ICAP Adherence Data Molly McNairy, MD, MSc Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
To Review Patients on ART in resource-limited settings can have good immunologic and virologic outcomes Rates of adherence and barriers to adherence similar across settings LTFU increases over time
(5X higher > 2-3 years)
LTFU relationship with mortality
40-50% of LTFU dead
Rosen 2007, McPherson 2008
Meta-Analysis: Adherence at 2 years Rosen et al. PLoS 2007 32 studies in SSA 1996-2007 ~75,000 patients in non-research ART 6 mo = 80% pts retained 12 mo = 60% pts retained At 2 Years*: BEST CASE = 84% WORST CASE = 46% AVERAGE = 61% ~40% LTFU at 2 years Of which, LTFU 56%, Death 40% 61% at 24 months
A closer look at ICAP Adherence Data June 2009 URS, PFaCTS, Patient-level “Those are other programs”
LTFU from treatment= 6 months since last clinic
Adherence program characteristics
Application for ICAP Sites Two-year cumulative risk of death, loss to follow-up9, and loss to program8among all patients since enrollment into care (Total 204,000) WORST CASE SCENARIO: 204,000 patients 50% at 2 years 100,000 patients LTFU?
Two-year cumulative risk of death, loss to follow-up9, and loss to program8among ART patients since ART initiation (Total 91,612 patients)
Pediatric ART patients since ART Initiation Patient level data through June 2009 (n= 28 sites)
Applying the Meta-Analysis ResultsTo ICAP Adherence Data “Good Adherence>95%” Our GAP *Rosen et al PLoS Med 4 (10) 2007
Cumulative and current enrollment in ART care at ICAP-supported HIV care and treatment programsas of June 2009 (n= 327,092) Cumulative initiating ART Lost to follow up Reported dead Number of patients ART patients retained in care
Status of ART patients at ICAP sites June 2009 (n= 327,092) 10.3% per year on ART Lost to Follow-up 5.3% per year on ART Reported Dead .59% per year on ART Stopped ART *Includes patients who transferred out while on ART.
PFaCTS Data on Adherence services Type of patient support service Type of adherence service # outreach workers Methods for tracking missed appointments Time to follow-up/tracking
Sites offering on-site patient support services (n=323) Take Home: All sites have services, but what are those services doing? % sites with service
Mean number of outreach workers at ICAP-supported HIV care and treatment sites (n=183) Mean number of outreach workers
Number of outreach workers per 1,000 active ART patients at ICAP sites with at least 1 dedicated outreach worker,PFaCTS Round 4 (Jan-Jun 2009) n=8 n=48 n=18 n=11 n=17 n=39 n=8 n=33 n=207 n=24 n=1 Note: The bubbles represent the median across sites and the bars represent the IQR.
Prevention Services Offered at ICAP Sites % sites