Scaling-up HIV/AIDS Care and Treatment Including ART
|
|
- Janel Owen
- 5 years ago
- Views:
Transcription
1 Scaling-up HIV/AIDS Care and Treatment Including ART Masami Fujita Medical Officer, HIV/AIDS, WHO/WPRO Phnom Penh, Cambodia December 2004
2 HIV-AIDS global overview millions people already infected 1% current world population 30 millions people already passed away Destroying families, communities, economies Driving poverty, illiteracy Collapsing health systems & social systems Threatening security Entire countries face economic & social collapse 2 WPRO
3 HIV burden in the world 3 WPRO
4 HIV/AIDS burden as of 2004 Adults and children living with HIV/AIDS Adults and children newly infected Adult and child deaths due to AIDS World Asia/Pacific 39.4 million 8.2 million 4.9 million 1.2 million 3.1 million 0.5 million 4 WPRO
5 Widening Gap of AIDS Treatment Yearly deaths as a proportion of 1995 values Introduction of HAART Highly active antiretroviral treatment AIDS deaths in Africa AIDS deaths in Western Europe Source: Adapted from WHO/UNAIDS Statistics, & HIV/AIDS Surveillance in Europe, End- year report 2001, No. 66, CESES 5 WPRO
6 Extensive efforts made ART in resource-limited settings feasible People living with HIV/AIDS play critical role Prices have been dropping Funding is increasing (WB, GFTAM, US, etc.) Country response building on small scale-initiatives 6 WPRO
7 The 3 by 5 Initiative WHO, UNAIDS and partners: Addressing a global public health emergency 400,000 people receive treatment today Treat 3 million by 2005 Measurable, fixed target towards the goal of universal access to ART Accelerating HIV prevention 7 WPRO
8 The 5 pillars of the 3 by 5 strategy Global leadership, strong partnership & advocacy Urgent sustained country support Simplified, standardized tools for delivering antiretroviral therapy Effective, reliable supply of medicines & diagnostics Learn by doing & rapidly identify & reapply new knowledge & successes 8 WPRO
9 Global guiding principles: Three ONEs hone agreed AIDS action framework that provides the basis for coordinating the work of all partners hone national AIDS coordinating authority with broad based multi-sectoral mandate hone agreed country level monitoring and evaluation system 9 WPRO
10 Natural Course of HIV Infection and Common Complications CD4+ cell Count Acute HIV infection syndrome Asymptomatic TB TB HZV OHL PPE OC CMV, MAC PCP CM Months CD4+ T cells Years After HIV Infection VL Relative level of Plasma HIV-RNA WPRO
11 Antriretroviral Treatment (ART) hcontrol of HIV replication hrestoration and/or preservation of immunologic function 8 stabilization or increase in CD4 cell count hreduction of HIV-related complications himprovement of quality of life h Increased survival 11 WPRO
12 Goals of Therapy Plasma HIV-RNA (copies/ml) 1,000, ,000 10,000 1, VL < Goal is Viral load undetectable viral load CD4 12 WPRO 370 M1 M2 M3 M6 M12 M18 M24 Months on triple therapy CD4 count (cells/mm 3 )
13 For successful ART hdo not initiate ARVs too soon: When the CD4 count is high or in patients with no symptoms 8If ARVs are started too soon, the patient will incur the risks of therapy (side effects, viral resistance) without the clinical benefits hdo not initiate ARVs too late: 8If ARVs are started too late, the patient will be at high risk for clinical complications of AIDS However, it is still possible to start ARV in patents with very advanced disease 13 WPRO
14 Manage OIs and other conditions before ART h Stabilize OIs and other acute infections before commencing ART, in principle h TB (next slide) h Treat esophageal candidiasis but commence ART as soon as can swallow pills h Anemia (Hb<8): Look for treatable cause (e.g. blood loss, malaria, MAC, etc.), use no-azt containing regimen h Pregnancy: Commence ART after the 1 st trimester, Avoid EFV for pregnant women or women with the potential h Conditions which may be improved/resolved with ART MAC, CMV, Chronic diarrhea, Skin conditions such as PPE, seborrheic dermatitis 14 WPRO
15 WHO Clinical Stage I Asymptomatic hno weight loss hno symptoms or only: Persistent generalized lymphadenopathy hprophylaxis: INH prophylaxis if eligible hart: Only if CD4< WPRO
16 WHO Clinical Stage II Mild disease h Weight loss 5-10% hsores or cracks around lips (angular cheilitis) h Itching rash (seborrhea or prurigo) hherpes zoster within last 5 years hrecurrent upper respiratory infections such as sinusitis or otitis h Recurrent mouth ulcers hprophylaxis: INH prophylaxis if eligible Cotrimoxazole prophylaxis hart: Only if CD4<200 or TLC <1200/mm3 16 WPRO
17 WHO Clinical Stage III Moderate disease h Weight loss >10% h Oral thrush (or hairy leukoplakia) h More than 1 month: - Diarrhoea - Vaginal candidiasis -Unexplained fever h Pulmonary TB with last year h Prophylaxis: - INH prophylaxis if eligible and able to exclude TB - Cotrimoxazole prophylaxis - Other prophylaxis on treatment plan h ART: - If CD4 not available, treat in all stage 3 - If CD4 available, take into consideration CD4<350 when deciding to treat 17 WPRO
18 WHO Clinical Stage IV Severe disease (AIDS) h HIV wasting syndrome (WL >10% plus either unexplained chronic diarrhea or chronic weakness and unexplained prolonged fever) h Oesophageal thrush, PCP, Extra-pulmonary TB, CMV retinitis, Cryptococcal meningitis, Toxoplasmosis of the brain, HIV encephalopathy, Lymphoma, Invasive cervical cancer, Kaposi sarcoma,, More than 1 month of Herpes simplex ulcerations (>1 month), etc. h Prophylaxis: - INH prophylaxis if eligible and able to exclude TB - Cotrimoxazole prophylaxis - Other prophylaxis on treatment plan h ART: - All in stage 4 are medically eligible (most OI need to be stabilized before ART) 18 WPRO
19 % patients with viral suppression <400 copies/ml Adherence Matters % 70-80% 80-90% 90-95% <95% Percent adherence to therapy From Peterson et al, 6th Conf ROI 1999 abstr #92 19 WPRO
20 Probability of virologic failure In case, drug taking is like this for many months. SUN MON TUE WED THU FRI SAT 50 % 75 % 36 % 20 WPRO
21 Key Elements of Comprehensive HIV/AIDS Care and Treatment HIV Testing & Counseling Pre-test education/counselling HIV testing Post-test counselling Clinical care Management of OIs including TB ART incl. Adherence support Palliative care incl. Symptom & pain Mobilization & coordination of key players incl. PHA Public health and clinical services (incl. TB, ANC/MCH, STI), PHA, CBO, Local authority, FBO and NGO Referral across and within levels for organizing entry points to and continuity of care Promotion of PHA group development and peer support Participation of PHA in planning, implementation and evaluation HIV Prevention Safer sex and condom promotion Harm reduction Universal precautions and PEP PMTCT Psychological & socioeconomic support HIV counselling and spiritual support End of life care Social welfare and legal support Nutritional and daily living support Stigma & discrimination reduction Prolonged quality of life through optimal ART adherence Accelerated HIV prevention 21 WPRO
22 Identifying level of focus for rapid expansion hin Africa where HIV prevalence is very high, decentralized service delivery at PHC/community level is being developed hin selected countries in Asia with HIV prevalence of 0.1-3%, what level of service delivery should be the focus? 22 WPRO
23 Provincial/Tertiary - Management of complicated cases - Specialized services & support Referral up & down District/Intermediate - Comprehensive services including ART & coordination - PHA group formation & peer support Health Centre & Home-Community - ART adherence support -Basic care 23 WPRO
24 District or intermediate level of service delivery as the focus hwith capacity to provide HIV/AIDS clinical management of common OIs & basic ART hhas sufficient numbers of PHAs to form groups his not too far for PHAs to access care (e.g. transportation) hnot too close to home and community where stigma and discrimination is still a barrier 24 WPRO
25 HIV Tests OI Drugs - Prophylaxis - Treatment ARV Drugs Lab for OI diagnosis & ART monitoring Service packages Provincial/tertiary level District/intermediate level Health centre/home-community level 25 WPRO
26 ARV Guidelines WHO December 2003 hfirst line regimen: (d4t or ZDV) + 3TC + (NVP or EFZ) d4t/3tc/nvp AZT/3TC/NVP d4t3tc/efv AZT/3TC/EFV hfixed dose combination (FDC) Never use AZT & d4t together: Antagonistic 26 WPRO
27 Selection of first line regimen hd4t: No lab requirement, 30mg (<60kg), 40mg (>60kg) ZDV: Require hemoglobin check hnvp: Dose escalation first 2 weeks Not for Refampicin containing TB regimen EFV: Not for pregnant women 27 WPRO
28 % of patients progressing Why NOT to use dual and monotherapy 30 Progression to AIDS/Death No therapy Mono-therapy 15 Dual-therapy 10 5 Triple therapy Months JAMA 1998 & CMAJ WPRO
29 4S hstart h (AZT-d4T, NVP-EFV if toxicity) hswitch (to 2 nd line if failure) Symptom based - Occurrence of Stage III, IV conditions (Should not switch in case of IRS) CD4 based - Return of CD4 cell to pre-therapy baseline or below - >50% fall from on therapy CD4 peak level (No other infection to explain transient CD4 decrease) hstop 29 WPRO
30 Substituting and Switching 1st Line ART Regimen d4t to ZDV If neuropathy or pancreatitis and severe anemia If neuropathy or pancreatitis d4t to ddi (or ABC) Substitu te TDF to ABC If renal failure LPV/r to SQV/r 1 st Line d4t+3tc+nvp 2 nd Line Therapeutic Failure TDF+ddI+LPV/r TB/HIV ddi to ABC If clinical hepatitis If severe rash If severe dislipidemia If severe GI intolerance NVP to EFV NVP to EFV LPV/r to NFV (or ATV/r) Switch 30 WPRO
31 Substituting and Switching 1st Line ART Regimen If severe anemia or persistent GI intolerance ZDV to d4t If severe anemia and neuropathy or pancreatitis ZDV to ddi (or ABC) If renal failure TDF to ABC LPV/r to SQV/r 1 st Line ZDV+3TC+NVP 2 nd Line Therapeutic Failure TDF+ddI+LPV/r TB/HIV If clinical hepatitis If severe rash If severe dislipidemia If severe GI intolerance NVP to EFV NVP to EFV LPV/r to NFV (or ATV/r) DISTRICT/REGIONAL LEVEL ddi to ABC Switch LOCAL LEVEL 31 WPRO
32 Substituting and Switching 1st Line ART Regimen Substitu te d4t to ZDV If neuropathy or pancreatitis and severe anemia d4t to ddi (or ABC) Substitu te TDF to ABC If neuropathy or pancreatitis If renal failure LPV/r to SQV/r 1 st Line d4t+3tc+efv Therapeutic Failure 2 nd Line TDF+ddI+LPV/r TB/HIV ddi to ABC If severe CNS symptoms or preganacy If severe dislipidemia If severe GI intolerance EFV to NVP If hepatitis or severe rash EFV to NFV LPV/r to NFV (or ATV/r) Switch 32 WPRO
33 Substituting and Switching 1st Line ART Regimen If severe anemia or persistent GI intolerance ZDV to d4t If severe anemia and neuropathy or pancreatitis ZDV to ddi (or ABC) TDF to ABC If renal failure TB/HIV LPV/r to SQV/r 1 st Line ZDV+3TC+EFV 2 nd Line Therapeutic Failure TDF+ddI+LPV/r ddi to ABC If severe CNS symptoms or pregnancy If severe dislipidemia If severe GI intolerance EFV to NVP If hepatitis or severe rash EFV to NFV LPV/r to NFV (or ATV/r) Switch33 WPRO
34 Main symptoms Neurological Respirotory Cryptococcossis Managing OIs & other conditions at district hospital Disease Prophylaxis Diagnosis Treatment TB P: INH Smear, CXR NTP regimen Bacterial pneumonia P:Cotri. CXR, Smear Antibiotics PCP P&S:Cotri. Clinical, CXR Cotri. Toxoplasmosis TB meningitis Bacterial meningitis S:Fluconazole P:Cotri. S:Pyrimethamine +sulfadiazine Spinal tap, Indian Ink Clinical P: INH Clinical, Spinal tap Clinical, Spinal tap Diarrhea P: Cotri. (Empirical treatment) Amphotericin B, flucytosine, fluconazole, or referral (*) Pyrimethamin+sulfadiazone, or referral (*) NTP regimen Antibiotics Rehydration fluids, loperamide, antibiotics, metronidazole, cotrimoxazole, mebendazole, (ART) 34 WPRO
35 Managing OIs & other conditions at district hospital Main symptoms Skin & mucosal Disease Prophylaxis Diagnosis Treatment Candidiasis Clinical Topical (gentian violet, nystatin or clotrimazole lozenges), fluconazole or ketoconazole Lymphadenop athy Peniciliosis S: Itraconazole Clinical, Smear Amphotericin B, itraconazole, Herpes Simplex Clinical Topical, acyclovir if available Herpes Zoster Clinical Topical, acyclovir if available PPE, Seb.der. Clinical Steroid (ART effective) Fever Septicemia (Empirical treatment) TB P: INH Clinical, Aspitation Antibiotics NTP regimen 35 WPRO
36 An example of laboratory requirement for OI management and ART at district hospital h HIV testing h Complete blood count (CBC) and differential h Pregnancy test hsputum smear for TB hgram and Wright stains h Malaria smears hurinalysis h Chest X-Ray <Preferable> h Alanine Aminotransferase (ALT) hcd4 count hfundoscopy, Spinal tap and Indian Ink stain 36 WPRO
37 A framework for country action on HIV/AIDS Care and Treatment 1. Political commitment, coordination and management: 3 Ones 2. Uninterrupted supply of affordable HIV medicines and diagnostics 3. Scaling up ART integrated into Continuum of Care 4. Equitable access to care including ARV 5. Responding to diverse and changing situation: M&E 6. Accelerating HIV prevention 37 WPRO
38 Uninterrupted supply of affordable HIV medicines and diagnostics hhow can it be integrated into existing drug procurement and supply system? hwhat need to be done differently for HIV medicines and diagnostics? 38 WPRO
World Bank Training Program on HIV/AIDS Drugs
World Bank Training Program on HIV/AIDS Drugs Training Module 3 Selection and Quantification based on the World Bank document Battling HIV/AIDS: A Decision Maker s Guide to the Procurement of Medicines
More informationmedical monitoring: clinical monitoring and laboratory tests
medical monitoring: clinical monitoring and laboratory tests Purpose of monitoring Check on the physical, psychological and emotional condition of the patient Detect other treatable conditions Identify
More informationTHE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010
THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010 The South African Antiretroviral Treatment Guidelines 2010 Goals of the programme Achieve best health outcomes in the most cost-efficient manner
More informationTunisian recommendations on ART : process and results
Second Arab Congress of Clinical Microbiology and Infectious Diseases May 24-26, 2012. Tunisian recommendations on ART : process and results M. BEN MAMOU UNAIDS Email: BenmamouM@unaids.org M. CHAKROUN
More informationGUIDELINES FOR THE USE OF ANTIRETROVIRAL THERAPY IN PAPUA NEW GUINEA
GUIDELINES FOR THE USE OF ANTIRETROVIRAL THERAPY IN PAPUA NEW GUINEA These guidelines were prepared for the Papua New Guinea National AIDS Council and the Papua New Guinea National Department of Health.
More informationUpdates on Revised Antiretroviral Treatment Guidelines Overview 27 March 2013
Updates on Revised Antiretroviral Treatment Guidelines 2013 Overview 27 March 2013 Introduction of Fixed Dose combination (FDC) FDCs will be available in facilities on 1 April 2013 The FDC ARV that will
More informationWESTERN CAPE ART GUIDELINES PRESENTATION 2013
WESTERN CAPE ART GUIDELINES PRESENTATION 2013 The WC guidelines are based on SA National ART guidelines dated 24th March 2013 Acknowledgement goes to members of the Adult and Paediatric HAST policy advisory
More informationINITIATING ART IN CHILDREN: Follow the six steps
INITIATING ART IN CHILDREN: Follow the six steps STEP 1: DECIDE IF THE CHILD HAS CONFIRMED HIV INFECTION Child < 18 months: HIV infection is confirmed if the PCR is positive and the VL is more than 10,000
More informationMDR TB/HIV INTEGRATION MDR TB WORKSHOP 18 SEPTEMBER 2015
MDR TB/HIV INTEGRATION MDR TB WORKSHOP 18 SEPTEMBER 2015 HIV & MDR :Impact of early ART initiation Adjusted HR: 0.14; p = 0.042 86% reduction in mortality with ART Initiation during MDR-TB treatment 2015
More informationFurther publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for
Further publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for South-East Asia, World Health House, Indraprastha Estate,
More informationHIV Treatment Update. Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University
HIV Treatment Update Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University Outline Rationale for highly active antiretroviral therapy (HAART) When to start
More informationRajesh T. Gandhi, M.D.
HIV Treatment Guidelines: 2010 Rajesh T. Gandhi, M.D. Case 29 yo M with 8 weeks of cough and fever. Diagnosed with smear-positive pulmonary TB. HIV-1 antibody positive. CD4 count 361. HIV-1 RNA 23,000
More informationSasisopin Kiertiburanakul, MD, MHS
What s Newin Antiretroviral Therapy? Sasisopin Kiertiburanakul, MD, MHS Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Rotating RCPT,
More informationDifference of opinion? Michelle Moorhouse 24 Sep 2014
Difference of opinion? Michelle Moorhouse 24 Sep 2014 Meet NN 52 years, female Nurse in pre-art clinic Referred Feb 2012 by dermatologist History of severe reactions to ART Erythema and bullous eruptions
More informationFurther publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for
Further publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for South-East Asia, World Health House, Indraprastha Estate,
More information2009 Recommendations for Antiretroviral Therapy in Adults and Adolescents. When to Start and What ART to Use in 1 st and 2 nd Line December 2009
2009 Recommendations for Antiretroviral Therapy in Adults and Adolescents When to Start and What ART to Use in 1 st and 2 nd Line December 2009 Historic Evolution of CD4 Criteria for ART Initiation in
More information2009 Revisions of WHO ART Guidelines. November 2009
2009 Revisions of WHO ART Guidelines November 2009 Guidelines Development Process 01/09 2009 WHO ART guideline revision process Scope of the work 03/09 WHO Guideline review committee approval 04/09 05/09
More informationMeasure #161: HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy
Measure #161: HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy 2012 PHYSICIAN QUALITY REPTING OPTIONS F INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION:
More informationThe NEW ARV Guidelines FAQs
The NEW ARV Guidelines FAQs Dr Madeleine Muller MBChB (Pret).MRCGP(Lon).Dip Hiv Man IYDSA Clinical Advisor Acknowledgments IYDSA for materials and support NDOH for slides CDC our funder HIV Clinician Society
More informationPAEDIATRIC HIV INFECTION. Dr Ashendri Pillay Paediatric Infectious Diseases Specialist
PAEDIATRIC HIV INFECTION Dr Ashendri Pillay Paediatric Infectious Diseases Specialist Paediatric HIV Infection Epidemiology Immuno-pathogenesis Antiretroviral therapy Transmission Diagnostics Clinical
More informationPrinciples of Antiretroviral Therapy
Principles of Antiretroviral Therapy Ten Principles of Antiretroviral Therapy Skills Building Workshop: Clinical Management of HIV Infection and Antiretroviral Therapy, 11 th ICAAP, November 21st, 2011,
More informationManagement of HIV Infected Children and Adolescents: Public Sector Approach in Kenya
Management of HIV Infected Children and Adolescents: Public Sector Approach in Kenya KPA 2018 24-04-2018 Dr. Margaret Wainaina- Wafula Outline Introduction Evaluation of a child living with HIV. Standard
More informationOverview of 2013 WHO consolidated ARV guidelines and update plans. Marco Vitoria HIV/AIDS Department WHO Geneva September 2014
AMDS ANNUAL STAKEHOLDERS AND PARTNERS MEETING Overview of 2013 WHO consolidated ARV guidelines and update plans Marco Vitoria HIV/AIDS Department WHO Geneva September 2014 AMDS ANNUAL STAKEHOLDERS AND
More informationTreatment strategies for the developing world
David A Cooper National Centre in HIV Epidemiology and Clinical Research The University of New South Wales Sydney, Australia First line standard of care First line in the developing world First line failure
More informationUPDATE TRAINING ARV TREATMENT GUIDELINES TRAINERS CASE STUDIES & ANSWER GUIDE
UPDATE TRAINING ARV TREATMENT GUIDELINES TRAINERS CASE STUDIES & ANSWER GUIDE 3/13/2013 Contents Group Work Instructions... 2 PMTCT... 3 Case Study 1: Unbooked Pregnant Women... 3 Case Study 2: First ANC
More informationUpdate on global guidelines. and emerging issues on perinatal HIV prevention. WHO 2013 Consolidated ARV Guidelines
WHO 2013 Consolidated ARV Guidelines Update on global guidelines H I V / A I D S DEPARTMENT and emerging issues on perinatal HIV prevention Children & HIV, St. Petersburg, Russia Sept 25-26, 2014 Dr. Nathan
More informationMedical Challenges of HIV/AIDS pandemic: The WHO perspective. SOLTHIS HIV Forum
Medical Challenges of HIV/AIDS pandemic: The WHO perspective SOLTHIS HIV Forum Marco Vitoria HIV/AIDS Department World Health Organization September 2013 Topic 2002 2003 2006 2010 2013 When to start 1
More informationNational Clinical Symposium
National Clinical Symposium Drug Toxicity Workshop September 14-15, 2006 NCHADS Social Health Clinic Case Study NCHADS Social Health Clinic 1 Case study drug toxicity 34 year-old woman, diagnosed HIV +ve+
More informationWhat's new in the WHO ART guidelines How did markets react?
WHO 2013 ARV Guidelines What's new in the WHO ART guidelines How did markets react? Dr. J. Perriëns Coordinator, HIV Technology and Commodities HIV department, WHO, Geneva When to start in adults Starting
More informationPRIORITIES FOR HIV/AIDS PROCUREMENT AND PRODUCT DEVELOPMENT
PRIORITIES FOR HIV/AIDS PROCUREMENT AND PRODUCT DEVELOPMENT Dr Chewe Luo MMed (Paeds), Mtrop Paed, PhD Senior Adviser and Team Leader Country Programme Scale up HIV Section Programme Division UNICEF, NY
More informationTB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011
TB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011 OUTLINE Background Global Incidence The Problem" The 3 I s Drug Resistant
More informationCare of HIV Infected People
Care of HIV Infected People Patrick Ndase, MD, MPH MTN Annual Meeting Marriott Key Bridge, Arlington, VA April 21-23, 2008 Why Care for HIV infected in such a meeting? Site Core Community Why Care for
More informationTreatment experience in South Africa. Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand
Treatment experience in South Africa Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand Overview South African Prevalence Adherence Combination ddi + d4t Nevirapine Hepatotoxicity
More informationCryptococcosis of the Central Nervous System: Classical and Immune-Reconstitution Disease
Cryptococcosis of the Central Nervous System: Classical and Immune-Reconstitution Disease Assist Prof. Somnuek Sungkanuparph Division of Infectious Diseases Faculty of Medicine Ramathibodi Hospital Mahidol
More informationINTEGRATING HIV INTO PRIMARY CARE
INTEGRATING HIV INTO PRIMARY CARE ADELERO ADEBAJO, MD, MPH, AAHIVS, FACP NO DISCLOSURE 1.2 million people in the United States are living with HIV infection and 1 in 5 are unaware of their infection.
More informationhttp://www.savinglivesuk.com/ HIV Awareness Study Morning 24 th November 2017 Agenda HIV Basics & Stages of HIV HIV Testing, Health Advising & Sexual Health Saving Lives Antiretroviral Medication Antenatal/Postnatal
More information10/17/2015. Chapter 55. Care of the Patient with HIV/AIDS. History of HIV. HIV Modes of Transmission
Chapter 55 Care of the Patient with HIV/AIDS All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. History of HIV Remains somewhat obscure The earlier
More informationHIV: What Every Clinician Needs to Know ARIZONA STATE ASSOCIATION OF PHYSICIAN ASSISTANTS SPRING CONFERENCE BETTIE COPLAN MARCH 2018
HIV: What Every Clinician Needs to Know ARIZONA STATE ASSOCIATION OF PHYSICIAN ASSISTANTS SPRING CONFERENCE BETTIE COPLAN MARCH 2018 Overview Overview recent trends in HIV incidence in the U.S. HIV screening
More informationGoal of this chapter. 6.1 Introduction Good practices for linkage to care General care for people living with HIV 84
Clinical guidelines across THE CONTINuUM OF CARE: LINKING PEOPLE DIAGNOSEd WiTH hiv infection to hiv care and treatment 06 6.1 Introduction 84 6.2 Good practices for linkage to care 84 6.3 General care
More informationINTERNAL QUESTIONS AND ANSWERS DRAFT
WHO CONSOLIDATED GUIDELINES ON THE USE OF ANTIRETROVIRAL DRUGS FOR TREATING AND PREVENTING HIV INFECTION Background: INTERNAL QUESTIONS AND ANSWERS DRAFT At the end of 2012, 9.7 million people were receiving
More information0% 0% 0% Parasite. 2. RNA-virus. RNA-virus
HIV/AIDS and Treatment Manado, Indonesia 16 november HIV [e] EDUCATION HIV is a 1. DNA-virus 2. RNA-virus 3. Parasite 0% 0% 0% DNA-virus RNA-virus Parasite HIV HIV is a RNA-virus. HIV is an RNA virus which
More informationNewly diagnosed HIV patient. Dr. Heila Redpath 06 FEBRUARY 2014
Newly diagnosed HIV patient Dr. Heila Redpath 06 FEBRUARY 2014 PRIMARY HIV INFECTION: SEROCONVERSION SYMPTOMATIC HIV INFECTION AND AIDS ASYMPTOMATIC LATENT INFECTION CLOSED CIRCLES: CD4 cells OPEN
More informationOI prophylaxis When to start, when to stop. Eva Raphael, MD MPH Family and community medicine, pgy-2 University of California, San Francisco
OI prophylaxis When to start, when to stop Eva Raphael, MD MPH Family and community medicine, pgy-2 University of California, San Francisco Learning Objectives o Recognize when to start OI prophylaxis
More informationART TREATMENT PROGRAMME 2004
Presentation title ART TREATMENT PROGRAMME 2004 Cabinet decision in 29 th November 2003 Initial sites were hospital based, required central review National Costing Model of HIV/AIDS Treatment 2010 Cost
More informationSESSION VI: Forecasting, estimating requirements for Procurement of HIV related supplies
ENSURING SECURE and RELIABLE SUPPLY and DISTRIBUTION SYSTEMS in DEVELOPING COUNTRIES, in the CONTEXT OF HIV/AIDS and PMTCT SESSION VI: Forecasting, estimating requirements for Procurement of HIV related
More informationAnnex A: Impact, Outcome and Coverage Indicators (including Glossary of Terms)
IMPACT INDICATORS (INDICATORS PER GOAL) HIV/AIDS TUBERCULOSIS MALARIA Reduced HIV prevalence among sexually active population Reduced HIV prevalence in specific groups (sex workers, clients of sex workers,
More informationARV Consolidated Guidelines 2015
ARV Consolidated Guidelines 2015 This document outlines the draft list of PICO questions to support systematic review process for the 2015 ARV guidelines process. PICO questions are grouped by clinical
More informationhiv/aids Programme Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants
hiv/aids Programme Programmatic update Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants EXECUTIVE SUMMARY April 2012 EXECUTIVE SUMMARY Recent developments
More informationFixed Dose Combination a Simplified Approach to Pediatric Antiretroviral Treatment
Fixed Dose Combination a Simplified Approach to Pediatric Antiretroviral Treatment Dr. David Pugatch Clinton Foundation Phnom Penh, Cambodia February, 2007 Lecture Goals To introduce and define fixed dose
More informationEuropean Guidelines. for the Clinical Management and Treatment of HIV Infected Adults
European Guidelines for the Clinical Management and Treatment of HIV Infected Adults 2005 These Euroguidelines result from the comparison of guidelines from several European countries and from a discussion
More informationGlobal AIDS New Developments in Care
Global AIDS New Developments in Care Royce C. Lin, MD Assistant Clinical Professor of Medicine scope pledge delivery future Adults and children estimated to be living with HIV, 2005 Western & Eastern Europe
More informationLahey Clinic Internal Medicine Residency Program: Curriculum for Infectious Disease
Lahey Clinic Internal Medicine Residency Program: Curriculum for Infectious Disease Faculty representative: Eva Piessens, MD, MPH Resident representative: Karen Ganz, MD Revision date: February 1, 2006
More informationLinkages between Sexual and Reproductive Health and HIV
Linkages between Sexual and Reproductive Health and HIV Manjula Lusti-Narasimhan Department of Reproductive Health and Research World Health Organization The HIV pandemic 25 years 1981 2006 Rationale for
More informationWhy is there not enough coordination and collaboration between programmes to implement collaboration TB/HIV activities
Why is there not enough coordination and collaboration between programmes to implement collaboration TB/HIV activities Olga P. Frolova Head of the TB/HIV Health Care Centre, Ministry of Health Social Development,
More informationScaling Up Treatment in Zimbabwe: The path to high coverage
Scaling Up Treatment in Zimbabwe: The path to high coverage IAS Conference Dr. Tsitsi Mutasa-Apollo ART Programme Coordinator, Zimbabwe 30 th June, 2013 Kuala Lumpur, Malaysia Outline Introduction Background
More informationMedical monitoring: Clinical monitoring and laboratory tests
medical monitoring: clincial monitoring and laboratory tests: 1 medical monitoring: clinical monitoring and laboratory tests Medical monitoring: Clinical monitoring and laboratory tests Aims This section
More informationThe HIV Program UNIT 2 HIV CURRICULUM PARTICIPANT S MANUAL
T F A R D UNIT 2 The HIV Program UNIT 2 BACKGROUND The HIV Program Poverty and lack of access to basic human rights such as adequate nutrition compound the devastating effects of HIV on communities. Comprehensive
More informationImmediate Offer of HIV Treatment: How To Deliver on the Second 90 (including Supply Chain Management and Drug Stockouts)
Immediate Offer of HIV Treatment: How To Deliver on the Second 90 (including Supply Chain Management and Drug Stockouts) Roselyne TOBY,MD, ID specialist Infectious Disease Unit/Yaounde Central Hospital
More informationDifferentiated Care Improving Engagement and Retention in HIV Care. Meg Doherty, MD PhD MPH World Health Organization
Differentiated Care Improving Engagement and Retention in HIV Care Meg Doherty, MD PhD MPH World Health Organization Why differentiated care and how can it facilitate epidemic control Effects on linkage,
More informationDiagnosis and Initial Management of HIV/AIDS: What the Primary Care Provider Should Know
Diagnosis and Initial Management of HIV/AIDS: What the Primary Care Provider Should Know Carolyn K. Burr, EdD, RN Co-Clinical Director Deputy Director François-Xavier Bagnoud Center December 17 th, 2013
More informationCan we treat our way out of the HIV epidemic?
Can we treat our way out of the HIV epidemic? Richard E. Chaisson, MD Center for AIDS Research Center for TB Research Johns Hopkins University Schoolboy s (and politician s) tricks for evading the question
More informationBASIC HIV COURSE EXAMINATION
[Pick the date] HU CFAR BASIC HIV COURSE EXAMINATION [Type the author name] The mission of the Harvard University Center for AIDS Research (HU CFAR) is to expand, promote, and facilitate collaborative,
More informationModule 6: ARVs in Children
Module 6: ARVs in Children Module Objectives To review the use of ARVs in children and their impact on disease progression To provide nurses with a general understanding of the differences in ARV use in
More informationPaediatric ART: eligibility criteria and first line regimens. (revised) Dave le Roux 13 August 2016
Paediatric ART: eligibility criteria and first line regimens (revised) Dave le Roux 13 August 2016 Outline Eligibility criteria for starting ART Evolving evidence for earlier ART W Cape, National, WHO
More informationPresented by: Melissa Egan, Regional Health Education Coordinator, CATIE Date: Tuesday October 8th, 2013, 1 2pm EST
Presented by: Melissa Egan, Regional Health Education Coordinator, CATIE Date: Tuesday October 8th, 2013, 1 2pm EST Agenda 1. HIV and the immune system 2. The progression of untreated HIV 3. Monitoring
More informationBHIVA Clinical Audit. Management of patients who switch therapy; re-audit of patients starting therapy from naïve
BHIVA Clinical Audit Management of patients who switch therapy; re-audit of patients starting therapy from naïve 1 2004-5 5 audit projects Reporting now:! Survey and case note review of patients switching
More informationAdapting Treatment 2.0 in Viet Nam - Toward Universal and Sustainable Access -
Adapting Treatment 2.0 in Viet Nam - Toward Universal and Sustainable Access - Associate Professor, Bui Duc Duong, MD, Ph.D. Deputy Director General, Ministry of Health Socialist Republic of Viet Nam HIV
More informationFirst line ART Rilpirivine A New NNRTI. Chris Jack Physician, Durdoc Centre ethekwini
First line ART Rilpirivine A New NNRTI Chris Jack Physician, Durdoc Centre ethekwini Overview: Rilpirivine an option for ARV Naïve patients History Current guidelines Efficacy and Safety Tolerability /
More informationUPDATE ON THE CLINICAL MANAGEMENT OF HIV IN BARBADOS
UPDATE ON THE CLINICAL MANAGEMENT OF HIV IN BARBADOS 82 nd UWI/ BAMP CME November 18th and 19th, 2017 Tiffany Jordan, MB BS Locum Clinical Medical Officer, Ladymeade Reference Unit OBJECTIVES 1. Epidemiology
More informationNatural History of Untreated HIV-1 Infection
Opportunistic infections Dr. Guido van den Berk December 2009 HIV [e] EDUCATION Natural History of Untreated HIV-1 Infection 1000 + CD4 Cells 800 600 400 Constitutional Symptoms Early Opportunistic Infections
More informationImmune Reconstitution Inflammatory Syndrome. Dr. Lesego Mawela
Immune Reconstitution Inflammatory Syndrome Dr. Lesego Mawela TOPICS FOR DISCUSSION IRIS Case Epidermiology Pathogenesis of IRIS Risk factors for IRIS Epidemiology of IRIS Health system burden of IRIS
More informationIs current first line ART good enough? Francois Venter Wits Reproductive Health & HIV Research Institute
Is current first line ART good enough? Francois Venter Wits Reproductive Health & HIV Research Institute Results: by April 2011 Budget: $3.5 billion 80% of 3,686 health facilities providing ARVs 50% ARV
More informationOutline. A 41 Year-old Male COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH. Q1: What anti-fungal regimen would you start?
Outline COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH Considerations for antiretroviral use in patients with coinfections Concerning and how to manage drug-drug interactions ARV-other drugs
More informationStrategic use of antiretroviral drugs to prevent HIV transmission
Strategic use of antiretroviral drugs to prevent HIV transmission 22th Tunisian Congress of Infectious Diseases 2nd Congress of Federation of Arab Societies of Clinical Microbiology and Infectious Diseases
More informationFigure S1: Overview of PMTCT Options A and B. Prevention of Mother to Child HIV Transmission (PMTCT)
Figure S1: Overview of PMTCT Options A and B Prevention of Mother to Child HIV Transmission (PMTCT) Option A: combined Antiretroviral therapy (ART) for all women meeting WHO 2010 criteria for initiation
More informationProgram to control HIV/AIDS
90-90-90 Program to control HIV/AIDS Hamid Sharifi Associate Professor in Epidemiology [sharifihami@gmail.com] 1 Targets for ending the AIDS epidemic 2 New HIV infections in low- and middle-income countries,
More informationClinical Management Guidelines 2012
Central American Course Monitoring and Evaluation for HIV/AIDS Policy and Program Management 1 2 3 4 Module 1 Unit 1 Clinical Management Guidelines 2012 National TB, HIV/AIDS & other STIs Programme Ministry
More informationPage 1. Outline. Outline. Building specialized knowledge: HIV. Biological interactions. Social aspects of the epidemic. Programmatic actions
Harvard-Brazil Collaborative Public Health Field Course January 2014 Lecture # 8 Building specialized knowledge: HIV Aluisio Segurado Department of Infectious Diseases School of Medicine, University of
More informationART for prevention the task ahead
ART for prevention the task ahead Dr Teguest Guerma WHO/HQS WHO's role and vision Status of the epidemic Overview Progress and challenges in treatment and prevention scale up ART for prevention Questions
More informationScaling up priority HIV/AIDS interventions in the health sector
TOWARDS UNIVERSAL ACCESS? Scaling up priority HIV/AIDS interventions in the health sector Yves Souteyrand, WHO October 2011 Towards universal access targets UN General Assembly High level Meeting June
More informationOutline. Aim with PMTCT. How are children transmitted. Prevention of mother-to-child transmission of HIV. How does HIV transmit to children?
Prevention of mother-to-child transmission of HIV Outline AimofPMTCT How HIV is transmitted to children Epidemiology of HIV in children How to reduce HIV transmission to children Guidelines Lars T. Fadnes
More informationClinical Case Scenario. HIVeEducation Workshop, Sint Maarten 2009
Clinical Case Scenario HIVeEducation Workshop, Sint Maarten 2009 Background Mrs. S is a 34 year-old woman who was referred from the VCT center after testing HIV positive three weeks ago. Her husband recently
More informationJOINT WHO/UNAIDS/UNICEF STATEMENT ON USE OF COTRIMOXAZOLE AS PROPHYLAXIS IN HIV EXPOSED AND HIV INFECTED CHILDREN
JOINT WHO/UNAIDS/UNICEF STATEMENT ON USE OF COTRIMOXAZOLE AS PROPHYLAXIS IN HIV EXPOSED AND HIV INFECTED CHILDREN WHO, UNAIDS and UNICEF, guided by recent evidence, have agreed to modify as an interim
More informationANTIRETROVIRAL THERAPY IN NAMIBIA
ANTIRETROVIRAL THERAPY IN NAMIBIA SAHIVCS CONFERENCE CAPETOWN 25-28- NOVEMBER 2012 DR. F. MUGALA MUKUNGU M.MED (INT.MED) SPECIALIST PHYSICIAN KATUTURA STATE HOSPITAL WINDHOEK NAMIBIA Current status in
More informationDEPARTMENT. Treatment Recommendations for. Pregnant and Breastfeeding Women: Critical Issues Consolidated ARV Guidelines. Dr.
2013 Consolidated ARV Guidelines H I V / A I D S Treatment Recommendations for DEPARTMENT Pregnant and Breastfeeding Women: Critical Issues Dr. Nathan Shaffer Objectives of Presentation obackground ooverview
More informationWhen to start: guidelines comparison
The editorial staff When to start: guidelines comparison The optimal time to begin antiretroviral therapy remains a critical question for the HIV field, and consensus about the appropriate CD4+ cell count
More informationversus CD4. PoC - Messaging - Specificity and - Ethics sensitivity of HIV - Feedback from diagnostic tests demonstration projects
PRE-CONFERENCE WORKSHOPS WEDNESDAY, 24 OCTOBER 2018 10h00 14h00 Pre-Conference Workshop Pre-Conference Workshop Pre-Conference Workshop Pre-Conference Workshop ITREMA trial feedback PrEP for the private
More informationTUBERCULOSIS AND HIV/AIDS: A STRATEGY FOR THE CONTROL OF A DUAL EPIDEMIC IN THE WHO AFRICAN REGION. Report of the Regional Director.
30 August 2007 REGIONAL COMMITTEE FOR AFRICA ORIGINAL: ENGLISH Fifty-seventh session Brazzaville, Republic of Congo, 27 31 August Provisional agenda item 7.8 TUBERCULOSIS AND HIV/AIDS: A STRATEGY FOR THE
More informationHIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA
HIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA Dr Irene Mukui National AIDS & STD Control Programme 1 Outline Introduction HIV trends and current Statistics Access to ART Successes Challenges 2
More informationADDRESSING MDR TB IN THE CONTEXT OF HIV: Lessons from Lesotho. Dr Hind Satti PIH Lesotho Director MDR-TB program
ADDRESSING MDR TB IN THE CONTEXT OF HIV: Lessons from Lesotho Dr Hind Satti PIH Lesotho Director MDR-TB program TB Situation in Lesotho 12,275 TB new cases notified in 2007 Estimated prevalence of 544
More informationFurther publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for
Further publications can be obtained from the HIV/AIDS Unit, Department of Communicable Diseases, World Health Organization, Regional Office for South-East Asia, World Health House, Indraprastha Estate,
More informationWorld Health Organization. A Sustainable Health Sector
World Health Organization A Sustainable Health Sector Response to HIV Global Health Sector Strategy for HIV/AIDS 2011-2015 (DRAFT OUTLINE FOR CONSULTATION) Version 2.1 15 July 2010 15 July 2010 1 GLOBAL
More informationClinical Manifestations of HIV
HIV Symptoms Diane Havlir, MD Professor of Medicine and Chief, HIV/AIDS Division University of California, San Francisco (UCSF) WorldMedSchool; July 2, 2013 1 Clinical Manifestations of HIV! Result from
More informationInfertility Treatment and HIV
Infertility Treatment and HIV Infertility Treatment by IVF Or Intra-cytoplasmic Sperm Injections (ICSC) In Chronic HIV-1 Sero- discordant Couples (Poster 670) Retrospective study of outcome of IVF or ICSC
More informationAntiretroviral therapy for adults and adolescents KEY MESSAGES. HIV/AIDS Department BACKGROUND
KEY MESSAGES New WHO Recommendations: Antiretroviral therapy for adults and adolescents The World Health Organization (WHO) is revising its guidelines on antiretroviral therapy (ART) for adults and adolescents.
More informationThe New National Guidelines. Feeding in the Context of HIV. Dr. Godfrey Esiru; National PMTCT Coordinator
The New National Guidelines (2010) for PMTCT and Infant Feeding in the Context of HIV Dr. Godfrey Esiru; National PMTCT Coordinator Presentation outline Evolution of the PMTCT guidelines in Uganda Rational
More informationINH Prophylaxis Therapy (IPT) should NOT be implemented for all HIV patients in the Asia Pacific
INH Prophylaxis Therapy (IPT) should NOT be implemented for all HIV patients in the Asia Pacific Thuy Le, MD DPhil Duke University School of Medicine, USA Oxford University Clinical Research Unit Hospital
More informationHIV Lecture. Anucha Apisarnthanarak, MD Division of Infectious Diseases Thammasart University Hospital
HIV Lecture Anucha Apisarnthanarak, MD Division of Infectious Diseases Thammasart University Hospital End-2001 global estimates for children and adults People living with HIV/AIDS New HIV infections in
More informationChildren and AIDS Fourth Stocktaking Report 2009
Children and AIDS Fourth Stocktaking Report 2009 The The Fourth Fourth Stocktaking Stocktaking Report, Report, produced produced by by UNICEF, UNICEF, in in partnership partnership with with UNAIDS, UNAIDS,
More information1. Africa Centre for Health and Population Studies 2. London School of Hygiene and Tropical Medicine 3. University College London
A systematic review of the effects of interrupted antiretroviral interventions for prevention of mother-to-child transmission of HIV on maternal disease progression and survival Naidu KK 1, Mori R 2, Newell
More information