NO TIME TO WAIT! Promoting Point-of-Care Early Infant Diagnosis for HIV GEORGINA CASWELL 30 JULY 2020
NO TIME TO WAIT! Promoting Point-of-Care Early Infant Diagnosis for HIV OVERVIEW • Early infant diagnosis: the facts and barriers to uptake • POC EID benefits and where it is in use • The new GNP+ and UNICEF Strategic Framework and Resource Pack • Animation • Q & A G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
POINT-OF-CARE EARLY INFANT DIAGNOSIS IS NEEDED BECAUSE… THE HIV RESPONSE IS FAILING CHILDREN G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
EARLY INFANT DIAGNOSIS: THE FACTS In the Sub-Saharan region, in 2019: • Only 61.2% of infants exposed to HIV were tested within their first two months of life • Only 51.1% of children living with HIV were receiving antiretroviral treatment • There were 130,000 new HIV infections in children aged 0-4 • There were 58,000 AIDS-related deaths in children aged 0-4 HIV estimates for children dashboard - UNICEF G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
WHY IS EARLY INFANT DIAGNOSISSO IMPORTANT? COUNTRY EXAMPLES OF INFANT TESTING & TREATMENT RATES, 2019 % OF HIV-EXPOSED INFANTS TESTED % OF CHILDREN LIVING WITH HIV BEFORE TWO MONTHS OF AGE ON TREATMENT CÔTE D’IVOIRE 53% 36% DEMOCRATIC REP 16% 28% OF CONGO UNITED REP 47% 66% OF TANZANIA ZIMBABWE 56% 71% HIV estimates for children dashboard - UNICEF G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0 1 7 J U N E 2 0 2 0
EID: WHAT ARE BARRIERS TO UPTAKE OF EID? Mothers want to know the HIV status of their child . What’s stopping them? • Fear and stigma • Lack of information • Health system weaknesses + Only certain clinics offer the test + Can take as long as 3 months to get results (if at all) G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
POC EID: BENEFITS • Results are returned to caregivers much more quickly - 98% of POC testing results were returned to caregivers within 30 days, compared with only 19% of lab-based EID results. • The time between taking a blood sample and initiating an infant on ART is significantly reduced - 92% of infants diagnosed using POC technology initiated ART within 60 days of sample collection, compared with 43% of those diagnosed using lab- based EID. • Infants begin ART sooner and at a younger age - Infants diagnosed with POC technology initiated ART much more rapidly (same day compared with 49 days) and at a younger age (1.6 months compared with 3.3 months) than those diagnosed through lab- based EID. Bianchi F, Cohn J, Sacks E, Bailey R, Lemaire JF, Machekano R, et al. Evaluation of a routine point-of-care intervention for early infant diagnosis of HIV: an observational study in eight African countries. Lancet HIV. 2019;6(6):e373–81 . G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
POC EID: WHERE IS IT IN USE? • Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Rwanda, Senegal, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe (funded and delivered by ASLM, CHAI, EGPAF, UNICEF and Unitaid). • Burkina Faso, Cabo Verde, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Ghana, Mali, and Nigeria (led by UNICEF, in collaboration with the IRESSEF and RARS). • Can we afford it? Study showed total cost of running a test and returning the result to the caregiver within 30 days was much less with POC technology (US$27.24) than traditional lab-based methods (US$131.02). G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
OUR NEW STRATEGIC FRAMEWORK + Aimed at community-based organisations, applicable to other partners too + To help CBOs engage with EID in different ways: • To improve understanding of EID • To share knowledge of EID (and POC EID) with others in the community • To advocate for improvements to services, policies and funding relating to EID • To actively play a part in the implementation and monitoring of EID in communities G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
OUR NEW STRATEGIC FRAMEWORK + Provides a step-by-step guide on how to develop an EID action plan + Additional materials include § Targeted FAQ leaflets for policy makers and caregivers § Job aid for peer supporters G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
OUR NEW STRATEGIC FRAMEWORK + The step-by-step guide on how to develop an EID action plan: assess the situation implement consider monitor and your evaluate capacity Define your goal choose create an your action plan audience identify specific objectives G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
ASSESS THE SITUATION G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
CONSIDER YOUR CAPACITY G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
CHOOSE YOU AUDIENCE G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
IDENTIFY SPECIFIC OBJECTIVES G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
CREATE AN ACTION PLAN G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
So for example… Audiences Objectives Activities Entry points Communications /Opportunities channels Mentor mothers Mothers of HIV To increase by 10% the Antenatal support Conduct a training number of infants being groups session for mentor exposed infants tested using POC EID mothers, to explain how technologies in your POC EID technology country within 2 years. works and the benefits it can bring. G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
IMPLEMENT AND MONITOR G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
RESOURCE PACK + To support the Strategic Framework a resource pack has been included: • Advocates Fact Sheet • Caregivers FAQ • Job aid for peer supporters • Guidance for policymakers G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
WHERE CAN YOU FIND THE RESOURCES? On the GNP+ website: WWW.GNPPLUS.NET/RESOURCES G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
NO TIME TO WAIT! ANIMATION https://www.facebook.com/GNPplus/videos/2774252666130285/ G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
PILOTING THE TOOLS IN MALAWI & SENEGAL N O T I M E T O W A I T !
THE CENTRAL ROLE OF COMMUNITIES Communities have a role to really mobilise, give information and create demand. Jackie Okinyi, Women Fighting AIDS in Kenya, 2019 The aim is to counsel, test and initiate, but this only works well if work has already been done to ensure there is a basic level of awareness about HIV. Pre-education needs to happen across the wider community. Edna Tembo, Community of Women Living with HIV/AIDS, Malawi, 2019 G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
QUESTION & ANSWER SESSION We welcome questions on any of the topics covered in this presentation. To get in touch, please contact us on info@gnpplus.net G e o r g i n a C a s w e l l N O T I M E T O W A I T ! 3 0 J U L Y 2 0 2 0
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