Download Jhpiego - Background - Conference Programme AIDS 2016

Towards the last 90% of the 90:90:90 strategy:
A review of viral suppression rates in a HIV program in
Central and Eastern Kenya
Dr Moses Kitheka,
Chief of Party, Jhpiego Kenya
21st International AIDS Conference,
Durban, South Africa.
20th July 2016
Background - HIV in Kenya
 2013: Estimated 1.6 million PLHIV, (191,840
Children). Estimated 101,560 New Infections
 Kenya adopted 90:90:90 approach in programing and
implementation
 Key Documents:- National plan for Accelerating HIV
Care and Treatment & Kenya AIDS Strategic
Framework
 Viral Load testing for routine treatment monitoring
since mid 2014
2
Kenya AIDs Strategic Framework
2014/15- 2018/19
Main Objective
 To review the Viral suppression rates in samples
submitted for viral load testing by APHIAPLUS KAMILI
from January 2015 to December 2015
4
Project background
 Led by Jhpiego, APHIAPLUS KAMILI is
a USAID funded project supporting HIV
services in 142 health facilities since
January 2011
 Total of 35,120 clients on ART (3,332
children) as at December 2015
 Viral load monitoring done through
specimen collection at facilities,
processing and sample transport
network to National laboratories
 Results posted online immediately,
then physical results send to the
health facilities
5
What have we done?
 Clinical and laboratory staff trained on clinical and
laboratory management/monitoring of HIV patients
 Commodity support- EDTA Tubes, CryoVials, request
forms etc.
 On site Technical Assistance and Mentorship
 Logistical Support for laboratory transport of specimen to
central laboratories
 SOPs and Job Aides
6
Methods for analysis
 Retrospective, cross sectional analysis of VL results
on all specimens send for VL testing with results
posted online from January 2015 to December 2015
 Source: Results of viral load tests posted online –
www.nascop.org/eid
 Used the R-Statistical software
 Viral suppression defined as
• Suppressed: VL < 1,000 copies/ml
• Not suppressed: VL ≥ 1,000 copies/ml
Progress in Viral load testing
30000
24,030
25000
TOTAL TESTS
20000
15000
10000
5000
227
2189
1322
0
Jan-Dec 12
Jan-Dec 13
Jan-Dec14
Jan-Dec 15
YEAR
8
Results
 Total Viral load results
analyzed-24,030
 Crude Viral Suppression
rate 84%
 Viral suppression
analyzed in different
different categories
9
Viral Suppression by Sex (N=22,244)
P Value <0.001
% Viral suppression
84%
82%
FEMALE
N = 15,344
SEX
MALE
N = 6,900
10
Viral Suppression by Age
(N=21,293)
% Viral Suppression
P value <0.001
85%
83%
71%
66%
N=413
N=2,726
N=1,963
0-2 YEARS
3-5 YEARS
6-15 YEARS
Age
73%
N=833
N=15,358
16-24 YEARS
25+ YEARS
11
Suppression by Duration on ART
(N=16,387)
% Viral Suppression
86%
85%
84%
84%
83%
81%
0-6 MONTHS
7-12 MONTHS
13-24 MONTHS
25-60 MONTHS
61-120 MONTHS
120+ MONTHS
12
Duration on Treatment
Suppression based on Indication for
VL testing (N=17,264)
% Viral Suppression
83.4%
82%
81%
80%
71%
N=882
N=828
CLINICAL FAILURE
IMMUNOLOGICAL
FAILURE
N=52
PREGNANT MOTHER
N=14,981
N=521
ROUTINE VL
SINGLE DRUG
SUBSTITUTION
Indication for Viral Load
13
Conclusion
 Fairly good viral suppression rate, yet to reach 90%
 Viral load testing is important in monitoring treatment
and program success
 Females have better viral suppression than males
 Viral suppression lower in younger clients, especially
adolescents, and better in those above 25 years of
age
 Clients identified with possible clinical and
immunologic failure had fairly good viral suppression
Way forward
 Need to address the other 90s to complete the cascade
 Re-evaluate adolescent care cascade to improve
adherence and enhance quality of care
 Need to intensify routine viral load monitoring as a way to
better monitor treatment success and adherence
 Clients not suppressed - Adherence counselling and
treatment monitoring for treatment failure
15
Acknowledgments





USAID
Ministry of Health, Kenya
County Governments
All health care workers
Communities
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Suppression by ART regimen
100%
91%
87%
85%
82% 82% 83%
90%
80%
70%
74%
68% 64%
% Viral suppression
60%
50%
40%
30%
20%
10%
0%
Regimen
17
Analysis…..
Variable
Bivariate
Odds ratio
Gender: Female
1.155310
Age: 25+ yrs
0-2
3-5 years
6-15 years
16-24 years
0.30921090. 0.2514118
76113460.38 0.3819088
089710.4337 0.6827425
557
0.8499619
0.3422494
0.4243185
0.3701587
0.5099633
Failure: Routine
Clinical failure
Immunological
Pregnant
Drug substitution
Duration:
Months
0-6
13-24
25-60
61-120
120+
95% CI
Multivariate
p-Value Odds ratio 95% CI
p-Value
1.071624 1.245037
<0.001
1.038782
9.353127 1.152732
0.475
<0.001
<0.001
<0.001
<0.001
0.3107823
0.8088518
0.4375439
0.4423663
0.2338842 0.4154402
0.6992667 0.9384978
3.732135 0.5139438
3.598326 0.5468909
<0.001
0.00470
<0.001
<0.001
0.8126852
0.8954680
0.4926617
0.8513646
0.6864359
0.9671582
0.7490235
1.0772142
0.2756365
0.9266037
0.6842442
1.0694594
0.0177
0.2333
0.0211
0.1574
0.7652473
0.8006715
0.4015799
0.8661054
0.6270862 0.9403572
0.6478412 0.9975698
0.1970350 0.8837200
0.6621947 1.1488518
0.00958
0.04333
0.01593
0.30570
0.7648131
0.9221004
0.8884153
0.9441058
1.0765524
0.6548628
0.8944595
0.7989797
1.0649867
0.7857829
1.0039129
0.8359107
0.000746
0.268500
0.058287
0.353110
0.734196
0.9380002
0.9033947
0.8754164
0.9576521
0.9643734
0.7728074 1.1420984
0.7633619 1.0700490
0.7562161 1.0126393
0.8240357 1.1120966
0.6109829 1.5901838
0.52043
0.23816
0.07399
0.57145
0.88128
7-12
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Regimen: TDF/3TC/
EFV
ABC/3TC/NVP
ABC/3TC/ATVr
ABC/3TC/EFV
ABC/3TC/LPVr
AZT/3TC/ EFV
AZT/3TC/ NVP
AZT/3TC/ABC
AZT/3TC/ATVr
AZT/3TC/LPVr
TDF/3TC/ATVr
TDF/3TC/LPVr
TDF/3TC/NVP
0.2691723
0.2354170
0.4187483
0.3178912
0.6903214
0.6715426
0.7490540
0.5243378
0.7438881
0.4681588
1.4481710
0.8655444
0.21389489 0.3401185
0.09246745 0.6412982
0.32404824 0.5460736
0.21932888 0.4681609
0.57911213 0.8266761
0.60983166 0.7392889
0.12062118 14.3602008
0.18759812 1.8530298
0.50386437 1.1365604
0.21984449 1.11262514
0.91240498 2.4475873
0.77263210 0.9702518
<0.001
0.00285
<0.001
<0.001
<0.001
<0.001
0.79207
0.25577
0.15243
0.06275
0.13888
0.01293
0.4839887
0.4233561
0.7648243
0.6262169
0.7616974
0.7325590
6086.4047336
2.2562784
0.9480684
0.2903689
1.52.2067
0.8254543
0.3572243 0.659384
7
0.1172464e-1.70132
07
0.5481377 1.079611
8
0.3888611 1.037721
1
0.6107141 0.956236
6
0.6444614 0.832601
2
NA
0.4381080 41.37340
34
0.5777765 1.64357
43
0.11934410.774486
1
0.8649215 2.933505
0
0.7156485 0.952913
2
<0.001
0.19392
0.12047
0.06055
0.01724
<0.001
0.94186
0.43707
0.84062
0.00838
0.17506
0.00862
19