two high prevalence settings in Zimbabwe and Malawi Nolwenn Conan Menard Chihana Background Cascade of HIV care Proportion of people living with HIV who are diagnosed Proportion od diagnosed ID: 836941
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1 Gaps in the cascade of care in two high
Gaps in the cascade of care in two high prevalence settings in Zimbabwe and Malawi Nolwenn Conan - Menard Chihana Background - Cascade of HIV care - Proportion of people living with HIV who are diagnosed - Proportion od diagnosed who are enrolled on ART - Proportion of people in treatment have a full suppressed Viral
2 Load - UNAIDS 90 - 90 - 90
Load - UNAIDS 90 - 90 - 90 - Increasing ART coverage and increasing the number of HIV positive individuals with an undetectable Viral Load lead to a reduction of HIV transmission . Background ⢠Since 2011 MSF activities in Gutu (Zimbabwe) and Nsanje (Malawi) â Mentoring approach to increase access to quality HIV care
3 through decentralization of ART diagno
through decentralization of ART diagnosis and treatment from hospital to clinics ⢠Decision to implement HIV population surveys: â To give information on HIV prevalence, cascade of care and data coverage in both districts â To estimate the impact of the mentoring approach after 5 years of implementation in both settings and to define plans and priority interventions â
4 To compare the HIV population based sur
To compare the HIV population based survey findings with the National survey outcomes Study locations Malawi - Nsanje District Zimbabwe - Gutu District Study objectives Primary Objective ⢠To estimate population viral load suppression (Viral load 1 , 000 cp/ml) among adults, stratified by gender Secondary Objectives ï· To est
5 imate HIV cascade of care ï
imate HIV cascade of care ï· To estimate the HIV prevalence ï· To estimate ART coverage among HIV positive All estimates stratified by age and gender Methodology ⢠Design: cross - sectional t wo stage cluster sampling ⢠Study population: all individuals ⥠15 years old in Gutu District (pop= 203,533 ) and Nsanje
6 District (pop=241,107) ⢠Survey d
District (pop=241,107) ⢠Survey duration: 13 weeks of data collection on each site We obtained ethics approvals from the MSF ERB, MRCZ and NHSRC Methodology:Study procedures ( adults ) Interview head of household Interview eligible individuals Household questionnaire Adults questionnaire HIV test on spot in series Negative Positive Interview HIV positive
7 Laboratory tests Laboratory testi
Laboratory tests Laboratory testing: VL; Genotyping; ART blood level; Incidence; 10% HIV confirmatory QC; + CD4 in Gutu Questionnaire HIV & ART HIV rapid test (RDT) Discordant* *HIV confirmatory testing Pre counselling Post counselling Results Households completed Individuals eligible Individuals included Individuals tested Gutu 2,400 5,440
8 4,979 (91.5%) 4,840 (89.0%) Nsanje
4,979 (91.5%) 4,840 (89.0%) Nsanje 2,443 5,322 4,848 (91.1%) 4,672 (87.8%) P articipation and inclusion rate Results Women, n (%) 3,122 (57.4) 2,893 (54.4) Age, median years [IQR ] 36 [20 - 56] 33 [22 - 47] Married, n (%) 2,850 (52.3) 3,137 (64.7) Secondary education, n (%) 2,866 (57.6) 894 (18.4%) Farming, n (%) 2,789 (56.0) 3,083 (63.6
9 ) Living continuously in the District
) Living continuously in the District n (%) 3,826 (76.8) 3,891 (83.3) Table: Participantsâ socio - demographic characteristics Gutu Nsanje Results HIV Prevalence MSF Overall * : 13.6 % (95%CI: 12.6 - 14.5) (*5 HIV indeterminate tests on spot) MSF Women vs. Men : 14.5 % vs. 12.3% (p=0.03) MSF Overall*: 12.1% (95%CI: 11.2 -
10 13.0) (* 1 HIV indeterminate te
13.0) (* 1 HIV indeterminate tests on spot) MSF Women vs. Men: 14.0% vs. 9.5 % (p1) Gutu Nsanje HIV prevalence stratified by gender and age group 0,0 5,0 10,0 15,0 20,0 25,0 30,0 35,0 40,0 45,0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Prevalence Age Group Male Female 0,0 5,0 10,0 15,0 20,0 25,0 30,0 35,0 40,0 45,0 15-19 20-24 25
11 -29 30-34 35-39 40-44 45-49 50-54 55-59
-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Prevalence Age Group Male Female Results Gutu : MSF vs. National 15 - 64 years old Prevalence = 15.4 % vs. 14.6 % Results Gutu : MSF vs. National 15 - 64 years old 86,5 94,0 85,9 74,2 86,8 86,5 60,0 70,0 80,0 90,0 100,0 % MSF National survey Overal l * * 1 missing value Prevale
12 nce = 15.4 % vs. 14.6 % Cascade of
nce = 15.4 % vs. 14.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 00cp/ml coverage Results Gutu : MSF vs. National 15 - 64 years old 86,5 94,0 85,9 74,2 86,8 86,5 60,0 70,0 80,0 90,0 100,0 % MSF National survey 91,0 96,0 85,9 77,1 87,3 87,9 60,0 70,0 80,0 90,0 100,0 % Overal l * * 1 missing value Women *
13 * 1 missing value Prevalence = 15
* 1 missing value Prevalence = 15.4 % vs. 14.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 00cp/ml coverage Results Gutu : MSF vs. National 15 - 64 years old 86,5 94,0 85,9 74,2 86,8 86,5 60,0 70,0 80,0 90,0 100,0 % MSF National survey 91,0 96,0 85,9 77,1 87,3 87,9 60,0 70,0 80,0 90,0 100,0 % 78,9 90,0 86
14 ,1 69,7 86,0 84,1 60,0 70,0 80,0
,1 69,7 86,0 84,1 60,0 70,0 80,0 90,0 100,0 % Overal l * * 1 missing value Women * * 1 missing value Men* * 5 missing values Prevalence = 15.4 % vs. 14.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 00cp/ml coverage Results Gutu : MSF vs. National 15 - 64 years old 86,5 94,0 85,9 74,2 86,8 86,5 60,0 70,
15 0 80,0 90,0 100,0 % MSF National su
0 80,0 90,0 100,0 % MSF National survey 91,0 96,0 85,9 77,1 87,3 87,9 60,0 70,0 80,0 90,0 100,0 % 78,9 90,0 86,1 69,7 86,0 84,1 60,0 70,0 80,0 90,0 100,0 % Overal l * * 1 missing value Women * * 1 missing value Men* * 5 missing values MSF results : 71.4% of adults 15 - 24 previously diagnosed MSF results : 58.3 % of men previous
16 ly diagnosed Prevalence = 15.4
ly diagnosed Prevalence = 15.4 % vs. 14.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 00cp/ml coverage Results Nsanje:MSF vs. National 15 - 64 years old Prevalence = 13.1 % vs. 10.6 % Results Nsanje:MSF vs. National 15 - 64 years old Overall * * 4 missing values 77,3 90,3 90,8 72,7 88,6 90,8 60,0 70,0
17 80,0 90,0 100,0 % MSF National survey
80,0 90,0 100,0 % MSF National survey Prevalence = 13.1 % vs. 10.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 0cp/ml coverage Results Nsanje:MSF vs. National 15 - 64 years old Overall * * 4 missing values Women * * 1 missing value 77,3 90,3 90,8 72,7 88,6 90,8 60,0 70,0 80,0 90,0 100,0 % MSF National survey 80,3
18 91,3 90,9 76,3 90,0 92,3 60
91,3 90,9 76,3 90,0 92,3 60,0 70,0 80,0 90,0 100,0 % Prevalence = 13.1 % vs. 10.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 0cp/ml coverage Results Nsanje:MSF vs. National 15 - 64 years old Overall * * 4 missing values Women * * 1 missing value Men* * 9 missing values 77,3 90,3 90,8 72,7 88,6 90
19 ,8 60,0 70,0 80,0 90,0 100,0 % MSF N
,8 60,0 70,0 80,0 90,0 100,0 % MSF National survey 80,3 91,3 90,9 76,3 90,0 92,3 60,0 70,0 80,0 90,0 100,0 % 70,5 88,1 90,6 66,7 86,0 87,9 60,0 70,0 80,0 90,0 100,0 % Prevalence = 13.1 % vs. 10.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 0cp/ml coverage Results Nsanje:MSF vs. National 15 - 64 years old Overal
20 l * * 4 missing values Women *
l * * 4 missing values Women * * 1 missing value Men* * 9 missing values 77,3 90,3 90,8 72,7 88,6 90,8 60,0 70,0 80,0 90,0 100,0 % MSF National survey 80,3 91,3 90,9 76,3 90,0 92,3 60,0 70,0 80,0 90,0 100,0 % 70,5 88,1 90,6 66,7 86,0 87,9 60,0 70,0 80,0 90,0 100,0 % MSF results : 64.3% of adults 15 - 24 previously diagnosed
21 MSF results : 42.3% of men 0 previo
MSF results : 42.3% of men 0 previously diagnosed Prevalence = 13.1 % vs. 10.6 % Cascade of care Diagnosed coverage ART coverage Viral Load 0cp/ml coverage Strength & limitation ⢠Limitation â Some Viral Load test results in Gutu still need to be entered ⢠Strengths â Cross sectional survey: representability of the population livi
22 ng in Gutu & Nsanje Districts â
ng in Gutu & Nsanje Districts â High participation rate even among men â Comparability of results between District level with Country wide coverage Discussion General - An ageing HIV positive population; 25% of all HIV positive participants above 50 year old Coverage - Good results in coverage outcomes in both settings - Gender and age group imbalance spe
23 cifically in the diagnosed coverage -
cifically in the diagnosed coverage - Youths less aware of their HIV status than older adults - M ales less aware of their HIV status than females - Among HIV positive males 30 years old STILL � 40% in Gutu �and 55% in Nsanje not aware of their HIV status Discussion - Two firsts coverages: - Higher results in Gutu than national level - No
24 difference in Nsanje - Third covera
difference in Nsanje - Third coverage: in both settings similar results than national level �= Discussion at operational level next week Operational decision Acknowledgements Survey teams Gutu & Nsanje team MSF Zim & Malawi MoH Zim & Malawi MSF OCB Epicentre SAMU NICD, UCT All the study participants and Gutu & Nsanje Com