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Chloe Orkin British HIV Association Queen Mary University London

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Presentation on theme: "Chloe Orkin British HIV Association Queen Mary University London"— Presentation transcript:

1 Addressing the third 90: Improving clinical outcomes and retention in care
Chloe Orkin British HIV Association Queen Mary University London United Kingdom

2 Achieving 90-90-90 Professor Chloe Orkin,
Chair, British HIV Association Queen Mary University London

3 Disclosures Educational grants (HIV Unit): Merck Sharp & Dohme, Gilead Sciences, Janssen, ViiV Healthcare and Barts Charity Honoraria and travel sponsorship for lectures and advisory board contributions Member of the BHIVA Guidelines Subcommittee (20082017) Chair and executive trustee of BHIVA Not a patent holder or a shareholder No disclosures for spouse or family members

4 Target is 30 million on treatment by 2020-UNAIDS

5 To do this we need Fast Track cities and countries

6 Progress toward achieving the third 90: Target 3: 90% of those on ART virally suppressed (n=35)
UNAIDS target 90% Regional average 85% Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data. *Latest available data reported, ranging from

7 Achieving success

8 0% People living with HIV Virally suppressed People diagnosed
UK situation 2016 0% People living with HIV Virally suppressed People diagnosed On treatment

9 90% 97% 97% London Diagnosed On treatment Undetectable*
*VL <200 c/mL. Public Health England, 2016.

10 Cascade of Care §All numbers have been rounded to the nearest 100.
‡ All numbers are from the National HIV and AIDS Reporting System (HARS) directly and have been adjusted for missing information. * Virally suppressed was defined as having the latest reported viral load (VL) <200 copies/ml HIV and AIDS Reporting Section, National Infections Service, Public Health England

11 Examining our journey to improve the cascade of care
§All numbers have been rounded to the nearest 100. ‡ All numbers are from the National HIV and AIDS Reporting System (HARS) directly and have been adjusted for missing information. * Virally suppressed was defined as having the latest reported viral load (VL) <200 copies/ml HIV and AIDS Reporting Section, National Infections Service, Public Health England

12 Assessing standards against guidelines
Epidemiology Guidelines Audit Data from national surveillance on HIV epidemic Auditable outcomes from guidelines What are our services delivering? What should they be like? How can we improve ?

13 Improving care in the UK
BHIVA annual national audit BHIVA Standards for HIV clinical care

14 Audit: evaluates a process not an outcome
Audit : a snapshot in time Evaluates service delivery All clinics participate Not = national surveillance Voluntary Questions derived from guideline Auditable outcomes or clinical issues Data collection feasible for clinics

15 BHIVA National Audit timeline 2001-2018
2002 Time to starting ART 2004 Reasons for Switching ART 2006 ART initiation re-audit 2008 ART Failure 2009 HBV/HCV co-infection 2011 Adherence 2010 New diagnoses 2012 Retention in Care 2015 Routine Monitoring 2017 Mental health, substances 2018 Ageing 2003 Late Diagnoses 2005 Mortality 2007 In-patient care 2016 Late diagnoses 2014 Pregnancy 2013 Partner notification 2001 CD4 count at start

16 Tools: Self-audit spreadsheet tool (2015)
This is the audit spreadhsheet tool that is sent by us to each clinic/ To be filled out on x number of patients

17 Tools: Online survey system (2017)
New format this year, an online survey, explains the audit and works dynamically

18 Confidential feedback to each clinic: compared with national figures

19 Feedback: dashboard for grouped outcomes

20 Main Conclusion and recommendations from mortality audit:
Audit Conclusions Main Conclusion and recommendations from mortality audit: Late diagnosis accounted for 24% of deaths overall and 35% of HIV related deaths Causes not related to HIV accounted for 32% of deaths

21 National Dissemination
National presentation Given by doctor in training Embedding standard of care approach

22 Going beyond the 3rd 90 –achieving the 4th 90
Enhancing engagement with care Avoiding side effects and comorbidity 90% 97% Diagnosed Undetectable On treatment ? 4th 901 1. Lazarus JV, et al. BMC Med 2016;14:94.

23 BHIVA Standards for PLWHIV

24 Foster Engagement Melbourne fast-track City Feed into guidelines
Feed into commissioning for health Feed into national reporting requirements

25 Questions? @britishhivassoc @britishhivassoc British HIV Association

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