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ECONOMIC SUSTAINABILITY OF THE BOTSWANA HIV …

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MOVING FORWARDEnhanced ART Monitoring in Countries:Botswana
HarunaJibril, Deputy Permanent SecretaryBotswana Ministry of Health and WellnessIAS July 2017
Botswanahas made remarkableprogress in HIV treatment and caresince 2002:Nationalprevalence rate of18.5%(BAIS IV, 2014)Nationalincidence rate of0.71%(Spectrum 2017)Total HIV Population:403,326(31/12/16)ART Coverage of Total HIV Population:75.2%PMTCT Rate =<1.4% (2016)Recorded deaths since 2002-2014:23,959(10.1%)AdultsCumulative First Line Failure Rate:estimatedat12%(2002-2014)(Data sources: BAIS IV, 2013, Spectrum 2017 v.5.57& DHAPC programmatic data 2017)
Background
Background
After extensive economic analysis in 2016,it was clear that for Botswana to gain epidemiologic control of HIV - a Treat All Strategy - which included the useDolutegraviras 1stLine had to be adopted.On 1 June 2017 Treat All was launched.Approximately 30,000 patients have been initiated on DTG, with another 10,000 switched to DTG containing regimens
M&E System ImprovementsFor Treat All Implementation
Previously, all basic monitoring of ART indicators was conducted vertically through34 ARV Sites.In order to mainstream HIV data collection with Treat All, the Site Model was replaced to theNational Cluster Model(>90 sites)– no longer isolating HIV information from normal pharmacy and clinical data channels.The DHIS system was also expanded
M&E System ImprovementsFor Treat All Implementation
In PEPFAR funded sites(approximately 100)all basic M&E indicators were collected on aninnovative SMS reporting system, which allowed the initial information on DTG initiations (toxicities and unexpected averse side effects) to be captured on a weekly basis.
M&E System ImprovementsFor Treat All Implementation
ForPregnancydata, Botswana-Harvard Partnership monitors 40% of all deliveries in the country and agreed to add DTG monitoring to their data collection efforts.
M&E System ImprovementsFor Treat All Implementation
ForTB, the Botswana National Tuberculosis Programme are working closely with research partners U Penn, BUMMHI, and BHP to monitor any unexpected adverse side effects.Nothing unusual has been noticed apart from an initial increase in TB Iris (TB unmasking) primarily due to physician oversights in beginning ART before ruling out TB.Close monitoring continues with expected long-term outcomes available in 2018
M&E System ImprovementsFor Treat All Implementation
The Botswana Epidemiological ART Treatment (The BEAT) Study Cohort is prospectively monitoring patients initiated or switched to DTG over three years as compared toAtripla.The BEAT will establish an operational research cohort within the Botswana Ministry of Health and Wellness and is being developed in collaboration with BHP, BUMMHI and the University of Botswana.
Preliminary DTG Outcomes
Approximately 40,000 patients are receiving DTG in Botswana (as of 30/6/17)30,000 First-Line Initiations10,000 treatment switches to DTGBCPP data as of March 2017, 90% of all initiated on DTG achieved fullvirologicsuppression by 3 months (n>1,000).
Preliminary DTG Outcomes
Toxicities / Adverse Side Effects:<1%less than 20 treatment switchesprimarily due to GI disturbance
DTG Outcomes
PregnancyTherewere no significant differences in safety outcomes between DTG andAtriplain pregnancy.See Abstract #MOAX02 (24/7/17 - RebeccaZash).
DTG Outcomes
Integrase ResistanceMonitoringOf48 First Line failuresgenotyped only2patients were found to have integrase mutations(bothpreviously treated and failingRaltegraviratthe time of switch to DTG):- Patient 1: Q148(went on to fullysuppress on DTG)- Patient 2:Q148, E138, N155(highly treatmentexperienced)
DTG Outcomes
TB OutcomesInitially higher number of IRIS (TB unmasking) detected – due primarily to physician error initiating before ATT.No Adverse Side EffectsReported to DateAwaiting Year One Reporting
Many Thanks
Botswana Ministry of HealthDepartment of HIV/AIDS Prevention & CareBotswana-Harvard PartnershipBaylor Children’s Clinical Centre of ExcellenceBUMMHICareenaCentre for HealthCDC-PEPFARHestonPhillips, UNAIDSUniversity of Botswana

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ECONOMIC SUSTAINABILITY OF THE BOTSWANA HIV …