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Advanced HIV Disease Update:Mozambique
Irénio GasparMOH Mozambique28/07/2020
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• HIV prevalence: 13.2% (15-49 years) (2,243,966PLWH)
HIV in Mozambique
2Source: Spectrum 5.87
Indicator 2019
PLWHIV 2,243,966
Adults LWHIV 2,093,570
Children LWHIV 150,396
# New infections 132,944
# New daily infections 364
# Deaths related to HIV/AIDS 50,586
# Pregnant women HIV+ 107,723
Vertical transmission rate 14
Source: 5,97
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Progress towards 90-90-90
HIV in Mozambique
3
Fonte: Shiny 90, SIS-MA, H04-A & Spectrum v5.87, DISA-Link
Children, 0-14
Adults, 15+
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
What is known about the prevalence of AHD?
AHD in Mozambique
4
39% 39%
34%31%
29% 29% 28%25%
21%18% 18%
73%71%
68%65%
63% 62%58%
53%
44%
38% 37%
0%
10%
20%
30%
40%
50%
60%
70%
80%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Evolução % Pacientes com CD4 baixo ao início do TARV: Moçambique
CD4 < 100 CD4 < 200
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
What is known about mortality rates amongst PLHIV? • An estimate of 50.586 people died due to HIV related conditions
in 2019
AHD in Mozambique
5Source: Spectrum 5.87
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• There is a sub-group at the C&T TWG group that is dedicated to AHD issues
• Policy development• Training package elaboration• GF grant preparation• M&E tools and indicators
• RoC are a part of the C&T TWG, but are not participating in the AHD sub-group.
AHD Coordination and Leadership
6
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Is there a national AHD strategy?• It is being developed (December)
• Are there national AHD guidelines?• It is being developed (September)
• Are there national training materials related to AHD? • It is being developed (September)
AHD Policies and Guidelines
7
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• What is the essential package of AHD diagnostic and treatment services?
• Mozambique intends to scale up the AHD package that WHO recommends in 2021 to levels of the health system
• Right now only main referral hospitals treat conditions such as Crypto meningitis. No systematic screening of crypto is being implemented w/ CrAg
• TB is clinically screened and Xpert/Ultra is available country wide (no TB-LAM available yet). TB meningitis diagnosis only at referral hospitals
• Kaposi's sarcoma treatment is provided in referral hospitals.
AHD Essential Package
8
• How and where are CD4 tests done?
• 100% CD4 testing coverage.
• National policy: CD4 test is indicated for new patients and patients
reintegrated to care; for patients with virologic failure; for critically ill
patients at any time; to monitor patients on treatment w/ initial CD4
count ˂ 350
• Due to changes in donor funding, CD4 testing is not supported by
PEPFAR anymore since 2018. This translates as a lack of access to
CD4 testing in country (only few HF continue offering CD4 testing)
• From 2021 on, Mozambique expects to regain access to CD4 testing
through GF grant.
• The Pima platform will lead CD4 testing (with an average of 79% of
CD4 tests), followed by facscalibur (with 15%) and facscount (with 6%)
in terms of contribution for the same period of time.
Laboratory Services: CD4 Testing
9
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Are there data or documentation challenges related to
AHD?
• At the moment the M&E tools being used don´t capture many of the
indicators needed to measure AHD and the impact of the interventions
• The M&E component for AHD needs to be developed
Monitoring & Evaluation
10
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
§ There is a model center at Maputo City, considered a referral center on AHD, that offers ambulatory comprehensive package of screening, treatment and follow up of patients with AHD. It includes:
• Kaposi sarcoma treatment
• Crypto meningitis diagnosis (CrAg), pre-emptive therapy and optimized treatment (LAMB, Fluocytosine, fluconazol)
• TB diagnosis (TBLAM, FASH, Xpert Ultra PTB/EPTB) and treatment (including MR/XR)
• Management of patients on 2nd line failure (including GNT)
• Palliative and home-based care
DSD Models for AHD and P@HR (1)
11
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• In Maputo city also, AHD minimum package is offered in one of
Distric Hospitals (José Macamo) as part of initial triage in emergency
department, with a referral-contrareferral flow with ambulatory care
at CRAM;
• AHD package (CrAg, TBLAM, Crypto treatment, TB treatment) is
also integrated in Beira’s Central Hospital and in PHC of Munhava,
with a referal-contrareferral flow to assure continuity of care.
DSD Models for AHD and P@HR (2)
12
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Mozambique has a Warm line service that takes phone calls from all around the country. 85% of calls are HIV related, most of them are complicated HIV cases. The line is attended by experienced clinicians and Internal Medicine specialists:
• Orientations are given to diagnose and treat complicated patients;
• Referrals are organized when needed (referral centers contacted in order to assure access to the best care available).
Good Practices
13
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Current lack of access to diagnostic tests (CD4, TB-LAM, CrAg) and optimized treatment (LAMB-flucitosine, irregular provision of
fluconazole);
• The main referral hospitals in each province, that are prepared to attend more complicated patients (AHD) don´t have ART services available;
• Lack of trained HRs to deal with the AHD in the primary levels HFs.
Challenges
14
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
• Finalize the national strategy and guidelines and implement the training package
• Get approval for the GF proposal
• Keep the referral center of Maputo city offering AHD services, and becoming a model center where on job trainings can take place, in order to expand the model to all provinces
Priorities for 2020 – 2021
15
The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020
Acknowledgements
16