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PEPFAR Plans for Initiating ART and Providing Laboratory Services Tedd V. Ellerbrock, MD, FACOG Global AIDS Program Centers for Disease Control and Prevention. Goals of PEPFAR. During a 5-year period, the goals of PEPFAR are - PowerPoint PPT Presentation
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PEPFAR Plansfor Initiating ART andProviding Laboratory
Services
Tedd V. Ellerbrock, MD, FACOGGlobal AIDS Program
Centers for Disease Control and Prevention
Goals of PEPFAR
During a 5-year period, the goals of PEPFAR are
To treat at least 2 million HIV-infected people with antiretroviral therapy (ART)
To prevent 7 million new HIV infections, which is about 60% of the projected new infections in the 14 participating countries
To care for 10 million HIV-affected individuals and AIDS orphans
Goals of PEPFAR
During a 5-year period, the goals of PEPFAR are:
To treat at least 2 million HIV-infected people with antiretroviral therapy (ART)
To prevent 7 million new HIV infections, which is about 60% of the projected new infections in the 14 participating countries
To care for 10 million HIV-affected individuals and AIDS orphans
PEPFAR Plans for Initiating ARTand Providing Laboratory
Services
If we plan to initiate ART and provide lab services for 2 million HIV-infected persons, we need to address several important questions and develop a consensus about what are the best answers to these questions
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #1
What are the major factors that will determine how many HIV- infected persons will be treated through PEPFAR?
Major Factors that will Determine How Many HIV- infected Persons will be Treated through PEPFAR
• Goal of PEPFAR – treat at least 2 million with ART• Funding of PEPFAR – $10 billion over 5 years• Need – 20 million HIV-infected persons live in the
14 PEPFAR countries and at least 3 million (15%) of these qualify for ART
• Feasibility – if we receive the funding, determining how many persons we can feasibly treat with ART will probably not be an option because those who are not treated are at risk of serious illness and death
Major Factors that will Determine How Many HIV- infected Persons will be Treated through PEPFAR
• Goal of PEPFAR – treat at least 2 million with ART• Funding of PEPFAR – $10 billion over 5 years• Need – 20 million HIV-infected persons live in the
14 PEPFAR countries and at least 3 million (15%) of these qualify for ART
• Feasibility – if we receive the funding, determining how many persons we can feasibly treat with ART will probably not be an option because those who are not treated are at risk of serious illness and death
Questions that Need to be Answered to Initiate ART for 2
Million Persons Question #1
What are the major factors that will determine how many HIV- infected persons will be treated through PEPFAR?
Response
The major factors that will determine how many persons will be treated through PEPFAR are probably the goals of PEPFAR, the funding for PEPFAR, and the need for ART; stating that a goal is not feasible may not be an option.
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #2
If we initiate ART for 2 million persons during the next 5 years, how many persons should we start on ART during the first year of PEPFAR?
Number of HIV-infected Persons Who Need to be Started on ART Annually during the
Next 5 Years
0
100,000
200,000
300,000
400,000
500,000
600,000
2004 2005 2006 2007 2008
Year
No.
of H
IV-i
nfec
ted
Per
sons
Number of HIV-infected Persons Who Need to be Started on ART Annually during the
Next 5 Years
200,000 – during the first year 300,000 – during the second
year 400,000 – during the third year 500,000 – during the fourth
year 600,000 – during the fifth year
2,000,000 – total during 5 years
Questions that Need to be Answered to Initiate ART for 2
Million Persons Question #2
If we initiate ART for 2 million persons during the next 5 years, how many persons should we start on ART during the first year of PEPFAR?
Response
If we initiate ART for 2 million persons during the next 5 years, we estimate that about 200,000 will have to be started on ART during the first year of PEPFAR
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #3
How can we initiate ART for 200,000 HIV-infected persons during the first year of PEPFAR?
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
Need to address issues related to: Clinical careDrugs and health
commoditiesLaboratory supportTraining Community mobilizationMonitoring and evaluation
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
For laboratory support, we need to decide which of the following services we can provide:
HIV diagnosticsHematologyChemistriesCD4+ countsViral loads
Diagnosis of OIs Diagnosis of malariaDiagnosis of TBDiagnosis of STIsPediatric HIV diagnostics
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
For each laboratory service, we need to need to address issues related to:
Training Infrastructure Equipment and supplies Quality assurance Information systems
Questions that Need to be Answered to Initiate ART for 2
Million Persons Question #3
How can we initiate ART for 200,000 HIV-infected persons during the first year of PEPFAR?
Response
To initiate ART for 200,000 HIV-infected persons during the first year of PEPFAR, we will probably have to provide only essential laboratory services in at least some settings
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #4
What laboratory services are essential for initiating ART for 200,000 persons during the first year of PEPFAR?
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
Essential Laboratory Servicesfor the First Year of PEPFAR
(in order of priority)
1) HIV diagnostics2) Diagnosis of TB 3) Diagnosis of malaria 4) CD4+ counts5) Chemistries
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
Essential Laboratory Services for Large Urban Hospitalsduring the First Year of
PEPFAR
1) HIV diagnostics2) Diagnosis of TB 3) Diagnosis of malaria 4) CD4+ counts
Plan for Initiating ART for 200,000 Persons during First Year of PEPFAR
Essential Laboratory Services for District Hospitals
during the First Year of PEPFAR
1) HIV diagnostics2) Diagnosis of TB 3) Diagnosis of malaria
Questions that Need to be Answered to Initiate ART for 2
Million Persons Question #4
What laboratory services are essential for initiating ART for 200,000 persons during the first year of PEPFAR?
Response
In some settings, diagnostics for HIV, TB, and malaria may be the only laboratory services that we can provide during the first year of PEPFAR
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #5
How can we develop a strategic plan for laboratory services during the first year of PEPFAR?
Strategic Plan for Laboratory Services during the First Year of
PEPFAR For the services listed below, we could suggest objectives for each of 2 types of clinical settings (for example, for large urban and district hospitals) and make recommendations about how best to achieve these objectives:
HIV diagnosticsHematologyChemistriesCD4+ countsViral loads
Diagnosis of OIs Diagnosis of malariaDiagnosis of TBDiagnosis of STIsPediatric HIV diagnostics
Strategic Plan for Laboratory Services during the First Year of
PEPFAR
During this meeting, the work groups could develop first year objectives for 2-3 services for 2 types of clinical settings and make recommendations about how best to achieve these objectives
The objectives and recommendations could be reviewed and discussed during the work group presentations on the second day of the meeting
After the meeting, the objectives and recommendations could be compiled into a strategic plan for providing laboratory services during the first year of PEPFAR
Questions that Need to be Answered to Initiate ART for 2
Million Persons Question #5
How can we develop a strategic plan for laboratory services during the first year of PEPFAR?
Response
We can use the work groups during this meeting to develop a strategic plan for laboratory services during the first year of PEPFAR
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #6
How can we help to implement a strategic plan for laboratory services during the first year of PEPFAR?
Strategic Plan for Laboratory Services during the First Year of
PEPFAR By March 31, 2004, USG staff in each PEPFAR
country has been asked to submit a country plan for the first year of PEPFAR
In consultation with in-country USG staff, we could organize a lab team to assist each PEPFAR country prepare the country plan for laboratory sevices for the first year of PEPFAR
The lab teams could use the strategic lab plan for the first year, developed initially at this meeting, as guidance when preparing the country plans
GAP Laboratory Support StructureSteering Committee
T. Mastro, S. Wiktor, A.Demby, P. Crippen – GAPR. Martin, T. Hearn, J. Ridderhof – PHPPO
M. Rayfield, J. Kaplan, R. Ballard, S. McDougal – DASTLRYvette Benjamin - APHL
APHL
GAP country-specific lab liaison team
Laboratory Technical Advisory Group
CDC/CIOs, Lab Leaders in GAP countries, WHO
DASTLR PHPPO
GAP country
STI Lab
Sys Dx
Surv Dx
Care QA TB
Technical Working GroupsOI
UTAPUTAP
COUNTRY Laboratory Points of Contact
Botswana Thomas Hearn, DLS/PHPPO
Cote d’Ivoire
Austin Demby, GAP
Ethiopia Robert Martin, DLS/PHPPO
Guyana Thomas Hearn, DLS/PHPPO
Haiti Richard Respess, DASTLR
Kenya Mark Rayfield, DASTLR
Mozambique
Amilcar Tanuri, DASTLR
Namibia Austin Demby, GAP
Nigeria Mark Rayfield, DASTLR
Rwanda Austin Demby, GAP
South Africa Ron Ballard, DASTLR
Tanzania Thomas Hearn, DLS/PHPPO
Uganda Austin Demby, GAP
Zambia John Ridderhof, DLS/PHPPO
CDC Lab Points of Contact by Country
Questions that Need to be Answered to Initiate ART for 2
Million Persons
Question #6
How can we help to implement a strategic plan for laboratory services during the first year of PEPFAR?
Response
We can help implement a strategic plan for laboratory services during the first year of PEPFAR by using lab teams to help countries prepare their country plans for the first year during January – March 2004
Summary To treat at least 2 million HIV-infected people with
ART during 5 years, we will probably need to initiate ART for about 200,000 persons during the first year of PEPFAR
To initiate ART for 200,000 persons during the first year, we need to develop plans for providing laboratory services during the first year of PEPFAR
This meeting offers a unique opportunity to begin preparing a strategic laboratory plan that can be used to prepare country plans for the first year of PEPFAR