Mövenpick Royal Palm HotelDar es Salaam, Tanzania

August 4-6, 2009

The 7th Annual Track 1.0 ART Program Meeting

The Latest Treatment Numbersand Transition Highlights

Tedd V. Ellerbrock, MD, FACOGCo-Chair, Adult Treatment Technical Workgroup

Team Leader, HIV Care and TreatmentGlobal AIDS Program, NCHHSTP

U.S. Centers for Disease Control and Prevention

Track 1.0 ART Program

The Track 1.0 ART Program is funded and administered by Global AIDS Programs at CDC and Health Resources and Services Administration (HRSA)

Four partners received Track 1.0 ART awards AIDSRelief (Catholic Relief Services Consortium)Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)Harvard School of Public Health (Harvard)Mailman School of Public Health of Columbia University (Columbia)

The program was funded in February 2004

Program Year

Annual Funding (millions)

No. of Countries

No. of Partner

Programs

No. of Treatment Facilities

1 (2004-05) $92 11 21 119

2 (2005-06) $172 13 24 279

3 (2006-07) $206 13 24 478

4 (2007-08) $320 13 25 652

5 (2008-09) $443 13 25 1,030

6 (2009-10) $389 13 25

Track 1.0 ART Program Funding, Countries, Partner Programs, and Facilities, by Program Year

Total Funding since February 2004 = $1.6 billion

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program Totals

Countries where Partners have Implemented Track 1.0 ART Programs, as of March 31, 2009

Countryby Partner

AIDSRELIEF EGPAF HARVARD COLUMBIA TOTAL

Botswana     X   1

Cote d’Ivoire   X   X 2

Ethiopia       X 1

Guyana X       1

Haiti X       1

Kenya X     X 2

Mozambique X   X 2

Nigeria X   X X 3

Rwanda X     X 2

South Africa X X   X 3

Tanzania X X X X 4

Uganda X       1

Zambia X X 2

TOTAL 9 5 3  8 25

Number of Track 1.0 Treatment Sitesby Country and Partner, as of March 31, 2009

Countryby Partner AIDSRELIEF EGPAF HARVARD COLUMBIA TOTAL

Botswana 1* 1

Cote d’Ivoire 90 28 118

Ethiopia 45 45

Guyana 3 3

Haiti 6 6

Kenya 28 44 72

Mozambique 28 47 75

Nigeria 34 20 30 84

Rwanda 11 46 57

South Africa 28 44 38 110

Tanzania 94 147 29 87 357

Uganda 19 19

Zambia 19 64 83

TOTAL 242 373 50 365 1,030

*Indirect Support

Number of Persons Currently on ARTby Country and Partner, as of March 31, 2009

Countryby Partner AIDSRELIEF EGPAF HARVARD COLUMBIA TOTAL

Botswana   8,729* 8,729

Cote d’Ivoire   33,727 1,489 35,216

Ethiopia   25,979 25,979

Guyana 727 727

Haiti 2,651 2,651

Kenya 30,801 9,404 40,205

Mozambique   12,207 41,224 53,431

Nigeria 25,227 44,657 19,796 89,680

Rwanda 3,237 15,820 19,057

South Africa 20,535 73,567 30,117 124,219

Tanzania 25,053 31,367 26,215 14,420 97,055

Uganda 22,044 22,044

Zambia 24,218 75,347 99,565

TOTAL 154,493 226,215 79,601 158,249 618,558

*Indirect Support

Number of Children (<15 years) Currently on ARTby Country and Partner, as of March 31, 2009

Countryby Partner AIDSRELIEF EGPAF HARVARD COLUMBIA TOTAL

Botswana   n/a* 0

Cote d’Ivoire   1,317 53 1,370

Ethiopia   2,123 2,123

Guyana 59 59

Haiti 180 180

Kenya 3,581 1,152 4,733

Mozambique   917 3,754 4,671

Nigeria 1,244 1,816 1,218 4,278

Rwanda 422 1,843 2,265

South Africa 1,478 8,146 2,842 12,466

Tanzania 1,868 2,593 2,589 1,033 8,083

Uganda 1,973 1,973

Zambia 2,256 4,898 7,154

TOTAL 13,061 17,871 4,405 14,018 49,355

*Indirect Support

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART Program

As of March 31, 2009: 1,666,943 ever enrolled in palliative care979,685 (59%) currently in palliative care860,661 ever started on ART618,558 (72%) currently on ART

Of those on ART, 49,355 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 49% were females

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Number of Persons on ARTby Partner and Quarter

Number of Persons on ART by Partner and Quarter, as of March 31, 2009

0

40,000

80,000

120,000

160,000

200,000

FY04

Q4

FY05

Q1

FY05

Q2

FY05

Q3

FY05

Q4

FY06

Q1

FY06

Q2

FY06

Q3

FY06

Q4

FY07

Q1

FY07

Q2

FY07

Q3

FY07

Q4

FY08

Q1

FY08

Q2

FY08

Q3

FY08

Q4

FY09

Q1

FY09

Q2

Ever Started Current Started in Quarter

AIDSRelief

208,913 Ever StartedOn ART

74% on ART

10,995 patients/quarter

Number of Persons on ART by Partner and Quarter, as of March 31, 2009

0

40,000

80,000

120,000

160,000

200,000

240,000

280,000

320,000

FY04

Q4

FY05

Q1

FY05

Q2

FY05

Q3

FY05

Q4

FY06

Q1

FY06

Q2

FY06

Q3

FY06

Q4

FY07

Q1

FY07

Q2

FY07

Q3

FY07

Q4

FY08

Q1

FY08

Q2

FY08

Q3

FY08

Q4

FY09

Q1

FY09

Q2

Ever Started Current Started in Quarter

EGPAF

16,324 patients/quarter

310,163 Ever StartedOn ART

73% on ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

FY04

Q4

FY05

Q1

FY05

Q2

FY05

Q3

FY05

Q4

FY06

Q1

FY06

Q2

FY06

Q3

FY06

Q4

FY07

Q1

FY07

Q2

FY07

Q3

FY07

Q4

FY08

Q1

FY08

Q2

FY08

Q3

FY08

Q4

FY09

Q1

FY09

Q2

Ever Started Current Started in Quarter

Harvard

69% on ART

6,068 patients/quarter

115,287 Ever StartedOn ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009

0

40,000

80,000

120,000

160,000

200,000

240,000

FY04

Q4

FY05

Q1

FY05

Q2

FY05

Q3

FY05

Q4

FY06

Q1

FY06

Q2

FY06

Q3

FY06

Q4

FY07

Q1

FY07

Q2

FY07

Q3

FY07

Q4

FY08

Q1

FY08

Q2

FY08

Q3

FY08

Q4

FY09

Q1

FY09

Q2

Ever Started Current Started in Quarter

Columbia

70% on ART

11,910 patients/quarter

226,298 Ever StartedOn ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

FY04

Q4

FY05

Q1

FY05

Q2

FY05

Q3

FY05

Q4

FY06

Q1

FY06

Q2

FY06

Q3

FY06

Q4

FY07

Q1

FY07

Q2

FY07

Q3

FY07

Q4

FY08

Q1

FY08

Q2

FY08

Q3

FY08

Q4

FY09

Q1

FY09

Q2

Ever Started Current Started in Quarter

Program Totals

72% on ART

45,298 patients/quarter

860,661 Ever StartedOn ART

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program OutcomesA Few Examples

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program OutcomesRetention on ART

EGPAF Project HEART:Percentage of Patients Ever Started on ART

Who Were Currently on ART, as of March 31, 2009

2-year Cumulative Risk of Death, Lost to Follow-up, and Lost to Program for ART Patients (ICAP-Kenya)

123

123

CD4 at ART Start and Active Status in Patients Randomly Sampled

Through the Quality Improvement Program: 2006 - 2008

CD4 baseline Active  LTFU 

Dropped Out 

Transferred  Deceased  Total

<50 605 71% 45 5% 36 4% 9 1% 154 18% 849

50 - 100 666 77% 47 5% 21 2% 19 2% 110 13% 863

101 - 200 1420 87% 58 4% 31 2% 22 1% 110 7% 1641

201 - 350 1621 90% 74 4% 26 1% 25 1% 59 3% 1805

>350 880 92% 31 3% 2 0.2% 14 1% 26 3% 953

Total 5192 85% 255 4% 116 2% 89 1% 459 8% 6111

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program OutcomesChange in CD4 Count

146

198

165 161

137 136124

115106

280

313 314

284 288

264 263 256

227

318

353345 342 345

316

287 291279

0

50

100

150

200

250

300

350

400

Overall Rwanda Mozambique Nigeria Tanzania Lesotho Ethiopia South Africa Kenya

Baseline 6-Month 12-Month

Increases in median CD4+ cell countsamong cohorts of patients initiating ART

CD

4 C

ell

Co

unt (

cells

/ul)

n = 5,712

n = 10,581

n = 22,936 n = 9,162 n = 7,628 n =7,153 N = 97,163

111

n = 7,759 n = 26,178

EGPAF Project HEART:Median CD4 Count at Baseline and at end of

12-Month Follow-Up Period, as of March 31, 2009

150(n=6223)

167(n=2084)

107(n=1359)

139(n=611)

170(n=914)

312(n=2541)

323(n=1180)

245(n=873)

361(n=115)

351(n=365)

0

50

100

150

200

250

300

350

400

450

500

550

Cote d'Ivoire Mozambique South Africa Tanzania Zambia

CD

4 co

unt

Change in CD4 Count during 48 Months on ART Harvard MDH Program in Tanzania*

Months on ART

1

1 *Shaded area = 95% CI

(n=13,575)

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program Outcomes Proportion with

Undetectable Viral Load

83.3 81.8 83.8

9.9 9.8 8.16.9 8.4 8.1

0%

50%

100%

6 months 12 months 18 months

Undetectable/< 40 cp/ML 40 - 500 cp/ML > 500 cp/ML

N=335 N=285 N=222

Proportion of patient with suppressed HIV RNAin Rwanda national program sample

% o

f pat

ient

s

123

123

Time to Virologic Failure in Nigeria

Patients at > 12months ART; Virologic failure = >1000 copies/mlJUTH =4009; 68MH=875; NIMR= 1723; UMTH=1945

APIN Plus/Harvard PEPFAR

123

(n=8552)

On Treatment, Viral Suppressionin Randomly Selected Patients, 2006 - 2008

88% 92% 87% 89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2006 2007 2008 Combined

Year 2006 2007 2008 Combined

Total No. of Samples

863 2140 3161 6164

No. of Countries 3 5 3 6123

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Transition Highlights

Track 1.0 ART ProgramTransition Activities to Date

January 2009 Track 1.0 transition plans submitted Internal technical review of plans Independent PEPFAR panel review of plans

February 2009 CDC and HRSA request revised plans

March 2009 Track 1.0 Transition Planning Workshop

with CDC country teams in Uganda

June - July 2009 Revised transition plans received Additional guidance from HHS on transition

August 2009 Track 1.0 Annual Meeting in Tanzania with

focus on the transition

January - October 2009

CDC & HRSA transition planning site visits in: Côte d’Ivoire, Uganda, Nigeria, Tanzania, South Africa, Rwanda, Mozambique, & Kenya

Track 1.0 ART ProgramEarly Transition Successes

South Africa

AIDSRelief has transitioned to 3 local partners –

South African Catholic Bishops’ Conference,the Institute for Youth Development, andSt. Mary’s Hospital

EGPAF plans to transition McCord Hospitalprogram to direct funding

Nigeria

Harvard expands financial and program transition to APIN+

Track 1.0 ART ProgramEarly Transition Successes

Rwanda

Columbia begins transition of components oftheir program and funding to MOH throughTRAC+ and other MOH units

Botswana

Harvard-Botswana MOH partnership transitionplanned to local NGO-MOH partnership