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Similaire à PITC Presentation by MSD
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PITC Presentation by MSD
- 1. Provider-Initiated HIV Testing and Counseling: An Introduction Dr Esther Tan, MSD
- 4. HIV Testing Policies – Evolution
- 8. Universal Access by 2010? 2005 G8 Summit at Gleneagles, Final Communiqué: “… working with WHO, UNAIDS and other international bodies to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010 .”
- 9. HIV Testing – Then and Now
- 11. WHO / UNAIDS: Guidance on Provider-Initiated HIV Testing and Counseling in Health Facilities (May 2007)
- 13. % of 15-49 yr old Africans ever tested and received test result Demographic and Health Surveys, MEASURE DHS, 2003-2005 Average: 10%
- 14. % of 15-49 yr old Africans who know their test result Demographic and Health Surveys, MEASURE DHS, 2003-2005 Average: 15%
- 15. Pregnant women who received an HIV test: data from the 10 countries with the highest estimated number of HIV-infected pregnant women, 2005 Average: 15-20%
- 16. HIV-positive tuberculosis cases identified through testing for HIV in 2005, Global TOWARDS UNIVERSAL ACCESS. Scaling up priority HIV/AIDS interventions in the health sector . Progress Report, WHO, Geneva, April 2007 Globally, only 14% of the HIV-positive TB patients identified through for HIV during their treatment TB patients should be offered HIV test
- 17. Unmet need for ARV in low- and middle-income countries, December 2006 No. of pp who need ARV and are not getting it
- 18. Lancet paper: Mortality in the months after starting ART in low- and high-income settings High mortality rate in first months of starting ARV
- 20. UK: Late diagnosis in high-risk groups A Complex Picture. HIV and other Sexually Transmitted Infections in the United Kingdom: 2006 Health Protection Agency, London, 2007.
- 30. Uptake of PMCT Testing by Testing Strategy, Kisumu, Kenya, 2003-04 Opt-In Opt-Out
- 44. UN PEP Starter Kits
- 49. 5 Patient Information Sheets
- 50. 5 Patient Information Sheets
- 51. Specific Info for Providers
- 52. Specific Info for Custodians
- 54. Thank you
Notes de l'éditeur
- HIV testing and counselling is essential for identifying women who can benefit from treatment either immediately or later, or from interventions to prevent HIV in their infants. Entry to such programmes is initially determined by the proportion of HIV-infected pregnant women identified, often through an HIV test in antenatal care settings. Testing coverage in pregnant women is low in many of the 10 countries with the highest estimated numbers of HIV-infected pregnant women (Fig. 15). The seven countries with the highest PMTCT antiretroviral treatment coverage have relatively high percentages of pregnant women receiving an HIV test. In more than 70 surveyed low- and middle-income countries that reported data for 2005, only 10% of pregnant woman received an HIV test. In sub-Saharan Africa the percentage was 9%, while there was higher coverage in Latin America and the Caribbean (46%) and in Eastern Europe and Central Asia (75%). The high coverage in Eastern Europe was considerably influenced by the large proportion of women attending ANC who received HIV testing in the Russian Federation (about 90%).
- We all know that tuberculosis patients in settings of high HIV prevalence have high rates of HIV coinfection. Ensuring that TB patients receive HIV testing and counselling should therefore be a high a priority for the health sector. In 2005, only 7% of TB patients were tested for HIV worldwide, of whom 23% tested HIV-positive. In countries with generalized HIV epidemics, only 13% of all TB patients were tested for HIV, of whom 48% were HIV-positive. Testing patterns vary between regions. Only 10% of TB patients were tested for HIV in sub-Saharan Africa, which carries 80% of the global HIV burden of TB, whereas 26% of TB patients were tested for HIV in Latin America and the Caribbean and 38% were tested in Europe and Central Asia. Of the patients tested for HIV in TB programmes, approximately 51% were found to have HIV in sub-Saharan Africa, whereas the corresponding values were 17% in Latin America and the Caribbean and 19% in Asia. Globally, 86% of the estimated number of HIV-positive TB patients are not tested for HIV during their treatment. Not offering HIV testing to all TB patients in countries with generalized HIV epidemics wasted the opportunity to inform approximately 460 000 HIV-positive TB patients of their status and ensure their access to comprehensive HIV treatment, care and support. It is not all doom and gloom though: data suggest that since 2003 there has been a threefold increase in both HIV testing of TB patients and detection of HIV/TB coinfection. A rapid expansion of HIV testing among TB patients, linked to provider-initiated testing and counselling, has recently occurred in some African countries. For example, in Rwanda in 2004, 46% of TB patients were tested for HIV and by late 2006 this had increased to 81%. In Kenya in 2005, 32% of TB patients were tested for HIV; this had increased to 64% by 2006. In Malawi in 2005, some 48% of TB patients were tested for HIV, of whom 69% were found to be HIV-positive. Nevertheless, a total coverage of HIV testing and counselling for TB patients of 7% is totally inadequate, as TB patients are already in the health care system, and every undiagnosed HIV infection in a patient with TB represents a major missed opportunity for HIV prevention, treatment and care.
- Too little, too late: HIV testing in the UK At the end of 2005 an estimated 63 500 adults aged 15 to 59 were living with HIV in the UK, of whom, 20 100 (32%) were unaware of their infection. Two in five (40%) HIV-infected Black and Minority Ethnic adults were diagnosed late and they were ten times more likely to die within a year of their HIV diagnosis than those with higher CD4 counts (6.4% compared to 0.67%). Only a minority of those diagnosed late had very recently arrived in the UK.
- Shown here are data from the Kisumu District Hospital in western Kenya. During the period January to April 2004 over 3,000 antenatal women in these clinics. In the first half of the year women were offered HIV testing using an opt-in VCT model requiring women to opt for the services. After July 2003 a policy of routine HIV testing with patient notification was instituted at the clinic. Not to be tested required active refusal. Using this opt-out approach to testing HIV test acceptance rates increased from between 10 and 30% in the early part of the year to between 50 and 90% currently. These findings are compelling and suggest that in antenatal settings routine testing should be instituted to increase the uptake of testing. We are in the process of strengthening and replicating this model to other sites.