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  National HIV Prevention , Care and Treatment Program  Adherence Technical Meeting  October 19 th  - 22 nd , 2009 Jules Mugabo M.D HIV, AIDS and STI Unit TRAC Plus/ Rwanda MOH TRAC  Plus  C enter for  T reatment and  R esearch  on  A IDS,  M alaria,  T uberculosis and  O ther  E pidemics
HIV Prevention Program ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VCT National program 2004-2008 2004 2005 2006 2007 2008 Estimation of general population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Targeted population for VCT (50% of the general population) 4,288,877 4,407,127 4,529,196 4,654,810 4,783,595 % Of clients tested (denominator:  Targeted population for VCT) 4.1% 10.2% 10.4% 16.1% 20.2% HIV seroprevalence in VCT 11.4% 9.4% 7.3% 4.8% 3.4% % of Health facilities offering VCT 26.5% 46.2% 51.8% 63.1% 75.4%
PMTCT Program 2004-2008 2004 2005 2006 2007 2008 Rwanda population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Expected pregnant women 351,688 361,384 371,394 381,694 392,255 % of pregnant women tested for HIV 27% 49% 59% 56% 75% % of HIV + women receiving ART prophylaxis 35% 51% 60% 55% 67% % of exposed children receiving ART prophylaxis 26% 33% 46% 65% 63% % of partners tested for HIV in PMTCT ND 32,6% 52,4% 65% 78% % of discordant couples in PMTCT ND 4,5% 3,7% 3,1% 2,7% % of Health facilities providing PMTCT 26.5% 46.2% 51.8% 63.1% 75.4%
Level of participation in PMTCT program
Rate of MTCT of HIV
Barriers to PMTCT use ,[object Object],[object Object],[object Object],[object Object]
Barriers to PMTCT use ,[object Object],[object Object],[object Object],[object Object]
Reasons for less adherence of  pregnant women to PMTCT services  ,[object Object],[object Object],[object Object]
PMTCT clients challenges and program weakness ,[object Object],[object Object],[object Object]
HIV Care and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ART Program 2004-2008 2004 2005 2006 2007 2008 Estimation of general population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Adults HIV+ adult (15+) 158,275 157,157 162,837 170,639 177,258 Adults in need of ARVs 50,106 48,733 49,316 52,949 92,421 Proportion of eligible adults receiving ART 18% 36% 64% 80% 62% Children HIV+ children (0-14) 29,373 29,621 29,878 30,275 31,299 Infants in need of ARVs 7,625 7,395 7,517 7,912 8,544 Proportion of eligible children receiving ART 7% 20% 37% 55% 66% Services coverage % of Health facilities offering 7% 18% 29% 36% 43%
Patients on ART end June 2009 = 70,234  patients) ARV regimen % patients  96.58 %  of adults  patients  D4T+3TC+NVP 48.07 AZT+3TC+NVP 34.82 D4T+3TC+EFV 5.40 AZT+3TC+EFV 8.29 Type of health facility Children Adults Hospital 37.3% 36.5% Health center 62.7% 63.5% Total 100%  100% 
Evaluation of Clinical and Immunologic  Outcomes from the National ART Program ,[object Object],[object Object],[object Object],[object Object]
Evaluation of Clinical and Immunologic Outcomes from the National ART Program ,[object Object],[object Object],[object Object]
Evaluation of Clinical and Immunologic Outcomes from the National ART Program ,[object Object],[object Object],[object Object]
Evaluation of Clinical and Immunologic Outcomes from the National ART Program ,[object Object],[object Object],[object Object],[object Object],[object Object]
  100% self-reported adherence during 3 and 30  days
Outcome: Self-reported adherence:  30-day recall  N=575 N=490 N=352
Current viral load
Timing of missed pills among patients reporting ≤100% adherence in 3 days preceding interview
Most common reasons for ever missing ART
Patient’s level factors  predicting  self-reported 30-day non-adherence  …
Patient’s level factors  predicting  self-reported 30-day non-adherence …
Patient’s level factors  predicting  self-reported 30-day non-adherence …
Facility level factors  predicting  self-reported 30-day non-adherence  …
Perspectives ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]

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Presentation: Results of National Adherence PHE

  • 1. National HIV Prevention , Care and Treatment Program Adherence Technical Meeting October 19 th - 22 nd , 2009 Jules Mugabo M.D HIV, AIDS and STI Unit TRAC Plus/ Rwanda MOH TRAC Plus C enter for T reatment and R esearch on A IDS, M alaria, T uberculosis and O ther E pidemics
  • 2.
  • 3. VCT National program 2004-2008 2004 2005 2006 2007 2008 Estimation of general population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Targeted population for VCT (50% of the general population) 4,288,877 4,407,127 4,529,196 4,654,810 4,783,595 % Of clients tested (denominator: Targeted population for VCT) 4.1% 10.2% 10.4% 16.1% 20.2% HIV seroprevalence in VCT 11.4% 9.4% 7.3% 4.8% 3.4% % of Health facilities offering VCT 26.5% 46.2% 51.8% 63.1% 75.4%
  • 4. PMTCT Program 2004-2008 2004 2005 2006 2007 2008 Rwanda population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Expected pregnant women 351,688 361,384 371,394 381,694 392,255 % of pregnant women tested for HIV 27% 49% 59% 56% 75% % of HIV + women receiving ART prophylaxis 35% 51% 60% 55% 67% % of exposed children receiving ART prophylaxis 26% 33% 46% 65% 63% % of partners tested for HIV in PMTCT ND 32,6% 52,4% 65% 78% % of discordant couples in PMTCT ND 4,5% 3,7% 3,1% 2,7% % of Health facilities providing PMTCT 26.5% 46.2% 51.8% 63.1% 75.4%
  • 5. Level of participation in PMTCT program
  • 6. Rate of MTCT of HIV
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. ART Program 2004-2008 2004 2005 2006 2007 2008 Estimation of general population (census 2002) 8,577,753 8,814,253 9,058,392 9,309,619 9,567,190 Adults HIV+ adult (15+) 158,275 157,157 162,837 170,639 177,258 Adults in need of ARVs 50,106 48,733 49,316 52,949 92,421 Proportion of eligible adults receiving ART 18% 36% 64% 80% 62% Children HIV+ children (0-14) 29,373 29,621 29,878 30,275 31,299 Infants in need of ARVs 7,625 7,395 7,517 7,912 8,544 Proportion of eligible children receiving ART 7% 20% 37% 55% 66% Services coverage % of Health facilities offering 7% 18% 29% 36% 43%
  • 13. Patients on ART end June 2009 = 70,234 patients) ARV regimen % patients 96.58 % of adults patients D4T+3TC+NVP 48.07 AZT+3TC+NVP 34.82 D4T+3TC+EFV 5.40 AZT+3TC+EFV 8.29 Type of health facility Children Adults Hospital 37.3% 36.5% Health center 62.7% 63.5% Total 100%  100% 
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20. 100% self-reported adherence during 3 and 30 days
  • 21. Outcome: Self-reported adherence: 30-day recall N=575 N=490 N=352
  • 23. Timing of missed pills among patients reporting ≤100% adherence in 3 days preceding interview
  • 24. Most common reasons for ever missing ART
  • 25. Patient’s level factors predicting self-reported 30-day non-adherence …
  • 26. Patient’s level factors predicting self-reported 30-day non-adherence …
  • 27. Patient’s level factors predicting self-reported 30-day non-adherence …
  • 28. Facility level factors predicting self-reported 30-day non-adherence …
  • 29.
  • 30.
  • 31.