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Prioritizing Advanced HIV Disease - PowerPoint Presentation

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Prioritizing Advanced HIV Disease - PPT Presentation

and Overcoming Barriers to Access Carolyn Amole Senior Director HIV Access Program CHAI Satellite Saving Lives Today Accelerating Access to Diagnostics and Drugs for Advanced HIV Disease ID: 908410

hiv ahd disease advanced ahd hiv advanced disease care community countries chai support package commodities treatment implementation partners access

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Slide1

Prioritizing Advanced HIV Disease and Overcoming Barriers to AccessCarolyn Amole Senior Director, HIV Access Program, CHAI

Satellite: Saving

Lives Today: Accelerating Access to Diagnostics and Drugs for Advanced HIV Disease

Slide2

There is an ineffective global response to advanced HIV disease (AHD), and an urgent need to accelerate access to critical, life-saving products for diagnosis, prevention, and treatment of AHD

Number of AHD related deaths globally (1990-2018)

Reduction in HIV-related mortality has stagnated

globally,

in

spite of increased ART coverage and a reduction in the number of new infections.

Number of AHD related deaths

In 2016, UN member states

agreed

to the

target of

cutting deaths from

AIDS to less than 500,000 per year. In 2018, there were 770,000 AIDS-related deaths. With six months until 2020 we are far from achieving the target.

1

Slide3

A

dvanced

HIV disease remains a persistent challenge

globally for both newly initiating patients and increasingly for ART

experienced patients

as well

1 in 3 people

living with HIV present to care with advanced disease

10%

will die within 3 months

An

increasing proportion of

those presenting with

AHD are ART experienced

Source:

WHO

Management of Advanced Disease Guidelines,

2017.

People living with HIV presenting to care

2

Slide4

The Unitaid Advanced

HIV Disease

Initiative, implemented by CHAI, aims to reduce morbidity and mortality and improve cost efficiencies by accelerating access to affordable, optimal products for preventing, testing and treating key opportunistic infections

Project Countries

Priority Health Products

Malawi, Nigeria,

South Africa, Tanzania, Uganda

and some support in Botswana and

Lesotho

Reduce the price of priority health products through

supply-side market interventions

Coordinate

the market

for

AHD commodities

Unitaid-CHAI

Advanced HIV Disease Initiative

Accelerate product introduction

and build demand for AHD commodities through

catalytic procurement

and adoption and rollout support

CD4

TB urine-LAM

CrAg

LFA rapid test

DiagnosticTB prevention therapyAmphotericin B (classic and liposomal)FlucytosineFluconazole

Therapeutics

Jan. 2019 –

Dec. 20203

Slide5

A number of key barriers are limiting access on both demand and supply sides of the market to these critical AHD commodities (CD4, TB LAM, CrAg LFA, TPT, AmB and L-

AmB, 5FC,

Fluc)

Demand Barriers

Supply Barriers

CD4

deprioritized

in favor of funding VL scale-up limits AHD case-finding

Gaps in national guidelines

lead to uncoordinated implementation of the AHD package of care

Lack of registration

of LAmB and 5FC

Poor implementation

of elements of the AHD package of care,

including inadequate training and facility readiness

Poor community engagement and lack of AHD awareness

Poor visibility

around the size of the CM

treatment

market

Lack of economies of scale

due to small, fragmented, and unpredictable demandHigh prices and long lead times for critical commoditiesLack of prioritization of AHD commodities in donor procurement plans Limited supplier base for AHD diagnostic and treatment products4

Slide6

Key insights from across focal countries are shaping our strategy to accelerate market access and enable successful implementation

Scale-up

of the AHD package of care requires a

coordinated

capacity-based

approach

that leverages existing

capability and expertise

in country

Utilization of

sustainable procurement mechanisms,

such

as the Global Fund’s Wambo platform, will assist in transition of procurement and support greater long-term sustainability for countriesCD4 is the critical gateway for AHD diagnosis and treatment, but there is limited use of CD4 for AHD screening at baseline and in cases of treatment failure

Key insights from

in-country

AHD engagement

Implementation

support from

partners

for training and capacity building

will be required to enable successful national scale-up

5

Slide7

CHAI and partners are working with governments across the product introduction pathway to facilitate rapid introduction of critical AHD commodities in countries

Community engagement

and

sensitization on AHD, and

development of patient literacy materials

on AHD

Include AHD commodities in all

stock and patient monitoring and reporting

tools

Support catalytic procurement in countries and w

ork

with suppliers to

ensure sustainable

supply at affordable pricing

Building the investment case for AHD

, and

u

pdating

national AHD treatment guidelines

based on WHO package of care

Support product registration

of AHD commodities

Coordination of

partners to ensure a capacity-focused AHD package of care

MoH-led AHD implementation plans; develop AHD materials trainings and job aidesAdoptionProduct RegistrationProcurement

Community Engagement

Transition Planning

Facility Level SupportMonitoring Uptake

6

Slide8

Coming Soon: The AHD Toolkit A consortium of partners are working to bring together a consolidated set of AHD materials that are openly accessible for countries to adopt and contextualize for their national AHD programs.

With contributions from:

AHD Toolkit

Text

Text

Text

Text

Text

Job aids

Training

materials

Community

sensitization

Programmatic

Tools

SOPs

As

countries scale up the AHD package of care, it is essential to ensure that strong training and tools are in place to facilitate proper use and drive countries towards the ultimate goal of reducing morbidity and mortality

Toolkit Highlights

HCW training package to diagnose and treat AHD both in hospital and 

ambulatory

care

Clinical

workshops

P

atient flow manualsAdherence counselling toolsFacility posters

7

Slide9

CHAI and Unitaid partnered with AfroCAB to launch a new community initiative for

AHD, kicking off with a Community Advisory Board meeting held in South Africa in March

“The information and knowledge gained in these CAB meetings has been invaluable. The knowledge acquired has enabled the CAB members to be effective in their work and bring this knowledge back to others. It felt like we were the experts.”  

-CAB meeting participant

Over 40 participants from 12 countries

discussed civil society's role in building demand 

around HIV treatment, diagnostics, and

AHD.

Community Advisory Board (CAB)

CAB meeting in Pretoria, South Africa

8

Slide10

“If you want to go fast, go alone. If you want to go far, go together.” Partnership on AHD will be essential to ensuring that we go far – and fast – in achieving our goals of reducing AIDS-related deaths.

Unitaid and CHAI have established an AHD Implementation Steering Committee to ensure effective coordination of efforts among implementers and

funders. Chaired by WHO, the role of the AHD

Implementation Steering Committee is to:

Track progress

on AHD activities and provide strategic input

to ensure activities best meet the needs of PLHIV

Enable collaboration

where there are synergies between

organizations

Share evidence, experience, and learnings

Work in collaboration to

advocate for increased focus on addressing mortality at both global and country levelsThis initiative is calling on all partners – including governments

, donors, suppliers

, implementing

partners & the HIV

community –

to join together to fight

advanced

HIV d

isease

Committee members include:

9

Slide11

Thank you! CHAI’s work in Advanced HIV Disease

is made possible by the generous support and partnership of Unitaid

Thanks to the CHAI team – James

Conroy, Richard Borain, Ikechukwu Amamilo, Katie Lamp, and Tara Schoenborn for contributing to this presentation, and a big thanks to Benvy Caldwell

for leading the planning for this satellite session.

10