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Future challenges for HIV prevention & treatment in high-risk populations Professor Anna Mia Ekström HIV/AIDS & Global Health Research Group
Future challenges forHIV prevention & treatment in high-risk populations
Professor Anna Mia Ekström
HIV/AIDS & Global Health Research Group
People living with HIV: 35.3 (32.2-38.8) million40 000 000
30 000 000
20 000 000
10 000 000
0
People living with HIV in the world
35 000 000
25 000 000
15 000 000
19901991 1992 1993 199419951996 1997 1998 199920002001 2002 2003 200420052006 2007 2008 20092010
5 000 000
Anna Mia Ekström Source: UNAIDS 2011
Anna Mia Ekström, HIV& AIDS Research Group
New HIV infections and AIDS-related deaths
4 000 000
3 000 000
2 000 000
1 000 000
0
Peo
ple
New HIV infections
3 500 000
2 500 000
1 500 000
500 000
19901991 1992 1993 199419951996 1997 1998 199920002001 2002 2003 200420052006 2007 2008 20092010
AIDS-related deaths
2.3 (1.9-2.7) million
1.6 (1.4-1.9) million
Anna Mia Ekström Source: UNAIDS 2011
Anna Mia Ekström, HIV& AIDS Research Group
• Male circumcision
• Prevent mother to child transmission (PMTCT)
• Antiretroviral treatment
• Safer sex (partners, condoms)
• HIV-testing
Methods for hiv-prevention
Anna Mia Ekström, HIV& AIDS Research Group
Real-life effectiveness?
Male circumcision reduced by 60% (?)
Anna Mia Ekström, HIV& AIDS Research Group
Prevention of mother to child transmission (PMTCT) risk down from 33% to<5%.
Anna Mia Ekström, HIV& AIDS Research Group
Source Of Funds
Procurement Agent/Body
Point of 1st warehousing
Point of 2nd warehousing
MEDICAL STORE
PRIMARY HEALTH CARE FACILITYDISTRICT STORE
ZONAL MEDICAL STORE
ESSENTIAL MEDICINES
ARVs MALARIA TB OIARVs Ped
REAGENT Blood safety(+ HIV test)
VACCINES CONDOMS CONTRACEPTIVESMEDICALSUPPLIES
REGIONAL/DISTRICT VACCINE STORE
HEALTH FACILITY
GOVERNMENT
MULTILATERAL DONOR
BILATERAL DONOR
NGO/PRIVATE
AXIOSTEC &CC
T
CRS IMA CUAMMHOSPITAL COLUMBIA HOSPITAL
TEC &CC
T
HEALTH FACILITY
HEALTH FACILITY HOSPITALTEC &CC
T
ZONAL BLOOD SAFETY CENTRE
Point of Distribution
GOVERNMENT
WBGLOBAL
FUND
SIDA
PEPFAR
USAID
UNICEF
WHO
ABBOTT
CSSC
COLUMBIA
PFIZER
JICA
CLINTON
UNITAID
CIDA
CDC
GAVI
CUAMM
HAVARD
NORAD
HOSPITAL
TEC&
CCT
CLINTON
HAVARD
MEDICALSTORE
CRS
SCMS
EGPAF
MOH& SW
AXIOS
UNICEF
JICA
CDC
COLUMBIA
ABBOTT
GAVI
CUAMM
CROWNAGENTS
USAID
TMAP
AXIOS
PATIENT
Weak health systems prevent effective implementation (ARVMAC, KI coordinated EU project)
Source: MOHSW & WHO. Courtesy of Don de Savigny
Anna Mia Ekström, HIV& AIDS Research Group
PMTCT in reality: only 1/10 complete the full program
Anna Mia Ekström, HIV& AIDS Research Group
Antiretroviral treatment: miracle drugs!
Saves lives! Reduce viral load, strenghten the immune defense, reduces risk of transmission by 96%
….but expensive, demans monitoring structures/staff, livlife long adherence due to high drug resistsnce risk and potentially serious side effects
Anna Mia Ekström, HIV& AIDS Research Group
Anna Mia Ekström, HIV& AIDS Research Group
Anna Mia Ekström, HIV& AIDS Research Group
Access to ART up by 60% last 24 months in low and middle income countries
Now: 8 million on ART (dec 2012)
Safer sex? HIV transmission in sexual networks
Man”Bank book””Girl friends”
”Weekend get-away”Anna Mia Ekström, HIV& AIDS Research Group
Vision Research Group
To contribute to evidence-based HIV prevention, treatment and care in resource-poor contexts with high HIV prevalence and among marginalized groups at high risk
Anna Mia Ekström, HIV& AIDS Research Group
Research in populations with high HIV prevalance and in marginalized groups at high risk
Anna Mia Ekström, HIV& AIDS Research Group
Who?
40 senior & affiliated researchers, postdocs, PhD students
Strong international network: universities, public & private partners
How?
Innovative, Interdisciplinary, Implementable!
Virology- clinic-epidemiology-policy
Population-baserade epidemiologiska studies HDSS, RDS, health
systems, qualitative methods, clinical cohorts collaboration with
Karolinska University Hospital and multiple clinics and hospitals abroad
Capacity building & international PhD exchange
ERA evaluation?
Excellent
Research group activities in brief
•
For more information, please see:Research group “HIV/AIDS and Global Health”
http://ki.se/research/[email protected]
AND TODAY:
Asli Kulane/Mohamad Farah: Visuals in health education for Somali immigrants
Keshab Debua: HIV in Nepal: surveillance among marginalized youth
Hanani Tabana: couple testing in South Africa
Rolling ppt on ARVMAC: results from EU project on ART scale-up (plan 8)
Anna Thorson/Susanne Strömdahl: Poster on HIV among MSM (ECDC)
