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Game Changer by Dr Shaari Ngadiman

This presentation was presented in National AIDS Conference Malaysia 2014

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Game Changer by Dr Shaari Ngadiman

  1. 1. WHAT NEED TO BE DONE GAME CHANGER – PAST AND FUTURE MINISRY OF HEALTH MALAYSIA
  2. 2. Reported HIV and AIDS-related deaths, Malaysia 1986 – 2014 (Jan-Jun) Cumulative HIV = 103,348 Cumulative deaths = 16,742 PLHIV (end of 2013) = 86,606
  3. 3. Reported HIV cases by mode of transmission and PWID/Sexual transmission ratio, Malaysia 2000-2013
  4. 4. MALAYSIA HIV SITUATION BY AGE GROUP
  5. 5. MALAYSIA HIV SITUATION BY RISK FACTORS
  6. 6. MALAYSIA HIV SITUATION BY GENDER
  7. 7. HIV Prevalence among KP at selected cities 2012 5.8 6.8 18.9 4.9 5.7 6.0 11.5 1.4 9.8 1.6 16.5 4.4 1.1 1.3 0 3.7 0 2 4 6 8 10 12 14 16 18 20 FSW (2012) MSM (2012) PWID (2012) TG (2012) HIVprevalence(%) National Melaka Historical City Kuantan Kota Kinabalu Kuching KL IBBS 2009 10.5 (n=551) KL IBBS 2009 22.1 (n=630) KL IBBS 2009 9.3 (n=540) KL VDTS 2009 3.9 (n=517)
  8. 8. Cascade for HIV treatment and care, Malaysia, 2013 85,322 59,725 17,202 14,622 10,235 5,118 0 50,000 100,000 Diagnosed PLHIV Enrolled in care Initiated ART Retained on ART after 12 months Received viral load test Suppressed viral load* Number * Number of patients initiating ART who are still on ART at 12 months and have VL of <1000copies/ml 263.0 245.4 370.8 333.9 0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0 500.0 National Melaka Historical City Kuantan Kota Kinabalu MedianCD4atARTinitiation
  9. 9. HIV SCREENING IN MALAYSIA, 2000 - 2013 (2013: 0.01%) 0.0 0.5 1.0 1.5 2.0 0 500,000 1,000,000 1,500,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Percent No.screening No. screening Detection Rate
  10. 10. WHAT WE ALREADY KNOW  Reducing trend  Predominantly male  Increasing female but slow  Majority PLHIV : PWID  Sexual transmission… past 3 years >50% new cases:  Heterosexual (majority)  MSM  Age group….maintained  ARV coverage….. 52.2% (2014 June)
  11. 11. WHAT WE ALREADY KNOW  Screening  Accessibility good  Numbers improving  But ….. KP may be still not reached  Workable intervention  Need aggressive intervention….
  12. 12. HIV Prevalence in adult population, Malaysia1986-2030 (AEM My2014)
  13. 13. UNDERSTANDING the epidemic
  14. 14. UNDERSTANDING the epidemic
  15. 15. WHAT NEED TO BE DONE!
  16. 16. NEW TREATMENT TARGET FOR 2020  90% PLHIV know their status  90% diagnosed with HIV receive sustained ART  90% of all who receiving ART will have viral suppression 90-90-90
  17. 17. FAST TRACK STRATEGY  Provide life saving HIV treatment  Every 10% increase in treatment coverage, there is 1% decline of new infection  Treatment as prevention……….  Treatment to discordant married couple  Option B+ to pregnant mothers  Strengthen & Bold prevention services for KP  Reach them  Community testing …..T&T ….. Referral guideline  MSM & reaching hidden MSM
  18. 18. FAST TRACK STRATEGY  Targeted intervention at high HIV prevalence  Priority areas  Implement proven interventions  Condoms  Harm Reductions  Male circumcision  Appropriate massage esp. on SRH  Consolidated effort eg. CGZ
  19. 19. WHERE APPROPRIATE
  20. 20. SUMMARY OF KEY INTERVENTIONS HIV PREVENTION STATUS 1. The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and sexually transmitted infections (STIs). 2. Among men who have sex with men, PrEP is recommended as additional HIV prevention choice within a comprehensive HIV prevention package. (NR) 3. Where sero-discordant couples can be identified and where additional HIV prevention choices for them are needed, daily oral PrEP (specifically tenofovir or the combination of tenofovir and emtricitabine) may be considered as a possible additional intervention for the uninfected partner 4. PEP should be available to all eligible people from key populations on a voluntary basis after possible exposure to HIV. 5. Voluntary medical male circumcision is recommended as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, particularly in settings with hyper-endemic and generalized HIV epidemics and low prevalence of male circumcision.
  21. 21. SUMMARY OF KEY INTERVENTIONS HARM REDUCTION FOR PWID STATUS 6. All people from key populations who injects drugs should have access to sterile injecting equipment through needle and syringe programmes 7. All people from key populations who are dependent on opioids should be offered and have access to opioid substitution therapy 8. All people from key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psycho-social interventions involving assessment, specific feedback and advice. 9. People likely to witness an opioid overdose should have access to naloxone and be instructed in its use for emergency management of suspected opioid overdose. NR
  22. 22. SUMMARY OF KEY INTERVENTIONS HIV TESTING AND COUNSELLING (HTC) STATUS 10. Voluntary HTC should be routinely offered to all key populations both in the community and in clinical settings. Community-based HIV testing and counselling for key populations linked to prevention, care and treatment services, is recommended, in addition to PITC. HIV TREATMENT AND CARE 11. Key populations living with HIV should have the same access to ART and ART managements as other populations 12. All pregnant women from key populations should have the same access to services for PMTCT and follow the same recommendations as women in other populations
  23. 23. SUMMARY OF KEY INTERVENTIONS PREVENTION AND MANAGEMENT OF CO-INFECTION AND C0-MORBIDITIES STATUS 13. Key populations should have the same access to TB prevention, screening and treatment services as other populations at risk of or living with HIV. 14. Key populations should have the same access to hepatitis B and C prevention, screening and treatment services as other populations at risk of or living with HIV. 15. Routine screening and management of mental health disorders (depression and psycho-social stress) should be provided for people from key populations living with HIV in order to optimize health outcomes and improve their adherence to ART. Management can range from co-counselling for HIV and depression to appropriate medical therapies.
  24. 24. SUMMARY OF KEY INTERVENTIONS SEXUAL AND REPRODUCTIVE HEALTH STATUS 16. Screening, diagnosis and treatment of STI should be offered routinely as part of comprehensive HIV prevention and care for key populations. 17. People from key populations, including those living with HIV, should be able to experience full, pleasurable sex lives and have access to range of reproductive options. 18. Abortion laws and services should protect the health and human rights of all women, including those from key populations. 19. It is important to offer cervical cancer screening to all women from key populations. 20. It is important that all women from key populations have the same support and access to services related to conception and pregnancy care, as women from other groups.
  25. 25. WHAT ELSE  Depend on us  Sit and discuss  Understand the epidemiology  Design appropriately  Deliver  Sustain  Review regularly including M&E  Adjust accordingly for the need.
  26. 26. TERIMA KASIH

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This presentation was presented in National AIDS Conference Malaysia 2014

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