treatment challenges of 2 nd /3 rd line hiv/aids, hepatitis-c in seychelles by dr louine morel
TRANSCRIPT
Treatment challenges of 2nd/3rd line HIV/AIDS, hepatitis-C in Seychelles BY DR LOUINE MOREL
Presentation outline Local Situation
Treatment availability
Advantages
Challenges
Way forward
Local Situation (source MOH Seychelles)
SUMMARY HIV & AIDS FROM 1987 TO JUNE 2014
Cumulative HIV Cases 608 (356M/252F)
Cumulative AIDS Cases 267 (165M/102F) Cumulative
Deaths 125 (75M/50F)
Cumulative HIV Positive Pregnancies 103
Living with HIV & AIDS 397 (226M/171F)
Cases on HAART 228 (124M/104F)
Left Seychelles 86 (55M/31F)
Cumulative Loss to Follow-Up cases 80 (53M/27F)
Cumulative Drop-Outs on HAART 36 (19M/17F)
Defaulter on treatment (>3 months) representing 14% of the HIV & AIDS clients eligible for treatment as per WHO recommended guidelines.
HEPATITIS C Since 2002 to June 2014
a cumulative of 440 cases of Hepatitis C of which 360(82%) were males and 80(18%) were females.
Out of the 440 cases, 36 (27M/9 F) had HIV and Hepatitis C Co-infection and 13 (7M/6F) Hepatitis C related deaths.
99% of cases are injecting drug users. Minimal access to services
Poor uptake on the Hepatitis B vaccination program
Treatment availability Antiretroviral
1st Line(NNRTI Base): 38% 2nd line(Protease Inhibitor base): 62% 3rd Line: 0%
397 PLWHIV: 60% on treatment
Treatment Availability Hepatitis C management
No treatment available
Interferon gamma used for other diseases
NO RIBAVIRIN at the moment
Follow-up of Hepatitis C patients: Blood test 2 time per year/ Annual Liver Ultrasound
Laboratories facilities: ill equipped: No genotyping no viral load available
R50million needed to treat Hepatitis C(calculated end 2013)
Advantages No stock rupture
One distribution point
Quarterly monitoring of patient outcomes and ARV drug stocks
90% of patients on ART viral load undetectable
Only 14% drop out on ART
Resistance testing done: Minimal resistance
One patient to this date resistant to all available ART in Seychelles
An overview of the challenges involved in ART drug management
Increased number of different ARV formulations
Increases the risk of stock outs
Keeping the number of different ARV formulations as small as possible while maintaining adequate treatment options for the vast majority of patients
Correctly forecasting the proportion of patients in need of changing of ART regimen
Balancing minimum order v/s wastage
Ensure that adequate alternative and second-line ARVs are available (switching ARV regimens)
Storage capacity in health facilities is limited Increase frequency of deliveries of ART to outer islands Similar challenges faced with the treatment for opportunistic infections LIMITED paediatric formulation ABACAVIR initiation FREE ART: Sustainability
Way forward
Adopting 90% treatment target: As a means to reduce infection
Increase usage of ABACAVIR
Purchasing 3rd line regimen
Investing in fix dose regimen
Stocking of ARVs on outer islands
COST: SUSTAINING cost of ART
Thank you!