TB/HIV in the Americas Review of Progress, Barriers and Successes

Transcription

1 TB/HIV in the Americas Review f Prgress, Barriers and Successes Dr. Massim N Ghidinelli Unit Chief HIV, Hepatitis, TB and STI Pan American Health Organizatin 19 th Cre Grup Meeting f the Glbal TB/HIV Wrking Grup Washingtn, DC, USA 11 February 2104

2 Outline Current situatin f TB, HI and TB/HIV in the Americas Prgress in implementatin f TB/HIV cllabrative activities Existing barriers and challenges t implementatin Opprtunities and nging reginal initiatives

3 ODM referids a TUBERCULOSIS Meta 6c: Detener y cmenzar a revertir la incidencia de VIH, malaria, TB.. Indicadr 6.9: Disminuir la prevalencia y mrtalidad de TB de 50% al 2015 respect a cass de TB n fuern diagnsticads ntificads

4 ART Cverage Antiretrviral therapy cverage (%) in Latin America and the Caribbean, per year, 2010 t 2012 Cverage ART< 15 years ld: 67% (50%-82%) Latin America: 73% Caribbean: 45% Latin America and the Caribbean Latin America Caribbean UNAIDS. Cuntry reprts n the advances in the wrld respnse t AIDS and estimates f UNAIDS n needs fr treatment based n threshld f CD4 f 350 cell./mm3.

5 ART cverage (%) Cverage f the antiretrviral therapy (%) in Latin America and the Caribbean, per cuntry, 2011 and 2012 Andean Caribbean Suthern Cne Mes America Reginal cverage:75%

6 Prgram tipping pint in the respnse t HIV in LAC, 2002 t 2012 Reginal value 2012: 0.9 New infectins Newly initiated n ART Data n newly start f antiretrviral treatments: WHO. Natinal reprts n prgress tward universal access, New infectin data: UNAIDS. Estimates f new infectins. Geneva, 2013.

7 New infectins / Newly initiated n ART Prgram tipping pint in the respnse t HIV: rati f new HIV infectins in patients wh begin ART, LAC, Reginal value: 0.9 Patients wh begin ART frm Natinal reprts f prgress tward universal access 2013 (WHO). New infectins, UNAIDS. Estimates f new infectins. Geneva, 2013.

8 HIV testing and early access t HIV diagnsis and care: % with late diagnsis Percentage f patients with baseline CD4 <200 cel/mm 3 in LAC, In half f the cuntries 40% r mre f patients present an advanced immunlgical stage (<200 cell/mm 3 ) in their 1st CD4 determinatin

9 Current situatin f TB/HIV in the Americas Cuntries with highest estimated number f HIV psitive incident TB cases in the Americas Cuntries with highest estimated rate f HIV amng incident TB cases in the Americas Brazil Haiti Mexic Clmbia Guatemala Venezuela United States Ecuadr Dminican Republic Peru 4,300 16,000 1,600 1,600 1,500 1,200 1, ,000 10,000 15,000 Haiti Guyana Guatemala St. Vincent & the Grenadines Suriname Belize Brazil Trinidad & Tbag Panama Ecuadr Number Rate per 100,000 ppulatin Surce: Reginal TB Reprt 2012

10 Current situatin f TB/HIV in the Americas Prprtin f TB patients tested fr HIV and prprtin with psitive results the Americas, % 50% 43% 44% 50% 54% 56% 57% 40% 30% 20% 16% 17% 17% 16% 16% 16% 10% 0% % f ntified TB cases HIV tested % f HIV tested psitive Surce: Reginal TB Reprt 2012

11 Current situatin f TB/HIV in the Americas Américas Santa Lucía Brasil Blivia Belice Barbads Antigua y Barbuda Guatemala Cuba Venezuela Perú El Salvadr Paraguay Nicaragua Hnduras Surinam San Vicente y las Granadinas Panamá Bahamas Guyana República Dminicana Haití Puert Ric Clmbia Trinidad y Tbag Méxic Uruguay Percentage f ntified TB/HIV cases receiving ART (data frm 26 cuntries ut f 36) 2012 Surce: Reginal TB Reprt % 20% 40% 60% 80% 100%

12 Current situatin f TB/HIV in the Americas Cuntries screening fr TB amng PLWH and prviding IPT the Americas 2012 Infrmatin n peple with HIV screened fr TB is very limited. Only 9 cuntries reprt n peple with HIV given IPT, mst f which are frm Haiti. Cuntry Peple with HIV given IPT Antigua and Barbuda 1 Cuba 1,339 Grenada 0 Guyana 154 Haiti 15,283 Hnduras 286 Nicaragua 230 Paraguay - Peru 1,416 Saint Lucia 1 Saint Vincent & the Grenadines - Ttal 18,710 Surce: Reginal TB Reprt 2012

13 Current situatin f TB/HIV in the Americas Percentage f TB/HIV ntified cases with CPT frm 16 reprting cuntries ut f 36 - the Americas 2012 Average Saint Lucia Panama Puert Ric Cuba Nicaragua Guyana Mexic Dminican Republic Saint Vincent & the Granadines El Salvadr Paraguay Haiti Hnduras Antigua & Barbuda Bahamas Trinidad & Tbag 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Surce: Reginal TB Reprt 2012

14 Prgress in implementatin f TB/HIV cllabrative activities All cuntries in the Americas are currently implementing TB/HIV cllabrative activities thugh at varius degrees Cllabratin between TB and HIV prgrammes ranges frm frmal t very infrmal, mre structured in settings with high TB/HIV c-infectin rates* Jint TB/HIV nrms and guidelines are being develped by natinal prgrammes Addressing TB/HIV a pririty fr all TB prgrams, increasingly s fr HIV prgrammes PAHO s new HT Unit expected t bst jint TB/HIV cllabratin * Surce: TB/HIV Reginal survey 2012

15 Existing barriers and challenges t implementatin TB/HIV jint planning partial r inexistent in several cuntries, unclear definitin f respnsibilities, activities and allcatin f resurces between the tw prgrams* Prvisin f TB and HIV services discnnected in mst cuntries with centralized HIV services and decentralized TB services* Inapprpriate metrics, limited data especially fr TB screening, CPT and IPT Infectin cntrl measures are nt fllwed adequately in many health facilities* * Surce: TB/HIV Reginal survey 2012

16 Onging reginal initiatives 1. Demnstrative prject n integratin f TB and HIV service prvisin t ptimize management f TB/HIV c-infected patients Hnduras and Dminican Republic Phased implementatin: sites selectin, assessment f TB & HIV service delivery, develpment f an integratin mdel (SOP), implementatin, in depth mnitring Currently in the frmative assessment phase. Use f quantitative and qualitative analysis Preliminary results frm Hnduras shw sme degree f TB and HIV cllabratin in place but significant fragmentatin, delays in diagnsis and treatment and lss t fllw-up Presentatin f results/reginal framewrk/tls at frthcming TB/HIV Cnsultatin

17 Onging reginal initiatives 2. Develpment and pilting f Reginal Infectin Cntrl practical guidelines based n WHO s IC plicy Cncrete steps fr implementatin f administrative, envirnmental and persnal prtectin measures at natinal, sub-natinal and health facility levels, as well as in cngregate settings and at the patient s hme Pilted in El Salvadr jintly by TB, HIV and health systems prgrams in cllabratin with prisn system Results t be available during secnd semester f 2014 This will guide implementatin f recmmendatins acrss the Regin

18 Onging reginal initiatives 3. TB/HIV: an integral part f TB Cntrl in Big Cities This framewrk is being implemented in three cities in the Regin in 2013: Lima (Peru), Bgtá (Clmbia) and Guarulhs/Sa Paul (Brazil) Fstering plitical cmmitment f natinal and lcal authrities; based n epidemilgical data and mapping f frmal and infrmal health prviders; adaptatin f health services t the needs f ppulatins at risk fr TB; inter-prgramatic apprach; and incrpratin f TB patients in existing scial prtectin schemes TB/HIV cllabrative activities are an imprtant cmpnent f the framewrk as rates f c-infectin are highest in big cities

19 Cnclusins 1. Despite prgress in implementing TB/HIV cllabrative activities, impact results still limited 2. Universal Health Access and fcus n Health System Strengthening t push integratin/synergies amngst Disease Cntrl Prgrammes 3. Pririties: prgrammatic synergies, jint planning (GF), service delivery mdels (PHC riented), metrics 4. Reginal initiatives t fster lcal-level implementatin and integratin