Reasons for treatment discontinuation during 1 st year of ART: data from 12 eastern European countries XVIII International conference on AIDS, Vienna, 19 July 2010 Dr Irina Eramova, WHO Regional Office for Europe

Focus of the presentation  Coverage with HIV care by health systems in EE countries  ART interruptions and reasons  Conclusions

Methods (1) How many PLHIV were seen for care in 2008?  Cumulative number of HIV/AIDS cases as of end 2008 – ECDC/WHO surveillance report on HIV/AIDS – For RUS – presentation from FAC at CIS coordination body,  Cumulative number of all deaths among PLHIV – Through WHO country staff and National AIDS Centers  Number of PLHIV seen for care in 2008 – WHO EURO questionnaire on health system response – National data from the countries – For RUS – presentation of Dr Onischenko at Suzdal conference 2009  Some data from EST, LVA, TKM, and UZB were not available

Methods (2) How many PLHIV stopped ART within first year?  Health system survey through questionnaire  Global 13 and Regional 19 indicators, including – “Reasons for discontinuation of HAART within the first 12 months among all patients”  Analysis of an average data on HAART interruption for 2007 and 2008  12 EE countries (excluding RUS, EST, and TKM)

Number of PLHIV seen for care in 2008 (1)

Number of PLHIV seen for care in 2008 (2)

Number of PLHIV seen for care in 2008 (3)

Percent of alive and known to health systems PLHIV seen for care in 2008

ART Discontinuation  How many PLHIV stop ART within 1 st year?  21% (671 of 3118 average) *Lack of data from RUS might affect the percentage of ART discontinuation

Reasons for ART discontinuation  38% - Death – late presentation  30% - Clinical decision, toxicity or unwillingness to continue ART – inadequate treatment preparedness – poor counselling on ARTand support of adherene – clinical decision to stop ART because of illicit drug use – Insufficient clinical management of treatment side effects  21% - Unknown/other reasons  11% - Lost to follow up

Conclusions  Health systems have to improve their performance in provision of treatment and care for PLHIV – There is a need to develop user-friendly services – There is an urgent need to increase the coverage with HIV care of those PLHIV already known to the health systems – There is a need for earlier HIV diagnosis and enrolment into care – There is a need to improve HIV case management ensuring continuum of care and adherence to ART – Electronic patient monitoring system should be introduced at clinical level

Acknowledgements  Anne-Marie Rinder Stengaard  Carlo Huber  WHO country staff  National counterparts from EE countries

Thank you!