Fabio Mesquita, MD, PhDDirector of the Brazilian Ministry of Health’s HIV/AIDS and Viral Hepatitis Department
www.aids.gov.br July 23th, 2014
TasP – Leadership perspective The Brazilian Ongoing Experience
HIV Prevalence Rate
Aids Detection Rate
SOURCE: The Brazilian Ministry of Health’s HIV/AIDS and Viral Hepatitis Department (MS/SVS/Departamento de DST, Aids e Hepatites Virais)(1) Cases notified in SINAN and registered in SISCEL/SICLOM by June 30 2012 and declared in the 2000 – 2011 SIMPreliminary data
Det
ectio
n R
ate
Year
Brazil North Northeast Southeast South Midwest
HIV/Aids in Brazil
Deaths due to AIDS, annual average: 12,000
15,000, considering 30% due to underreporting and
misreporting
HIV CONTINUUM of CARE (Cascade) - Brazil 2012
What have we learned?We were relatively successful in controlling the epidemic,
but were finding it hard to move on
Need to strengthen and redirect the national response
How?• Evidence Based Decision• Innovation• Creativity
Classic Prevention
Condoms
Harm Reduction
Enabling Environment
Treatment as Prevention
“The results have galvanized efforts to eliminate the global AIDS epidemic”
Dr. Bruce Alberts, editor of Science magazine
New Testing Algorithms NEW GOVERNMENT DIRECTIVE (DECEMBER 2013)
It introduces five new algorithms aimed at increasing access to testing and
diagnosis Algorithm 1: screening + confirmation -> RT finger prick
Algorithm 2: screening RT finger prick + confirmation Oral Fluid
Algorithm 3: screening 3rd generation immunoassays + confirmation VIRAL
LOAD quantification
Algorithm 4: 4th generation immunoassays as screening + confirmation
VIRAL LOAD quantification
Algorithm 5: combines 3rd generation immunoassay screening followed by
Western Blot/Imunoblot confirmatory test
FOCUS on Key Population
Focus on Key Populations 60 financed projects Use of screening with oral fluid RT technology 4 populations:
Trans Gay and other MSM PUD SW
4567 people tested by July 11
New Treatment ProtocolThe new Clinical Protocol and Therapeutic Guidelines (CPTG) for Treatment of the HIV Infection in Adults was discussed with an Advisory Board of experts, submitted to public consultation for 30 days, and published by Government Directive no. 27, on November 29, 2013.
CPTG is available at:- www.aids.gov.br/pcdt (pdf and html)- Apple stores and Google Play (App)
New Treatment Protocol
One of the highlights amongst the CPTG’s main
new items is a recommendation to initiate
antiretroviral therapy for all HIV positive people,
regardless of CD4, based on the possible impact
on morbidity and mortality, but also on the reduction
of HIV transmission. A Public Health Approach.
Brazil was the first developing country and the third
country in the world to use treatment as prevention
for all people with HIV and in its national
recommendations.
Use of fixed recommended dose for first-line preferred regimen: TDF + 3TC + EFV
Expansion of HIV Management to Primary Care
At the beginning of the AIDS epidemic:- High morbimortality – “AIDS-
deaths”- Few drugs available- Many pills a day- Many side effects- Low treatment success- HIV as acute disease
Specialized services
Specialists
Presently:- Decrease in mortality,
increased survival- Many treatment options- Few pills a day- Few side effects - High treatment success- HIV as chronic disease
New care model
Participation of Primary Care and Specialist Services in caring for PLWHA
Our goal for 2014: at least 100 thousand more people in treatment
New PLWHA on ART in the first semester of each year. Brazil, 2012-14
2014: a 30% increase, approximately, when compared to the same period in 2013
In 2014, the CD4 counts of 40% of the patients who began treatment was greater than 500
Distribution of individuals who began ART according to CD4 counts carried out 6 months earlier at most, by year of beginning in Brazil, 2009-2014*
(*) Up to June 2014.
TasP is integrated with other strategies for a new treatment policy in Brazil
TREATMENT2.0
Adapt delivery systems
Mobilize communities
POC and other
simplified monitoring
Optimize drug
regimens
Reduce costs
Combined fixed doses
VIVA MELHOR SABENDO
New diagnosis algorithms
New treatment protocol –
lines of treatmentHIV Management in
Primary Care
90 / 90 / 90: a Latin America Goal
90 / 90 / 90: a Latin America Goal
90%
90%
90%
90 / 90 / 90: a Latin America Goal
Jun/14
Jun/14
90%
90%
90%
