? ??????????????????????
????
24????????????
- ??????????????????????????????????????????????????
??????????????????????????????? - ?????????????????????
- 1.????????????????????????????????????????????????
?? - 2.?????????????????????????????????????????
- 3.???????????????????????????
- 4.???????????????????????EWI ?????????????????????
????????????????
25So -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
26Conclusions 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
27Thank you