P08.02
Background: The role of universal access to treatment in combination HIV prevention has been established. Estimation of coverage across steps in a continuum of care cascade (CCC), a key approach to monitor progress and identify barriers, is novel in Peru and most of Latin America. We aimed to build an estimation of the CCC for Peru, identify potential barriers defining losses across the process, and establish data gaps.
Methods: We drew from data from both peer-reviewed publications and official estimates (i.e. Global Fund Evaluation Reports, Government and UNAIDS bulletins) to estimate coverage for the CCC steps in Peru. We assessed whether a single CCC was appropriate, as opposed to specific CCC by sub-populations. Then we used the most plausible parameters to generate estimates of the cascade steps. We provide recommendations for initial policy changes and further research.
Results: Of 75,000 adults estimated to be living with HIV in Peru in 2013, 22,000 were women. Tested primarily in connection with reproductive health services, they generally showed a better CCC profile than men, with earlier access to and higher retention in care, and more frequent viral suppression after 6 months. Among men, data are available primarily for MSM and male-to-female transwomen (TW). Key barriers across the CCC include: low HIV testing rates (only 27% of HIV+ know their status) and late registration in care (as reflected in CD4 counts around 100 at ARVT initiation). Only 18% were virally supressed.
Conclusions: The CCC for women in Peru shows progress towards universal access, reflecting success of programs to prevent mother to child transmission, and possibly better health seeking. For MSM/TW, active promotion and facilitation of biannual HIV testing is needed to improve serostatus awareness, linked with easier access to care, with strategies to avoid losses to follow-up prior to ARVT initiation. Data for other men are extremely limited. An integrated, reliable information system to monitor progress is urgently needed.
