advanced hiv disease update: mozambique · •mozambique intends to scale up the ahd package that...

Advanced HIV Disease Update:Mozambique

Irénio GasparMOH Mozambique28/07/2020

The CQUIN Project Virtual Workshop on Advanced HIV Disease July 28-29, 2020

• HIV prevalence: 13.2% (15-49 years) (2,243,966PLWH)

HIV in Mozambique

2Source: Spectrum 5.87

Indicator 2019

PLWHIV 2,243,966

Adults LWHIV 2,093,570

Children LWHIV 150,396

# New infections 132,944

# New daily infections 364

# Deaths related to HIV/AIDS 50,586

# Pregnant women HIV+ 107,723

Vertical transmission rate 14

Source: 5,97


• Progress towards 90-90-90

HIV in Mozambique

3

Fonte: Shiny 90, SIS-MA, H04-A & Spectrum v5.87, DISA-Link

Children, 0-14

Adults, 15+


What is known about the prevalence of AHD?

AHD in Mozambique

4

39% 39%

34%31%

29% 29% 28%25%

21%18% 18%

73%71%

68%65%

63% 62%58%

53%

44%

38% 37%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Evolução % Pacientes com CD4 baixo ao início do TARV: Moçambique

CD4 < 100 CD4 < 200


What is known about mortality rates amongst PLHIV? • An estimate of 50.586 people died due to HIV related conditions

in 2019

AHD in Mozambique

5Source: Spectrum 5.87


• There is a sub-group at the C&T TWG group that is dedicated to AHD issues

• Policy development• Training package elaboration• GF grant preparation• M&E tools and indicators

• RoC are a part of the C&T TWG, but are not participating in the AHD sub-group.

AHD Coordination and Leadership

6


• Is there a national AHD strategy?• It is being developed (December)

• Are there national AHD guidelines?• It is being developed (September)

• Are there national training materials related to AHD? • It is being developed (September)

AHD Policies and Guidelines

7


• What is the essential package of AHD diagnostic and treatment services?

• Mozambique intends to scale up the AHD package that WHO recommends in 2021 to levels of the health system

• Right now only main referral hospitals treat conditions such as Crypto meningitis. No systematic screening of crypto is being implemented w/ CrAg

• TB is clinically screened and Xpert/Ultra is available country wide (no TB-LAM available yet). TB meningitis diagnosis only at referral hospitals

• Kaposi's sarcoma treatment is provided in referral hospitals.

AHD Essential Package

8

• How and where are CD4 tests done?

• 100% CD4 testing coverage.

• National policy: CD4 test is indicated for new patients and patients

reintegrated to care; for patients with virologic failure; for critically ill

patients at any time; to monitor patients on treatment w/ initial CD4

count ˂ 350

• Due to changes in donor funding, CD4 testing is not supported by

PEPFAR anymore since 2018. This translates as a lack of access to

CD4 testing in country (only few HF continue offering CD4 testing)

• From 2021 on, Mozambique expects to regain access to CD4 testing

through GF grant.

• The Pima platform will lead CD4 testing (with an average of 79% of

CD4 tests), followed by facscalibur (with 15%) and facscount (with 6%)

in terms of contribution for the same period of time.

Laboratory Services: CD4 Testing

9


• Are there data or documentation challenges related to

AHD?

• At the moment the M&E tools being used don´t capture many of the

indicators needed to measure AHD and the impact of the interventions

• The M&E component for AHD needs to be developed

Monitoring & Evaluation

10


§ There is a model center at Maputo City, considered a referral center on AHD, that offers ambulatory comprehensive package of screening, treatment and follow up of patients with AHD. It includes:

• Kaposi sarcoma treatment

• Crypto meningitis diagnosis (CrAg), pre-emptive therapy and optimized treatment (LAMB, Fluocytosine, fluconazol)

• TB diagnosis (TBLAM, FASH, Xpert Ultra PTB/EPTB) and treatment (including MR/XR)

• Management of patients on 2nd line failure (including GNT)

• Palliative and home-based care

DSD Models for AHD and P@HR (1)

11


• In Maputo city also, AHD minimum package is offered in one of

Distric Hospitals (José Macamo) as part of initial triage in emergency

department, with a referral-contrareferral flow with ambulatory care

at CRAM;

• AHD package (CrAg, TBLAM, Crypto treatment, TB treatment) is

also integrated in Beira’s Central Hospital and in PHC of Munhava,

with a referal-contrareferral flow to assure continuity of care.

DSD Models for AHD and P@HR (2)

12


• Mozambique has a Warm line service that takes phone calls from all around the country. 85% of calls are HIV related, most of them are complicated HIV cases. The line is attended by experienced clinicians and Internal Medicine specialists:

• Orientations are given to diagnose and treat complicated patients;

• Referrals are organized when needed (referral centers contacted in order to assure access to the best care available).

Good Practices

13


• Current lack of access to diagnostic tests (CD4, TB-LAM, CrAg) and optimized treatment (LAMB-flucitosine, irregular provision of

fluconazole);

• The main referral hospitals in each province, that are prepared to attend more complicated patients (AHD) don´t have ART services available;

• Lack of trained HRs to deal with the AHD in the primary levels HFs.

Challenges

14


• Finalize the national strategy and guidelines and implement the training package

• Get approval for the GF proposal

• Keep the referral center of Maputo city offering AHD services, and becoming a model center where on job trainings can take place, in order to expand the model to all provinces

Priorities for 2020 – 2021

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Acknowledgements

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