NAPWA Treatments Campaign 2012: Start the Treatments Conversation
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Phillip Keen, (NAPWA) discusses the background, goals and objectives of NAPWA's billboard and web campaign encouraging people with HIV to get up to date about treatments. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
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NAPWA Treatments Campaign 2012: Start the Treatments Conversation
- 1. NAPWA Treatments Campaign 2012 Start the Treatments Conversation Phillip Keen phillip@napwa.org.au May 2012
- 2. Overview • Background & rationale • Campaign goals and objectives • Campaign materials & Implementation • Evaluation and next steps
- 3. HIV Treatments: science and expert opinion • Untreated HIV infection may have detrimental effects at all stages of infection. Later treatment may not repair damage associated with viral replication and immune activation during early stages of infection. • Earlier treatment may prevent the damage associated with HIV replication during early stages of infection. • Earlier treatment may reduce risk cardiovascular disease, cancers, osteopenia/osteoporosis and neurologic complications. • Prevention benefits of HIV treatments (HPTN 052/Test & Treat)
- 4. Minimum, Most Recent, Maximum CVL and Newly Diagnosed and Reported HIV cases
- 5. ARV Treatment Guidelines • March 2012 Update to US DHHS Guidelines (followed in Australia): • ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pre-treatment CD4 cell count: o CD4 count <350 cells/mm3 (AI) o CD4 count 350 to 500 cells/mm3 (AII) o CD4 count >500 cells/mm3 (BIII)
- 6. But outdated beliefs • Indications that knowledge among some PLHIV about treatment advances is not consistently reviewed or renewed • Past negative experiences in terms of pill burden, side effects and toxicities influencing attitudes and beliefs • S100 prescribers play a very important role in guiding decisions about initiating treatment • Optimal health outcomes for PLHIV will be supported by addressing psychosocial and structural barriers
- 7. Psychological barriers “Commencing was terrifying. I was scared and the night before I started I was a mess. Initial physical reaction was minimal so that was a relief. Changing meds is also a scary thought which I am trying to avoid” (ARCSHS Tracking Changes, 2011) “I had thought it would be difficult for me to commence meds since this would be an acknowledgment of the progression of my HIV. However since starting my meds I have found that a lot of small irritating conditions have cleared up and my overall health is significantly improved. I'm just grateful every day that the meds exist!” (ARCSHS Tracking Changes, 2011)
- 8. What Proportion of the PLHIV Population is on Treatments? Source Proportion on ARVs Highly Specialised Drugs Program 53.9% (January – June 2010) / Kirby ASR (2009: 52.5%) Gay Community Periodic Surveys (2010 Data , ARTB 2011) 69.5% Futures 6 (2009) 79.6% AHOD (2010) 89%
- 9. Treatments Uptake Needed • NAPWA Treatments Target: 90% on treatments by 2015 • Rapid increases in treatments uptake occurred previously: 1996-1998 (20% > 70%) Year Estimated Proportion Population Additional Population on ARVs not on ARVs needed if 90% 2010 21,391 70% 6,417 4,278 2011 22,391 70% 6,717 4,478
- 10. Median CD4 at Diagnosis 2007 2008 2009 2010 Australia 424 420 406 399 NSW (M) 443 440 408 410 NSW (W) 300 450 380 356 Source ASR/State & Territory health authorities
- 11. CD4 at start of cART (closest CD4 with 6 months prior) Prior to 1 Jan 1 Jan 2006 2006 onwards Overall Total 1882 427 2309 Mean 327.9 324.0 327.1 SD 242.4 193.5 234.1 Median 288.5 294 290 25th 150 200 160 75th 450 422 445 n (%) n (%) n (%) 250-349 347 (18.4) 101 (23.6) 448 (19.4) <250 787 (41.8) 161 (37.7) 948 (41.1) >=350 748 (39.7) 165 (38.6) 913 (39.5)
- 12. Psychological barriers “The barrier to commence my HIV treatment was the hardest thing to work through personally. It took my doctor three years to convince me it was the right thing to do. In hindsight having now been on meds for over a year and my health at its best I wish I could have known and started them earlier. It’s important for others facing this hurdle to speak with people that have faced this....with positive outcomes.” (ARCSHS Tracking Changes, 2011)
- 13. Campaign: Goals and Objectives • Health Issue: o Some people living with HIV who would benefit from HIV treatments are not accessing them due to outdated understandings about their benefits and risks. • Campaign Goal: o To mobilise people living with HIV to achieve better health outcomes through increased access to appropriate HIV treatments. • Campaign Objectives: o To encourage people living with HIV to become better informed about the benefits of HIV treatments for themselves and their partners. o To encourage people living with HIV to talk to their doctor about the latest information about HIV treatments and whether initiating HIV treatments would benefit them.
- 14. Launch
- 15. Posters and Print advertisements Version 1 Long copy If you’re living with HIV then talk to your doctor. Early treatment can have important health benefits And can protect your partners. Don’t put off treatment Any longer and learn about the latest developments. START THE CONVERSATION TODAY
- 16. Posters and Print advertisements Version 2 Image Sydney Morning Herald (Spectrum) Saturday Age Courier Mail Saturday Star Observer SX Queensland Pride Men’s Health
- 17. Billboards, Bus & tram sides. Sydney, Melbourne, Brisbane Short copy If you’re living with HIV, Start a treatment conversation With your doctor
- 18. Billboards
- 20. Website Content • Benefits of early initiation of HIV treatments- for PLHIV and in protecting partners • HIV treatment guidelines • Psychological barriers to initiating and switching HIV treatments • Working with your doctor & where to find S100 docs
- 21. Evaluation and next steps • Generation II of campaign o Online advertising • External evaluation • Next Campaign: o PLHIV peer experiences of treatments • Policy work
- 22. Barriers to Treatments Uptake • Reducing barriers to treatment o Dispensing arrangements o Co-payments • Difficulties obtaining medication and co-payments associated with stopping ARVs (ARCSHS Tracking Changes, 2011) • ATRAS and other Medicare Ineligibles • Addressing Psychological barriers to initiating treatment o Recommend doctors commence discussing treatments at or soon after diagnosis & assess psychological supports needed
- 23. Thanks
Hinweis der Redaktion
- There is a growing body of science and expert opinion favouring earlier initiation of HIV treatments. (above 500)Definitive data on this question will come from START (NAPWA is the Australian START partner), the problem is that the data won’t be available until 2014.Decisions about treatments must always be a personal decision made by people living with HIV, taking into account all of their circumstances, but NAPWA wants to make sure that people living with HIV are getting access to current information about the benefits of treatments from their doctors, peers and community experts.
- This slide shows decline in new infections in San Francisco from 2004 to end 2009 of around 40% – during this period there was an intensive effort by SFDPH and CBOs to improve the level of linkage to care (an issue probably for Australia too) for people living with HIV. Testing was also promoted. Earlier treatment (as per DHHS guidelines) and health monitoring campaigns were in place.
- The DHHS guidelines position on recommending treatment above 500 was based on expert opinion.Rating of Recommendations: A = Strong; B = Moderate; C = OptionalRating of Evidence: I = data from randomized controlled trials; II = data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = expert opinion
- We see from Tracking Changes and other research that (i) many PLHIV have outdated beliefs about the risks of HIV treatments, and (ii) that there is a sometimes long psychological adjustment process needed by some people in contemplating whether or not to start treatments.
- We are not really sure what proportion of the PLHIV population are on ARVs. The three data sources here show quite different proportions of the proportion of people on treatments.The first estimate takes data from the HSD program, which tracks actual prescriptions of S100 antiretroviral drugs that are dispensed annually, and divides this by the estimates of people living with HIV alive in Australia from the Kirby Annual Surveillance Report. As the 2010 HSD data was only for the first six months of the year, I’ve provided the estimate for 2009 too. While the data on drugs dispensed through the HSD is reliable, the Kirby estimate of the size of the population is an estimate, so some might question this method for calculating an estimate, but NAPWA believes that this figure is useful in estimating the lower limit of the proportion of PLHIV who may be on HIV treatments.On the other hand, as the AHOD data is based on a sample of people attending clinics, the higher proportion of people on treatments is probably higher than across the whole PLHIV population in Australia.
- The NAPWA Board has adopted a target in relation to treatments uptake – to have 90% of the diagnosed HIV positive population on HIV treatments by 2015.Approximately 4,500 people would need to commence ARVs based on current estimates of the PLHIV population in Australia.This figure does not take into account growth in the population of PLHIV, or people ceasing ARVs.
- We see from AHOD that median CD4 at initiation is still quite low; people are losing on average over a 100 CD4 between diagnosis and initiation.But, we know from the AHOD data on median CD4 at initiation that – even before the recent DHHS Guidelines change (followed in Aust) that recommended that all PLHIV should be on Rx, that there were many people in Australia for whom treatment was already indicated.We need to urge doctors and people with HIV to start thinking about treatments sooner after diagnosis.We also see from some large treatment cohort studies like DAD and EuroCEDA that there is a bias towards treating older PLHIV; we think some docs may take the view that younger people are less likely to be adherent, and that there may be a bigger risk of long term toxicities if people start at younger ages (but note shifting expert opinion as per DHHS).
- We know that there are some people who are biased against treatment and will possibly never treat, but we believe that there are many others who are not currently treating who might shift depending on evidence. There has not been a dialogue about early treatment in Australia, so NAPWA wanted to provoke that dialogue with this campaign.Note NAPWA position that always a PLHIV’s personal decision .. But, importance of information.
- Ita! Yay!Launch and media coverage, Outdoor advertising, Print media, Website, Poster distributionNAPWA members/AIDS Councils/LHD local implementation Online advertising (Gen II)
- Mix of mainstream and gay press.Mainly Sydney, Melbourne and Brisbane, but some national (Men’s Health), and an online marketing component is planned for later