NAPWA Treatments Campaign 2012

Start the Treatments Conversation

Phillip Keenphillip@napwa.org.auMay 2012

Overview

• Background & rationale

• Campaign goals and objectives

• Campaign materials & Implementation

• Evaluation and next steps

HIV Treatments: science and expert opinion

• Untreated HIV infection may have detrimental effects at all stages of infection. Later treatment may not repair damage associated with viral replication and immune activation during early stages of infection.

• Earlier treatment may prevent the damage associated with HIV replication during early stages of infection.

• Earlier treatment may reduce risk cardiovascular disease, cancers, osteopenia/osteoporosis and neurologic complications.

• Prevention benefits of HIV treatments (HPTN 052/Test & Treat)

Minimum, Most Recent, Maximum CVL and Newly Diagnosed and Reported HIV cases

Success of Test and Treat in San Francisco? Reduced Time to Virologic Suppression, Decreased Community Viral Load,

and Fewer New HIV Infecti ons, 2004-2009M D a s , P C h u , G - M S a n t o s , S S c h e e r, W M c F a r l a n d , E V i tti n g h o ff , G C o l f a x

ARV Treatment Guidelines

•March 2012 Update to US DHHS Guidelines (followed in Australia):

• ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pre-treatment CD4 cell count:o CD4 count <350 cells/mm3 (AI)o CD4 count 350 to 500 cells/mm3 (AII)o CD4 count >500 cells/mm3 (BIII)

But outdated beliefs

• Indications that knowledge among some PLHIV about treatment advances is not consistently reviewed or renewed

• Past negative experiences in terms of pill burden, side effects and toxicities influencing attitudes and beliefs

• S100 prescribers play a very important role in guiding decisions about initiating treatment

• Optimal health outcomes for PLHIV will be supported by addressing psychosocial and structural barriers

Psychological barriers

“Commencing was terrifying. I was scared and the night before I started I was a mess. Initial physical reaction was minimal so that was a relief. Changing meds is also a scary thought which I am trying to avoid” (ARCSHS Tracking Changes, 2011)

“I had thought it would be difficult for me to commence meds since this would be an acknowledgment of the progression of my HIV. However since starting my meds I have found that a lot of small irritating conditions have cleared up and my overall health is significantly improved. I'm just grateful every day that the meds exist!” (ARCSHS Tracking Changes, 2011)

What Proportion of the PLHIV Population is on Treatments?

Source Proportion on ARVs

Highly Specialised Drugs Program(January – June 2010) / Kirby ASR

53.9%

(2009: 52.5%)

Gay Community Periodic Surveys(2010 Data , ARTB 2011) 69.5%

Futures 6 (2009) 79.6%

AHOD (2010) 89%

Treatments Uptake Needed

• NAPWA Treatments Target: 90% on treatments by 2015

• Rapid increases in treatments uptake occurred previously: 1996-1998 (20% > 70%)

Year Estimated Population

Proportion on ARVs

Population not on ARVs

Additional needed if

90%

2010 21,391 70% 6,417 4,278

2011 22,391 70% 6,717 4,478

Median CD4 at Diagnosis

Source ASR/State & Territory health authorities

2007 2008 2009 2010

Australia 424 420 406 399

NSW (M) 443 440 408 410

NSW (W) 300 450 380 356

CD4 at start of cART (closest CD4 with 6 months prior)

Prior to 1 Jan

20061 Jan 2006 onwards Overall

Total 1882 427 2309Mean 327.9 324.0 327.1SD 242.4 193.5 234.1Median 288.5 294 29025th 150 200 16075th 450 422 445

n (%) n (%) n (%)250-349 347 (18.4) 101 (23.6) 448 (19.4)<250 787 (41.8) 161 (37.7) 948 (41.1)>=350 748 (39.7) 165 (38.6) 913 (39.5)

Psychological barriers

“The barrier to commence my HIV treatment was the hardest thing to work through personally. It took my doctor three years to convince me it was the right thing to do. In hindsight having now been on meds for over a year and my health at its best I wish I could have known and started them earlier. It’s important for others facing this hurdle to speak with people that have faced this....with positive outcomes.” (ARCSHS Tracking Changes, 2011)

Campaign: Goals and Objectives• Health Issue:

o Some people living with HIV who would benefit from HIV treatments are not accessing them due to outdated understandings about their benefits and risks.

• Campaign Goal:o To mobilise people living with HIV to achieve better health outcomes

through increased access to appropriate HIV treatments.

• Campaign Objectives:o To encourage people living with HIV to become better informed about the

benefits of HIV treatments for themselves and their partners.o To encourage people living with HIV to talk to their doctor about the latest

information about HIV treatments and whether initiating HIV treatments would benefit them.

Launch

Posters and Print advertisements

Version 1Long copy

If you’re living with HIV then talk to your doctor.Early treatment can have important health benefits

And can protect your partners. Don’t put off treatmentAny longer and learn about the latest developments.

START THE CONVERSATION TODAY

Posters and Print advertisements

Version 2 Image

Sydney Morning Herald (Spectrum)Saturday AgeCourier Mail Saturday

Star ObserverSXQueensland Pride

Men’s Health

Billboards, Bus & tram sides.

Sydney, Melbourne, Brisbane

Short copy

If you’re living with HIV, Start a treatment conversationWith your doctor

Billboards

Website Content

• Benefits of early initiation of HIV treatments- for PLHIV and in protecting partners

• HIV treatment guidelines

• Psychological barriers to initiating and switching HIV treatments

• Working with your doctor & where to find S100 docs

Evaluation and next steps

• Generation II of campaigno Online advertising

• External evaluation

• Next Campaign:o PLHIV peer experiences of treatments

• Policy work

Barriers to Treatments Uptake• Reducing barriers to treatment

o Dispensing arrangementso Co-payments

• Difficulties obtaining medication and co-payments associated with stopping ARVs (ARCSHS Tracking Changes, 2011)

• ATRAS and other Medicare Ineligibles

• Addressing Psychological barriers to initiating treatmento Recommend doctors commence discussing treatments at or

soon after diagnosis & assess psychological supports needed

Thanks