Serge Masyn Director, Johnson & Johnson Global Public Health Mapping HIV Drug Resistance Hot Spots Serge Masyn Director, Johnson & Johnson Global Public Health Data Innovation Summit 27th June 2018 #DISUMMIT
37.6 mio 25.7 mio 26.3 mio 17.0 mio 19.5 mio 13.8 mio This map shows the surface of the world following HIV prevalence or the number of people living with HIV Globally 37.6 mio people live with HIV, 26.3 mio know they are infected (70%) and rough half of them are on treatment (52%) More than half, 25.7 mio people having HIV are living in Africa 17.0 mio (65%) have been diagnosed and 13.8 mio (54%) are receiving care. World Map Surface HIV Prevalence Source UNAIDS data 2017
37.6 mio 25.7 mio 26.3 mio 17.0 mio 19.5 mio 13.8 mio This map shows the surface of the world following HIV prevalence or the number of people living with HIV Globally 37.6 mio people live with HIV, 26.3 mio know they are infected (70%) and rough half of them are on treatment (52%) More than half, 25.7 mio people having HIV are living in Africa 17.0 mio (65%) have been diagnosed and 13.8 mio (54%) are receiving care. World Map Surface HIV Prevalence Source UNAIDS data 2017
Number of people living with HIV and accessing treatment globally Access to treatment is increasing globally and that is good. However, with an increasing number of people receiving care resistance is looming around the corner. Let me explain why…
1st LINE 2nd LINE $$ HIGH Viral Load INCREASING Viral Load SUPPRESSED Before treatment your viral load, the amount of virus in your body is high. You get an initial or first line medication regimen and if that works the virus is prevented from replicating your viral load is reduced If you are compliant and take your medication every day as prescribed your viral load can even be reduced to undetectable levels Now if you fail to take your medication, you give the virus a chance to replicate again In that process it makes a lot of errors, mutations, and precisely these can be resistant to your current therapy Then you need to switch to second line therapy which currently is much more costly then first line. https://www.google.be/search?q=hiv+drug+resistance+explained&rlz=1C1GGRV_en__751__751&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiDid3M7uLbAhUSZ1AKHV-ODuYQ_AUICigB&biw=1366&bih=635#imgdii=NZ_0b7Kn3_ytqM:&imgrc=DeQjUCcIm0eT-M: INCREASING Viral Load MUTATIONS RESISTANCE HIGH Viral Load SUPPRESSED Viral Load
1st LINE 2nd LINE $$ HIGH Viral Load INCREASING Viral Load SUPPRESSED Before treatment your viral load, the amount of virus in your body is high. You get an initial or first line medication regimen and if that works the virus is prevented from replicating your viral load is reduced If you are compliant and take your medication every day as prescribed your viral load can even be reduced to undetectable levels Now if you fail to take your medication, you give the virus a chance to replicate again In that process it makes a lot of errors, mutations, and precisely these can be resistant to your current therapy Then you need to switch to second line therapy which currently is much more costly then first line. https://www.google.be/search?q=hiv+drug+resistance+explained&rlz=1C1GGRV_en__751__751&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiDid3M7uLbAhUSZ1AKHV-ODuYQ_AUICigB&biw=1366&bih=635#imgdii=NZ_0b7Kn3_ytqM:&imgrc=DeQjUCcIm0eT-M: INCREASING Viral Load MUTATIONS RESISTANCE HIGH Viral Load SUPPRESSED Viral Load
1st LINE vs. 2nd LINE Viral Load testing Resistance Testing Coming back to the first map, the countries most in need are the Low and Middle Income countries. We also saw that the cost of 2nd line or 3rd line treatment is much higher than 1st line Viral load testing and resistance testing is also costly and countries do not always have the equipment and the knowledge to run the equipment. LMIC’s cannot afford to switch to second or third line therapy. So is in the interest of LMIC and to the benefit of the patients to keep on first line treatment And that is where we want to help Overall Economy HIV Prevalence
1st LINE vs. 2nd LINE Viral Load testing Resistance Testing Coming back to the first map, the countries most in need are the Low and Middle Income countries. We also saw that the cost of 2nd line or 3rd line treatment is much higher than 1st line Viral load testing and resistance testing is also costly and countries do not always have the equipment and the knowledge to run the equipment. LMIC’s cannot afford to switch to second or third line therapy. So is in the interest of LMIC and to the benefit of the patients to keep on first line treatment And that is where we want to help Overall Economy HIV Prevalence
IDENTIFY HIV-DR Hot Spots UNDERSTAND Driving Factors Without putting any additional burden on the countries we want to: Understand which factors contribute to the emergence of HIV-DR And we want to Identify where hot spots are
HEALTH CARE SYSTEM Health System Performance (0-100) Healthcare worker density Nurses per capita Health expenditure per capita Health expenditure per GDP COUNTRY Population Age and gender distribution Life expectancy GDP History / Political situation RESISTANCE STUDIES WHO / national surveys Investigator Initiated Studies PHIA surveys EWIs Modeling studies HIV Prevalence (% & #) Incidence (% & #) % know (1st 90) % on ART (2nd 90) % < 1,000 (3rd 90) % VL monitoring VL monitoring capacity Prevention coverage Key populations Age Distribution Gender distribution ART in guidelines since ART rolled out since % on 2nd / 3rd line %LTFU HIV-2 PMTCT coverage Etc. FORECASTS ARV 2nd/3rd line ARVs VL tests Health budgets / costs Resources, including human We want to bring together the best available data from various perspective to model: At country level, element like population, age and gender distribution At HIV level the prevalence, new infections, how many people are on treatment How strong or weak is the healthcare system Look into specific resistance studies And look at financial reports, forecast etc. * Non exhaustive lists
HEALTH CARE SYSTEM Health System Performance (0-100) Healthcare worker density Nurses per capita Health expenditure per capita Health expenditure per GDP COUNTRY Population Age and gender distribution Life expectancy GDP History / Political situation RESISTANCE STUDIES WHO / national surveys Investigator Initiated Studies PHIA surveys EWIs Modeling studies HIV Prevalence (% & #) Incidence (% & #) % know (1st 90) % on ART (2nd 90) % < 1,000 (3rd 90) % VL monitoring VL monitoring capacity Prevention coverage Key populations Age Distribution Gender distribution ART in guidelines since ART rolled out since % on 2nd / 3rd line %LTFU HIV-2 PMTCT coverage Etc. FORECASTS ARV 2nd/3rd line ARVs VL tests Health budgets / costs Resources, including human We want to bring together the best available data from various perspective to model: At country level, element like population, age and gender distribution At HIV level the prevalence, new infections, how many people are on treatment How strong or weak is the healthcare system Look into specific resistance studies And look at financial reports, forecast etc. * Non exhaustive lists
Inform the country on the level, patterns and trends in HIV-DR Train the healthcare personnel/community workers Budget and procure the necessary 2nd and 3rd line regimens Inform donors and suppliers on needs for 2nd and 3rd line drugs It is our vision that through this project we will be able to: Inform the country on the level, patterns and trends in HIV drug resistance, to help Include the prevention and management of resistance in the national guidelines Develop adequate strategies to prevent the further increase of resistance Train the healthcare personnel/community workers about resistance and how to prevent/detect it Budget and procure the necessary 2nd and 3rd line regimens Inform the donors and drug manufacturers about the anticipated needs for 2nd and 3rd line drugs. Other stakeholders such as WHO
Inform the country on the level, patterns and trends in HIV-DR Train the healthcare personnel/community workers Budget and procure the necessary 2nd and 3rd line regimens Inform donors and suppliers on needs for 2nd and 3rd line drugs It is our vision that through this project we will be able to: Inform the country on the level, patterns and trends in HIV drug resistance, to help Include the prevention and management of resistance in the national guidelines Develop adequate strategies to prevent the further increase of resistance Train the healthcare personnel/community workers about resistance and how to prevent/detect it Budget and procure the necessary 2nd and 3rd line regimens Inform the donors and drug manufacturers about the anticipated needs for 2nd and 3rd line drugs. Other stakeholders such as WHO
ORGANIZED BY SPONSORED BY And to do so, we need your help We need your help in finding data We need ideas And we need you as a resource to help bring all of that together in the HIV Hack to fight HIV Drug Resistance
Mapping HIV Drug Resistance Hot Spots THANK YOU Data Innovation Summit 27th June 2018 #DISUMMIT