BACKGROUND: 'Getting to Zero', UNAIDS 2011-2015 strategy establishes an ambitious goal in the HIV pandemic response. With sustained incidence and often increasing HIV prevalence among key populations (sex workers, men who have sex with men and people who inject drugs [PWID]), examination of the HIV treatment cascade from diagnosis of infection to achievement of reduction in viral load demands comprehensive data collection, analysis and presentation through application of a public health approach. The aim of this study was to employ a public health metrics framework to examine gaps in data and treatment coverage among people living with HIV (PLHIV) in the western pacific region.
METHODS: We employed a conceptual metrics framework as per the World Health Organization (WHO) guideline released in 2014 with 21 indicators measuring parameters from HIV treatment, TB/HIV co-infection, PMTCT (Prevention from mother-to-child-transmission) services, and HIV among key populations (KP). We then constructed a database outlining relevant indicators from 2009-2013 among eight countries in the region (Cambodia, China, Lao PDR, Malaysia, Mongolia, Papua New Guinea, Philippines and VietNam). Consequently, we extracted relevant cross-sectional and aggregate national level data from key reports, publications and unpublished sources, and through consultation with WHO country offices, and mapped against the indicators. The results were cross-validated for accuracy by two reviewers, time-trend cascade graphs were constructed by categories and key findings were interpreted.
FINDINGS:The results across eight countries over five years suggest that indicators measuring enrolment in care and achievement of suppressed viral load (< 1000 copies/ mL) are under reported in the region. Furthermore, while Philippines and Mongolia showed the greatest increase in the number of PLHIV, others showed plateauing or reduction in incidence. PMTCT services across the region showed poor data quality and treatment coverage with Philippines performing the poorest with 4% of HIV diagnosed pregnant women receiving ARV in 2013. Results of TB/HIV co-infection services were generally well documented with Cambodia showing the greatest and VietNam showing the poorest retention of TB/HIV patients along the continuum of care. Finally, study of KP suggested that PWID were the least studied group with testing rates as low as 6% in the Philippines in 2013.
INTERPRETATION: While metrics framework and construction of cascade graphs can be a significant tool in providing a visual snapshot of HIV epidemic on a large scale, it provides limited scope for asking comprehensive questions and distinguishing differences between cross-sectional vs. cohort data; both factors can impact the interpretation of data. Despite these shortcomings, this approach is a valuable tool with results suggesting a strong need for complete data collection, increased emphasis on linking HIV positive pregnant women with care and active intervention to increase testing rates among PWID in the region.