IAC Presentation on Selected Findings Community Access to Treatment, Care, and Support Study (CAT-S)...
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IAC Presentation on Selected Findings Community Access to Treatment, Care, and Support Study (CAT-S) Sushil Koirala, MA. MPH. Program Manager, APN+
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Transcript of IAC Presentation on Selected Findings Community Access to Treatment, Care, and Support Study (CAT-S)...
IAC Presentation on Selected Findings Community Access to Treatment, Care, and Support Study (CAT-S)
Sushil Koirala, MA. MPH. Program Manager, APN+
Background National PLHIV Networks in Asia and the Pacific region consistently shared that the
national authorities do not adequately document and share the barriers/enablers to PLHIV’s access to treatment, care and support
Information gathered through health system delivery and ad-hoc studies were not adequate to capture the real problems faced by PLHIV in the community
In February 2010, a meeting among 11 National PLHIV Networks from Asia and the Pacific region identified a need to monitor, document and share information related to the level of access to effective HIV treatment, care and support services in the region.
Asia Pacific Network of People Living with HIV/AIDS (APN+) facilitated the submission of a Rd. 10multicounty (7contries) proposal to the The Global Fund
Of which a small portion (10%) was approved in February 2011 for the design and implementation of community centric, community driven and community led study that captures real life experiences that are hindering/enabling access treatment, care and support among PLHIV in the region
Study objectives The overall objective of this study is to monitor and
document the issues related to PLHIV's access to HIV treatment, care, and support services in Asia and the Pacific region Assess the HIV treatment-related issues such as access to
pre-ART care, ART, ART adherence, treatment literacy, disclosure and stigma, high risk behaviours health seeking behaviours, financial burden, etc.
Develop baseline to measure longitudinal changes in the key issues (identified through phase I) in access to HIV treatment, care and support
FrameworkBangladesh Lao PDR Nepal Pakistan Philippines Vietnam Indonesia Consolidate
d
Sample size 600 530 1,598 525 1,320 1,615 1,655 7,843
Number of data collectors
15 11 14 11 14 15 18 98
Ethical approval
Medical Research
Council (BMRC)
Center for HIV/AIDS
and STI (CHAS)
Nepal Health Research
Council (NHRC)
Bridge Consultants Foundation
DOH Ethics Committee
(DREC)
Ha Noi School of
Public Health
AtmajayaUniversity
Start interview date
26-Nov-12 4-Jan-13 1-Oct-12 21-Nov-12 6-Nov-12 4-Dec-12 17-Nov-12 1-Oct-12
Latest interview date
30-Apr-13 7-Mar-13 29-Mar-13 4-Mar-13 7-May-13 21-Mar-13 31-May-13 31-May-13
Average time to complete question in minutes
71 69 64 77 57 69 53 64
Respondents- Place of enrollment (%)
Bangladesh Lao PDR Nepal Pakistan Philippines Vietnam Indonesia Total0
10
20
30
40
50
60
70
80
90
100
98.7
8.47.7
11.2
13.0
91.926.3 22.5
11.2
17.7
34.7 38.1
75.4
18.4
33.4
18.8
96.6
22.1
23.2
9.4
20.949.8
15.0
Community HealthServices Hospital Self-help group Others
Respondents- Gender (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Total0
10
20
30
40
50
60
70
80
90
100
57.0
50.346.4
57.9
67.8
87.6
53.1
60.1
42.3
41.9
53.6 40.7 30.1 11.0 46.6 37.4
0.7 7.8 1.3 2.11.4 0.4
2.4
Male Female Transgender
Respondents- Risk classifications (main,%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam0
10
20
30
40
50
60
70
80
90
100
4.58.5
40.8
22.326.9
13.317
24
13
3227
3744
75.8
MSM Sex workers Injecting drug users Domestic migrant workers International migrant worker
Reasons for HIV test (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated
0
10
20
30
40
50
60
70
80
90
100
23.2
3128
3429
25 27 27
34
23
82
28 30 2829
2125
40
11
52
23
3328
45.7
Overseas working Refer by a doctor Spouse/partner/children get sick/deathddue to /HIV infection
Want to know Risky behavior Never choose, got result from a doctor
Place of initial HIV test (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
10
20
30
40
50
60
70
80
90
100
11
24
85
34
51
33
43
36
1915
4
1611
41
6
17
6
31
6
16
96
29
18
61
21
0
3430
3
1822
49
51 0
18
47
Government hospital Private hospital/ clinic VCT center in hospita VCT center in NGO Others
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
100
200
300
400
500
600
281259
180
363 367
281 292 292
229201
108
310 320
254 240 244
Mean Median
Average baseline CD4 count (cells/mm3)
WHO 2010
WHO 2013
Average baseline CD4 count (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
10
20
30
40
50
60
70
80
90
100
50
38
58
3329
38
47
39
1813 13 13
23 2217 1716
29
15
23 22 2116
2216
2015
3127
20 1922
Less 250 251-350 350-500 500 and more
Baseline CD4 and clinical referral for HIV test (%)
Clinical referral for HIV test included;- Referred by a doctor due to suspected HIV-related symptoms or being sick- Husband/wife/partner/child tested positive- Illness or the death of husband/wife/partner/child
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
10
20
30
40
50
60
70
80
90
100
56 57
78
42 3649 53 52
16 11
6
13 24
19 16 15
13 19
7
2118
17 15 17
15 13 925 22 15 17 17
Less 250 251-350 350-500 500 and more
Baseline CD4 and NON-clinical referral for HIV test (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated
0
10
20
30
40
50
60
70
80
90
100
5971
81
50 47
7258 63
16
10
5
1227
13
1412
1112 6
19
11
9
1312
148 9
19 156
14 12
Less 250 251-350 350-500 500 and more
HIV diagnosis & baseline CD4 count
Duration of HIV
diagnosis
Bangladesh
Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidation
<1 year 268 278 204 335 324 216 408 258
1-2 years 256 252 243 407 341 319 399 312
2-3 years 291 259 177 378 351 317 346 309
3 years or more
288 257 171 352 379 293 273 290
Total 281 259 181 361 367 281 292 292
No Viral Load Test (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
20
40
60
80
10098.8
80.9
13.2
78.6
26.0
85.682.5
74.7
** 7.8% - cannot remember
No viral load test vs. change of ART regimen (%)
Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0
20
40
60
80
100 98
66
6
72
6
7675
63
99
81
18
76
18
82 84
73
Changed ART regimen* Never changed ART regimen
Cost of health care
Sick Past 6 months (%) Required Hospitalization (%)
0
10
20
30
40
50
60
70
80
90
100
26
43
9
63
12
71
2835
27
41
28
48
20 2321
41
Bangladesh Indonesia Lao PDR NepalPakistan Philippines Vietnam Consolidated
Bangl
ades
h
Indo
nesia
Lao
PDR
Nepal
Pakist
an
Philipp
ines
Vietn
am
Conso
lidat
ed
0
50
100
150
200
250
300
350
400
5280
4423
43
274
23
89100113 117
39
99
350
150132
Associated cost (USD)/ Episode Average income (monthly) USD
HIV Treatment Literacy
ARV regimen Regimen N %
Stavudin + Lamuvudin + Nevirapine 494 8.3Stavudin + Lamuvudin + Efavirenz 298 5.0Ziudovudine + Lamuvudin + Nevirapine 2318 39.0Ziudovudine + Lamuvudin + Efavirenz 1367 23.0Ziudovudine + Lamuvudin + Lopinavir/Ritonavir 87 1.5Staudinger + Lamuvudin +Lopinavir/Ritonavir 21 0.4Lamuvudin+Tenofovir + Nevirapine 358 6.0Lamuvudin +Tenofovir + Efavirenz 579 9.7Lopinavir + Ritonavir + Tenofovir 28 0.5Others 154 2.6Don't know 241 4.1
5,945 100%
Still using Stavudin: Indonesia- 6.7%, Laos 16.7%, Nepal 29.4%, Pakistan 20.4%, Philippines 9% Vietnam 16.6%, Bangladesh 0%
Self-reported ART Adherence
Countries % with > 95% adherence
% never missed a
dose
% missed an appointment of
HCP
Bangladesh 99.6 78.8 2.6
Indonesia 78.5 48.2 11.4
Lao PDR 49.3 83.7 9.1
Nepal 72.7 70.4 3.6
Pakistan 83.3 63.6 18.1
Philippines 88.2 58.2 9.9
Vietnam 70.1 60.3 12.7
Consolidated 76.3 62.9 9.7
Conclusions Low self initiated HIV testing, indication of late diagnosis, low CD4
at diagnosis Monitoring of viral load is almost non-existent in 5 out of 7
countries Despite large scale funding- cost of care is still a burden Mixed level of treatment literacy, some countries have
lower treatment literacy levels than others. Self-reported adherence is lower than 80% in 4 out of seven
countries. Less than 50% self-reported adherence in Laos Stavudine is still used in 6 out of 7 countries
Ways forward Data driven specific and clear message to the stakeholders at the country
level Use of data for prioritization and funding (esp. NFM) Continue expanding database- recognize and include community stories
(things that most designs skip but are very important) Expanding alert reporting, human right violations, service mapping and
monitoring of quality of care Continue to build an engagement platform for the community to interact,
share and learn Design country specific study for phase II and monitor “changes” over time
Acknowledgement Asar Alo Society, Bangladesh National Association of People Living with HIV, Nepal Pinoy Plus, Philippines Association of People Living with HIV, Pakistan Lao Network of People Living with HIV, Lao PDR Vietnam Network of People Living with HIV, Vietnam GWL- INA, Indonesia
Full report and presentation can be downloaded at apnmata.org
For questions, comments etc get in touch at
Thank you!
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