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
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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
Slide2There 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.
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Slide3A
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
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Slide4The 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
Slide5A 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
Slide6Key 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
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Slide7CHAI 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
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Slide8Coming 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
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Slide9CHAI 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
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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:
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Slide11Thank 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.
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