Transcript
Page 1: Simplification, cost-reduction strategies and examples from the field

Simplification, cost-reduction strategies and examples from the

fieldTeri Roberts

Diagnostics Advisor Medecins Sans Frontieres, Access Campaign

7th International AIDS Conference 2 July 2013

Page 2: Simplification, cost-reduction strategies and examples from the field

Virological monitoring detects treatment failure earlier than clinico-immunological monitoring

Page 3: Simplification, cost-reduction strategies and examples from the field

How viral load testing fits into the package of care to ensure people stay undetectable

Early treatment

Routine viral load

Adherence support

Community-based &

self-managed therapy

Drop routine CD4 monitoring for virally suppressed ART treated PLWHA and rather use routine VL monitoring to trigger the need for CD4 testing (is CD4 over 200 cells/ul?)

Page 4: Simplification, cost-reduction strategies and examples from the field

Viremic patients can re-suppress following an adherence intervention

Page 5: Simplification, cost-reduction strategies and examples from the field

The importance of preserving first line, affordable, robust, one-pill-a-day regimens

Page 6: Simplification, cost-reduction strategies and examples from the field
Page 7: Simplification, cost-reduction strategies and examples from the field

Implementation is done in support of, and in collaboration with, the Ministries of Health and reference laboratories

SAMBA

CAVIDI

BIOMERIEUX

BIOCENTRIC

Page 8: Simplification, cost-reduction strategies and examples from the field
Page 9: Simplification, cost-reduction strategies and examples from the field

• G. Patten et al. Poster TUPDD0106 (Oral abstract session: The point of point of care (Tuesday))

• Youth and adolescents have been identified as a particularly vulnerable group, at greater risk of loss from both pre-ART and ART care.

• MSF supported clinic in Khayelitsha, Cape Town, South Africa: implemented POC CD4-testing at a clinic dedicated to youth aged 12 to 25 years.

• POC CD4 testing significantly improved assessment for ART eligibility, ensuring that most youth were made aware of their treatment needs on the day of HIV diagnosis.

Does point-of-care (POC) CD4 testing reduce losses from care between HIV diagnosis, assessment for ART eligibility and ART initiation among HIV-positive youth in Khayelitsha, South Africa?

Page 10: Simplification, cost-reduction strategies and examples from the field

Group A (Before) Group B (After)

HIV Testing

Blood sample drawn for CD4 counting

WHO Staging*

ART preparation counselling sessions

ART Initiation

CD4 Result

ART eligibility assessed

Visit 1

Visit 2

Visit 3

Visit 4

Visit 5

Visit 6

HIV Testing

Blood sample drawn for CD4 counting

WHO Staging

ART preparation counselling session

ART Initiation

CD4 Result

ART eligibility assessed

Visit 1

Visit 2

Visit 3

Visit 4

Visit 544% 50%

34 days 28 days

P=0.6

Page 11: Simplification, cost-reduction strategies and examples from the field
Page 12: Simplification, cost-reduction strategies and examples from the field

Point-of-care versus laboratory-based tests for viral load testing

Regional-level laboratory tests will

use dried blood spot samples that can use

finger or heel prick blood

Page 13: Simplification, cost-reduction strategies and examples from the field

Diagnostic accuracy of DBS using the COBAS Ampliprep/COBAS TaqMan HIV-1 v2.0 (CAP/CTM)

• NMRL, Harare, Zimbabwe in collaboration with MSF• Sekesai Mtapuri-Zinyowera (WEPE610 - Poster Exhibition on Wednesday)• 118 finger prick DBS, venous blood DBS and plasma specimens from ART patients attending

two rural OI clinics in Buhera and Tsholotsho districts and one urban OI clinic in Harare• good sensitivity of DBS compared to HIV-1 RNA plasma but very low specificity, which

translated in a higher rate of false positive results with DBS at lower VLs (<3.5log)

COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 TestDried Fluid Spot Procedure RUO

Sample Collection

±70 μL of capillary and EDTA blood (air dry min. 3h)

detach and transfer1 spot (Ø 12 mm)

560C, 10 min, 1000 rpm+1000 μL SPEX

S-input tube

Controls

Fully automated nucleic acid extraction and amplification/detection

Pre-extraction

Page 14: Simplification, cost-reduction strategies and examples from the field

Pooling methods, in combination with the use of fingerprick DBS as a sample type for VL testing, can importantly reduce costs

while maintaining accuracy

Efficiency expressed as cost savings:• Example of Thyolo District

– Population: 620,000– HIV prevalence: 14,5%– # VL tests needed/year: 23,000– Price per VL test: $24

• Total cost/year = 23,000 x $24 = $552,000– Efficiency at 1,000 cps/mL = 28,6% => $157,800 saved– Efficiency at 5,000 cps/mL = 51,4% => $283,700 saved

Sample 1500 µL

100 µL

Pool 500 µL

Viral load testing

100 µL100 µL

100 µL100 µL

Sample 2500 µL

Sample 3500 µL

Sample 4 500 µL

Sample 5 500 µL

What to do with pooled results?1. Pooled VL result < threshold => no further testing 2. Pooled VL result > threshold => further testing

MSF has previously validated the use of fingerprick DBS on the bioMerieux NucliSENS EasyQ HIV-1 platform, which is RNA-specific

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Reports: www.msfaccess.org/reports

2012

IAS poster TUPDD0102 and Oral abstract session: The point of point of care (Tuesday)

2013


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