Creating a broader-based response to treatment failure and HIV drug resistance

Transcription

1 Creating a broader-based response to treatment failure and HIV drug resistance Addy Chen Coordinator, MSM+ Working Group Asia Pacific Network of People Living with HIV/AIDS (APN+)

2 Treatment Failure in Asia Adult China: 25% of patients in the national program met CD4 failure criteria after median 25 months 1 Thailand: ~4% of patients in the national program switched due to failure at median 1.6 years 2 Pediatric Single cohort data of children switched Chennai: 19% by median 34.5 months 3 Chiang Mai: 9-13% by ~200 weeks 4,5 TREAT Asia survey: 20% of children on their second or higher ART regimen 6 1) Zhang F, et al. Ann Intern Med, Aug 09. 2) Chasombat S, et al. JAIDS, Apr 09. 3) Kumarasamy N, et al. J Trop Ped, Oct 08. 4) Puthanakit T, et al. PIDJ, Oct 07. 5) Jittamala P, et al. PIDJ, Sep 09. 6) Prasitsuebsai W, et al. In revision.

3 Background TASER as part of global program to build capacity to monitor drug resistance PharmAccess and Aids Fonds, Netherlands Opportunity to highlight challenges of managing treatment failure International Civil Society Support, Netherlands AIDS Research Information for Asia Understanding treatment failure First TREAT Asia Report story to be translated into an Asian language

4 Think Tank Developing a Science-to-Community Partnership on Treatment Failure Participants Community Paul Cawthorne, MSF Access Campaign Addy Chen, APN+ Yuitiang Durier, Siriraj Hospital Rico Gustav, APN+ Pathompong Serkpookiaw, APN+ Science Jintanat Ananworanich, HIV-NAT Wasana Prasitsuebsai, Siriraj Hospital 3 TREAT Asia staff

5 Goal of Think Tank Science Clinical/Research Community Treatment literacy Advocacy Viral load, second-line antiretrovirals

6 Specific Objectives Assess existing education and advocacy activities on treatment failure and second-line drug access in the region Who are these activities targeted towards? Clinicians/researchers, HIV-positive community, policy makers Identify opportunities for increasing linkages between the scientific community, clinicians, and community around treatment failure and drug resistance Are there platforms for combined advocacy? Propose core components of a pilot science-tocommunity linkage project

7 Challenges in the Clinical Setting Lack of appropriate educational tools to explain treatment failure, resistance More graphics, less text Patients in Thailand not receiving viral load testing, even when it is available Reminders to clinicians? Adherence is just one part of the equation Growing recognition among clinicians, but not patients, that use of CD4 alone to identify treatment failure not reliable

8 AIDS Care China and TREAT Asia Supported by GSK Positive Action

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10 Community Experience Educational tools for treatment literacy often include only first-line ART and basic adherence Lack of community awareness on the need for and the availability of lab testing services Few community treatment experts available to explain complexities of ART outside the clinic Approachable, accessible, speak local languages Research advances in complex scientific language Country-specific challenges Paying for ART access or ARVs up front Mistrust of generic drug quality

11 Research Priorities Limited scientific evidence to inform guidelines on frequency of viral load monitoring or using targeted viral load to assess for treatment failure Drug toxicity issues Available pharmacokinetic data demonstrating variable LPV/r levels in Asian patients Hyperlipidemia with PI use Tenofovir in children

12 Regional Advocacy Loss of direction in the advocacy community after initial roll-outs of first-line ART ARV stock-outs a persistent problem Need to improve the quality of 1 st -line ART as a way to delay treatment failure Expanding access to and reducing cost of second-line ART and viral load testing can be focal points for advocacy Concerns for global reductions in HIV funding

13 Opportunities Community education Expand standard treatment literacy to include more discussions of failure and second-line Encourage development of community treatment experts Advocacy First-line: once-daily, potent FDC Second-line: consistent drug access and quality Research Identify best regimen(s) after NNRTI failure Adult and pediatric Viral load monitoring and/or targeted use to assess failure Drug toxicity

14 Approaches Involve the community To help develop and then deliver a second generation of treatment literacy information Engage medical providers and policy makers Local clinics and university centers Take strategic action on different levels at the same time Develop key media messages to raise awareness

15 Fund the fight against HIV/TB We are watching you IAS Cape Town 2009, Kenneth Cole Productions, 2005

16 TREAT Asia Next Steps Evaluate how existing treatment literacy materials convey messages on treatment failure Research literacy Community Advisory Boards (CAB) Translating research data into lay language Work with local advocacy groups and TREAT Asia network investigators to identify common areas for collaboration