Measuring Impact PHIA Findings from Malawi, Zimbabwe, and Zambia

Transcription

1 Measuring Impact PHIA Findings from Malawi, Zimbabwe, and Zambia Thokozani Kalua MBBS MSc Department of HIV and AIDS, Ministry of Health, Malawi 11 th INTEREST Workshop Lilongwe, Malawi, 19 May 2017

2 Nothing to disclose

3 What is PHIA? Population-based HIV Impact Assessment Cross-sectional household-based survey Nationally and sub-nationally (zonal) representative Focused on measuring impact-level indicators of the HIV epidemic through biomarkers and self-reporting

4 PHIA objectives Primary To estimate national HIV incidence To estimate sub-national prevalence of viral load suppression among adults Secondary To estimate national and sub-national prevalence among adults, >15 years To estimate national prevalence of HIV among children, <15 years To estimate presence of detectable antiretrovirals in HIV-positive adults and children To estimate the prevalence of transmitted drug resistance

5 Three-Country Overview Three countries: Similar population sizes Generalized HIV epidemic Contiguous Clade C Zambia Population: 15,967,000 Malawi Population: 17,750,000 Zimbabwe Population: 16,717,000

6 Survey methods Survey Design Sample size Eligibility Questionnaires Specimen Data collection Weighting Cross-sectional, two-stage cluster sample to achieve nationally representative sample Powered for national HIV incidence and subnational viral load suppression; ~30,000 participants, incl. 5,000 10,000 children Household members who slept over the night before Household, adult and adolescent interviews collecting demographic, behavioral and clinical information Whole blood for HIV, syphilis and hepatitis B testing Electronic data capture ~ six months of field work Adjustment for non-response at PSU, household, individual and biodata-levels; Post-stratification adjustment to make survey estimates of national age/sex counts conform to the counts given in the population projections

7 Laboratory methods Household Venous blood draw; finger/heel stick for <2 yrs HIV rapid testing per each national algorithm; CD4 for HIV+ Return of HIV rapid test results and counseling Satellite Lab Central Lab (in-country) Other Testing HIV confirmatory testing Quality assurance testing HIV RNA (viral load measurement) Early infant diagnosis: detection of HIV DNA in children 0 18 months old HIV-1 LAg-Avidity enzyme immunoassay Incidence (recency): LAg < 1.5 ODn and VL > 1000 copies/ml ARV detection Genotyping and drug resistance

8 Results from Malawi, Zimbabwe and Zambia

9 Response Rate - Household

10 Response Rate Interview and blood draw with HIV testing

11 Adult HIV Prevalence (Females: 15-49; Males: 15-54)

12 HIV Prevalence in children, 0-14 years

13 Annual HIV Incidence (15-49 years)

14 Viral Suppression in Adults (15-59) Living with HIV

15 Progress to 90/90/90 targets in adults

16 Overall conclusions Progress toward the goals in Malawi, Zambia and Zimbabwe demonstrates that the national HIV programs have made great strides in responding to their HIV epidemics PHIA estimates of national HIV incidence provide further evidence of epidemic control The goal of ending the AIDS epidemic by 2030 is within reach, provided there is targeted HIV testing, especially for men and young women and continued expansion of HIV treatment programs

17 Acknowledgements Government of Zimbabwe, Ministry of Health and Child Care National AIDS Council, Zimbabwe Ministry of Health, Zambia National Statistics Office, Malawi National AIDS Commission, Malawi ZIMSTAT BRTI Lancet Zimbabwe Central Statistical Office, Zambia Tropical Diseases Research Centre, Zambia University Teaching Hospital, Zambia Ministry of Health, Malawi Blantyre Health Research and Training Trust, Johns Hopkins University Laboratories Centre for Social Research, Malawi CDC Malawi CDC Zimbabwe CDC Zambia CDC Atlanta ICAP New York ICAP Zimbabwe ICAP Zambia ICAP Malawi ICAP South Africa Reginal Office PHIA study participants and field teams This project is supported by the U.S. President s Emergency Plan for AIDS Relief (PEPFAR) through CDC under the terms of cooperative agreement #U2GGH The contents are the responsibility of ICAP and do not necessarily reflect the views of the United States Government. The mark "CDC" is owned by the US Dept. of Health and Human Services and is used with permission. Use of this logo is not an endorsement by HHS or CDC of any particular product, service, or enterprise.

18 Thank you for your attention