1. Update on FHI-supported ART services Philippe Chiliade, MD, MHA Family Health International Date

4. FHI-supported ART Services Overview Scale-up of FHI-supported ART services –Total population and Pediatric cases Up-coming challenges –Reaching those in need of ART –Retention in care –Public health approaches / individualized approaches –Cost of HIV care and Funding issues –Quality of HIV care –Integration of HIV care into existing healthcare infrastructure –Interdependence of health status with overall development

5. Upcoming Challenges Reaching those in need of ART –Globally, 40 % of those in need of ART are on treatment (some are identified, most have not been tested) –There is a personal clinical benefit if ART is started before CD4 < 350 (how / who to prioritize?) –ART for those at high risk of transmitting HIV (pregnant women, MARPs?, discordant couples?) –Issues of ethics, infrastructure, HR, cost & funding

6. Upcoming Challenges Retention into care (pre-ART and ART care) –Around 50% of pre-ART patients are LTFU –Between 10% and 25% of ART patients are LTFU and this % increase with time on ART Public health approach vs individualized care –Issue of 1 st line ART cost (d4T, ZDV vs TDF) –Issue of ART monitoring (DART study results) –Access to 2sd line ART –Tasks shifting / sharing

7. Upcoming Challenges Cost of HIV care and funding issues –PEPFAR flat-funded / GFATM under-funded / Country budget shortfalls –Need for further scale-up of ART care –Cost of 2sd line ART –Cost of ART care monitoring –Need of operational research to identify “good practices”, more effective way to deliver HIV care –HIV Prevention vs HIV Care & Treatment –Exit strategies / Sustainability / Country compacts –Future role of international NGOs

8. Upcoming Challenges Quality of HIV care Integration of HIV care into existing healthcare structure At population and individual level, interdependence of health status and overall development

9. FHI-supported ART Services Bullets –Bullets bullets

10. FHI-supported ART Services Bullets –Bullets bullets

11. FHI-supported ART Services Bullets –Bullets bullets