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Treatment cascade of HIV-infected infants in the Thailand National Program PowerPoint Presentation

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Description : Treatment cascade of HIV-infected infants in the Thailand National Program

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, HIV-infected infants, Thailand

Published on : Jul 16, 2020 | Views : 1515 | Downloads : 1

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Treatment cascade of HIV-infected infants in the Thailand National Program: How close are we to the 90-90-90 target? 1 Thanyawee Puthanakit, 2 Pope Kosalaraksa, 3Witaya Petdachai, 4Rawiwan Hansudewechakul, 5Thitiporn Borkird , 6Rangsima Lolekha, 7Hansa Thaisri, 8Thanawan Samleerat , 9 Sarawut Boonsuk, 10Sumet Ongwandee2 on behalf of the ACC working group 8th International HIV Pediatrics workshop, Durban 15-16 July,2016
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PMTCT and Pediatric HIV services Treatment 90 HIV viral suppression 90 HIV Diagnosis 90 MCH Antenatal care HIV Early Infant Diagnosis Pediatric ARV Program 2006 HIV DNA PCR 2010 Treat all infants < 1 year 1990 HIV screening in pregnant women
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HIV Early Infant Diagnosis Program in Thailand Naiwatanakul T. Int AIDS Soc 2016;19:20511. Sirirungsri W. Lancet HIV 2016, 3;e259-e265.
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Linkage to care for HIV-infected infants Thai National Program 2008-2011 Naiwatanakul T. Int AIDS Soc 2016;19:20511. Sirirungsri W. Lancet HIV 2016, 3;e259-e265. Treatment 56% HIV viral suppression 47% Diagnosis 53% (37-63%)
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Active Case Management to promote Early ART Initiation August 2014 16 Laboratories North Chiang Rai Northastern Srinagarindh South Hat Yai Central Prachomklao Central HIVNAT EID Coordinator Blood samples from HIV-exposed infants for HIV DNA PCR Pediatric Treatment Coordinator Via Email + Line PCR positive PCR positive 2 Laboratories PCR@Birth PCR in infants
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Objective To describe the coverage of early infant diagnosis and treatment cascade of HIV-infected infants in the National Program under ACC structure. Diagnosis Treatment HIV viral suppression No. HIV infants identified Estimated No. No. infants initiated ART No. infected infants identified @ Month 6 & 12 HIV RNA <50 <400, <1000c/ml GARP report 2014: 4,869 HIV+ve pregnant women, 102 HIV infants SPECTRUM 2015: 4,450 HIV+ve pregnant women, 85 HIV infants Aug2014-Dec 2015; 6479 HIV+ve pregnant,128 HIV infants
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Results – Diagnosis and Treatment From Aug 2014 – Dec 2015 (17 months) Data of treatment cascade until June 30,2016 128 Estimated HIV-infected infants 21,415 samples for HIV DNA PCR 101 HIV infected infants (13 cases by PCR @birth) 85 HIV infected infants initiate HAART Treatment 84 % (95% CI 76-91) Diagnosis 79 % (95% CI 71-86)
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Characteristics of HIV-infected infants
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Results – Treatment outcome 101 HIV-infected infants 85 initiate HAART Month 6: N =73 Month 12: N=48 1-year Mortality rate = 15.8% (95% CI 9.3-24.4) 6 10 5 7 Loss to follow up = 14.8% (95% CI 8.6-23.3) 1 2
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79 % 84% 51-68% Diagnosis Treatment Viral suppression <50 to < 1000 c/ml 47% Treatment cascade of HIV-infected infants in the Thailand National Program Active case management to promote early ART initiation August 2014-June 2016 53% 56%
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Discussion: HIV diagnosis Entry point for HIV early infant diagnosis (EID) 16% of HIV-infected infants were not identified as HIV-exposed during ANC. Detect incident case: Repeat HIV testing in 3rd trimester, HIV status of partners by HIV couple counselling and testing. 1South African: 3.3% HIV incidence during pregnancy & breastfeeding, accounted for 26% of early MTCT HIV Early infant diagnosis HIV DNA PCR @ birth can detect 13 infants with in utero infection. Treatment was initiated at mean age of 1 month, yet have similar mortality, loss to follow up and virological suppression compare with the rest of cohort. 1Tua Ha Dinh PLoS ONE 2015; 10(5): e0125525 Diagnosis 79%
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Discussion: HIV treatment Active case management model using case manager system with real-time coordination Benefit: shorten time from laboratory HIV DNA PCR +ve result to initiate treatment. Challenges: data confidentiality, man power to maintain the system Treatment 84%
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Discussion:Treatment outcome 1-yr mortality rate: as high 15.8% (7.1% after ART) 1Sub-Saharan Africa: 30% die at age of 1 years 2Southern African cohort: 3- year mortality = 16% HIV viral suppression only 51-68%. 2Southern African HIV viral suppression at 1 year = 56% Lopinavir/r based regimen, high-genetic barrier ARV should be used to rather than NNRTI, to reduce risk of NNRTI class resistance. Retention in care and long-term adherence is challenging. 1 Newell ML Lancet 2004;364:1236-43. 2Porter M. JAIDS 2015;69:593-601 Viral suppression 51-68%
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Conclusions With the model of active case management, the cascade for management of HIV-infected infants is improved; with 79-84-68 for Dx-Rx-HIV suppression. Coordination of existing vertical programs and real time tracking are an integral part of the program. Challenges in high mortality rate and loss to follow- up rate are remained.
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Acknowledgements MoPH and ACC network • • • • The Bureau of AIDS TB and STIs, Department of Disease Control, MoPH: Dr.Sumet Ongwandee, Dr.Cheewanan Lertpiriyasuwat, Mrs. Patcharaporn Pawapootarnont and Ms. Jiraporn Chucherd Thailand MOPH-U.S. CDC Collaboration: Dr. Michael Martin, Dr. Rangsima Lolekha, Ms. Thananda Naiwatanakul, Ms. Worawan Faikratok, Ms.Benjamas Baipluthong The Bureau of Health Promotion, Department of Health, MoPH: Dr. Danai Teewunda, Dr.Sarawut Boonsuk, Ms.Chaweewan Tonputsa and Mr. Pariwat Tangpong Clinical Research Center, Department of Medical Sciences, MoPH: Dr. Archawin Rojanawiwat, Ms. Hansa Thaisri, Mr. Wiroj Puangtubtim, and Mr. Chaidan Boonrossak Faculty of Associated Medical Sciences, Chiang Mai University: Dr.Tanawan Samleerat National Health Security Office: Dr.Suchada ChaiwutResearch Sites: • • • • • • • HIV-NAT/TRC-ARC/Chulalongkorn University: Dr.Thanyawee Puthanakit, Dr.Torsak Bunupuradah, Dr.Wasana Prasitsuebsai, Stephen Kerr, Ms. Sasiwimol Ubolyam, Ms.Thidarat Jupimai, Mr.Apicha Mahanontharit, Ms.Naphassanant Laopraynak, Ms.Preeyarach Klaytong, Ms.Tulathip Suwanlerk, Ms.Thita Pitimahajanaka, Ms.Naruporn Kasipong, Ms.Thornthun Noppakaorattanamanee, Mrs. Kesdao Nanthapisal Queen Sirikit National Institute of Child Health: Dr.Piyarat Suntarattiwong, Dr.Pugpen Sirikutt, Ms.Pimsiri Leowsrisook, Ms.Yosawadee Na Nakorn Siriraj Hospital, Mahidol University: Dr. Kulkanya Chokephaibulkit, Ms.Kanokkarn Wongmayurachat Srinagarind Hospital, Khon Kaen University: Dr.Pope Kosalaraksa, Ms. Chanasda Sopharak, Ms. Somjai Ratanamanee Prachomklao Hospital: Dr. Witaya Petdachai, Ms. Manee Yentang, Ms.Paweena Kaewdang Nakornping Hospital: Dr.Suparat Kanjanavanit, Ms.Thida Namwong, Ms.Siripim Kamphaengkham Chiangrai Prachanukroh Hospital: Dr.Rawiwan Hansudewechakul, Ms. Areerat Khongponoi Hat Yai Hospital: Dr.Thitiporn Borkird, Dr.Rachanee Saksawad , Ms.Usa Sukhaphan MHRP: Dr. Jintanat Ananworanich, Dr. Lydie Trautmann, Ms. Suteeraporn Pinyakorn, Ms. Oratai Butterworth, Ms.Madelaine Ouellette This work was supported by the Thai Ministry of Public Health budget including Department of Medical Sciences (DMSc) research grant , Presidents’ Emergency Plan for AIDS Relief (PEPFAR) through CDC under the terms of 5U01GH000616-05 and US NIH R01- AI114236 The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.

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