Treatment challenges of 2nd/3rd line HIV/AIDS, hepatitis-C in Seychelles BY DR LOUINE MOREL

Presentation outline Local Situation

Treatment availability

Advantages

Challenges

Way forward

Local Situation (source MOH Seychelles)

SUMMARY HIV & AIDS FROM 1987 TO JUNE 2014

Cumulative HIV Cases 608 (356M/252F)

Cumulative AIDS Cases 267 (165M/102F) Cumulative

Deaths 125 (75M/50F)

Cumulative HIV Positive Pregnancies 103

Living with HIV & AIDS 397 (226M/171F)

Cases on HAART 228 (124M/104F)

Left Seychelles 86 (55M/31F)

Cumulative Loss to Follow-Up cases 80 (53M/27F)

Cumulative Drop-Outs on HAART 36 (19M/17F)

Defaulter on treatment (>3 months) representing 14% of the HIV & AIDS clients eligible for treatment as per WHO recommended guidelines.

HEPATITIS C Since 2002 to June 2014

a cumulative of 440 cases of Hepatitis C of which 360(82%) were males and 80(18%) were females.

Out of the 440 cases, 36 (27M/9 F) had HIV and Hepatitis C Co-infection and 13 (7M/6F) Hepatitis C related deaths.

99% of cases are injecting drug users. Minimal access to services

Poor uptake on the Hepatitis B vaccination program

Treatment availability Antiretroviral

1st Line(NNRTI Base): 38% 2nd line(Protease Inhibitor base): 62% 3rd Line: 0%

397 PLWHIV: 60% on treatment

Treatment Availability Hepatitis C management

No treatment available

Interferon gamma used for other diseases

NO RIBAVIRIN at the moment

Follow-up of Hepatitis C patients: Blood test 2 time per year/ Annual Liver Ultrasound

Laboratories facilities: ill equipped: No genotyping no viral load available

R50million needed to treat Hepatitis C(calculated end 2013)

Advantages No stock rupture

One distribution point

Quarterly monitoring of patient outcomes and ARV drug stocks

90% of patients on ART viral load undetectable

Only 14% drop out on ART

Resistance testing done: Minimal resistance

One patient to this date resistant to all available ART in Seychelles

An overview of the challenges involved in ART drug management

Increased number of different ARV formulations

Increases the risk of stock outs

Keeping the number of different ARV formulations as small as possible while maintaining adequate treatment options for the vast majority of patients

Correctly forecasting the proportion of patients in need of changing of ART regimen

Balancing minimum order v/s wastage

Ensure that adequate alternative and second-line ARVs are available (switching ARV regimens)

Storage capacity in health facilities is limited Increase frequency of deliveries of ART to outer islands Similar challenges faced with the treatment for opportunistic infections LIMITED paediatric formulation ABACAVIR initiation FREE ART: Sustainability

Way forward

Adopting 90% treatment target: As a means to reduce infection

Increase usage of ABACAVIR

Purchasing 3rd line regimen

Investing in fix dose regimen

Stocking of ARVs on outer islands

COST: SUSTAINING cost of ART

Thank you!