The Brazilian Experience

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Presentation transcript:

The Brazilian Experience Implementation of DTG in the light of WHO’s new directions and signal of risk of NTD: how to scale up treatment, respect client choices and monitor risk Adele Schwartz Benzaken Ministry of Health of Brazil Departament of Surveillance, Prevention and Control of STIs, HIV / AIDS and Viral Hepatitis

No conflict of interests

Lessons from early adoption of DTG 2016: INSTI= U$ 8.8/day. Following negotiation (2017): U$ 1.50/day – DTG purchase. Exclusions: FSV, DDI, d4T and SQV; EFZ became alternative choice in case of contraindication to DTG; Even with all changes, MoH’s budget remained the same. Poster discussion session– Title “Keeping it up: National ownership and financial sustainability”. 25 July at 13:00-14:00 - Session room G104-105

Scaling Up DTG in Brazil - 2018 Switch may occur: Few adverse events Adherence improvement Few drug interactions Certain comorbidities Not recommended: Detectable VL Previous virological failure Well adapted patients Pregnant women Contraindication to DTG: TB; <12 yo; drug interactions The switch must respect person’s choice ARV switched to DTG #PLHIV* EFV 7.120 PI (ATVr, DRVr, LPVr) 3.036 *from April 16 to July 4 2018: new price negotiation = U$ 1.00

Brazilian Rapid Response - Review of Recommendations May 18th, 2018 (same date as WHO) WLHIV of childbearing potential age: Should NOT receive DTG Subject to effective contraceptive method (i.e. IUD; hormonal implant) Pregnant WLHIV (initiating ARV): EFV or ATVr if <14 weeks of pregnancy RAL if ≥14 weeks of pregnancy Women of childbearing potential age and PEP: Should NOT receive DTG Indication: ATV/r

Partnership: MoH-Brazil/Fiocruz/Vanderbilt U/NIH Initial Findings – Pregnant WLHIV DTG Exposed - Brazil, 2018 Distribution WLHIV with pre-conception exposure to DTG (Jan 2017 – May 2018): All 27 states 204 municipalities 491 cases DTG and pregnancy outcomes among ART-recipients in Brazil: a national population study. Partnership: MoH-Brazil/Fiocruz/Vanderbilt U/NIH National database linkage Outreach: phone calls and quick questionnaire (local programmes) Preliminary Results Outcome N % Live birth 91 53.8 Stillbirth 2 1.2 Abortion 8 4.7 Still pregnant 68 40.2 Total 169 100 No neural tube defects identified Source: MoH- Brazil

www.saude.gov.br www.aids.gov.br Thank you! adele.benzaken@aids.gov.br www.saude.gov.br www.aids.gov.br