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Lessons from ATRAS

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A report on findings from the AHOD Temporary Resident Access Study, which looked at access to HIV treatments for people not eligible for Medicare. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.

Published in: Health & Medicine
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Lessons from ATRAS

  1. 1. Lessons from ATRAS AFAO Hub: ASHM Aaron Cogle 17 September 2015
  2. 2. A AHOD T Temporary R Residents A Access S Study
  3. 3. ‘Medicare Ineligible’ • In Australia legally • No Access to PBS subsidised ARVs • Only 60% of HIV+ people who need treatment were getting it (before ATRAS) • 31% were on sub-optimal combinations (before ATRAS) • Existing provisions for this group vary across jurisdictions
  4. 4. Aims • To describe the population of HIV+ temporary residents • To describe the HIV disease status of this group • To model HIV transmission rates • To provide compassionate ARV access for up to 4 years (ends Nov 2015)
  5. 5. The Sample • Recruited 180 people from 21 sites • 74% male, 26% female • 46% SE Asia, 19% SS Africa, 11% S America, 11% S Pacific, 9% Europe, 6% N America • 31% Student visa, 33% Working visa, 14% Bridging visa, 13% Spousal Visa, 13% other visa • Route of transmission; 49% MSM, 39% Heterosexual contact, 12% Other
  6. 6. HIV Characteristics at Enrolment • The average CD4 cell count was 376 cells • 63% of recruits were receiving ART • Only 47% had an UDVL • 46% of those on treatment changed their regimen after enrolment into ATRAS
  7. 7. Changes in CD4 count Baseline Month 12 Month 24 No. Mean SD No. Mean SD No. Mean SD Total 161 376 227 151 475 198 106 534 235 Female 42 350 187 37 444 190 22 524 188 Male 119 385 239 114 485 201 84 536 247 Bridging 24 436 273 24 532 216 21 554 242 Other 21 357 296 15 430 191 11 465 157 Spouse 13 391 193 12 432 184 4 435 259 Student 56 328 162 56 479 195 42 511 182 Working 47 405 238 44 464 199 28 593 311 Asia/SE Asia 76 341 214 73 458 198 56 508 208 Europe 14 422 247 13 541 234 10 702 434 North America 9 526 318 7 449 160 5 506 254 South America 18 371 149 18 556 201 13 629 197 South Pacific 14 437 164 15 512 148 9 488 88 Sub-Saharan Africa 30 371 268 25 414 199 13 461 187
  8. 8. Changes in UDVL Baseline Month 12 Month 24 N % N % N % Total 76 47.2 126 88.7 99 94.3 Female 21 50.0 28 80.0 21 100.0 Male 55 46.2 98 91.6 78 92.9 Asia/SE Asia 32 42.7 63 91.3 52 94.5 Europe 7 50.0 12 100.0 11 100.0 North America 5 55.6 4 57.1 4 80.0 South America 5 27.8 16 100.0 12 92.3 South Pacific 8 57.1 10 76.9 8 100.0 Sub-Saharan Africa 19 61.3 21 84.0 12 92.3 Bridging 14 58.3 22 91.7 20 95.2 Other 12 60.0 13 81.3 11 100.0 Spouse 6 40.0 10 83.3 3 75.0 Student 21 38.9 45 93.8 38 95.0 Working 23 47.9 36 85.7 27 93.1
  9. 9. HIV transmission 53% detectable at baseline After 12 months (12% detectable) • 77.4% reduction in detectable viral load and who have a substantial risk of onward transmission After 24 months (6% detectable) • 93% reduction in the risk of onwards transmission
  10. 10. Transition to Medicare Eligibility • At July 2013 – 39 patients had left ATRAS • At July 2014 – 79 patients had left ATRAS • By November 2015 – 110 (estimated) patients will have left ATRAS Nearly two thirds of people return to C.O.O. or become eligible within 4 years.
  11. 11. Modelling • Estimated 450 Medicare Ineligible people in Australia at any time. • Treatment cost estimated at $29,642,230 • Potential to avert a median 81 new infections over 5 years. • Equivalent to a cost saving of $26,354,092 ($69,412,098 lifetime cost) Broadly cost-neutral
  12. 12. Lessons • Providing access to ARVs to PLHIV yields better health outcomes and a reduction in the risk of onward transmission • Treating Medicare Ineligible people is cost neutral over 5 years • Two thirds of Medicare ineligible become eligible within 2 years. • We can avert 81 new infections over 5 years. • Consistent with commitments in national strategy, legacy statement etc.
  13. 13. Gaps in the response • Medicare ineligible people are not recognised as a priority population by the national strategy • ‘Measured progress’ is not ‘actual progress’ • Federation vs State
  14. 14. Future ATRAS ends in November 2015: 70 people still on study Working with states to provide ongoing access for study participants Further reports imminent More advocacy

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