1988 Constitution: landmark for health The Unified Health System (SUS) UNIVERSALITY – as a fundamental right INTEGRALITY – from prevention to treatment.

1988 Constitution: landmark for health

The Unified Health System (SUS)

•UNIVERSALITY – as a fundamental right

•INTEGRALITY – from prevention to treatment

•EQUITY – no distinction with recognition of populations'

specificities

HEALTH AS A DEMOCRATIC ACHIEVEMENT

80% 74%

61%

44%

33%

HIV CONTINUUM OF CARE (Cascade) Brazil 2012

COMBINATION HIV PREVENTION

HARM REDUCTION

CLASSIC PREVENTION STRATEGIES

CONDOMS

Focus on Key Populations •33 supported projects -HIV Screening with Oral Fluid RT technology

• Trans • Gays and MSM• PUD• SW

STRUCTURAL INTERVENTIONS

Social NameTransgender and Transsexuals, you deserve a friendly service

“You can be served in public health system with the name you chose. Order SUS card with your name that you decide to use and exercise your right.”

STRUCTURAL INTERVENTIONS

President Dilma Roussef receives the LGBT Movement

June, 2013

STRUCTURAL INTERVENTIONS

Keila Simpson, Human Rigths Award, by President Dilma Roussef

December, 2013

International Drug Simposium: “From Coersion to Cohesion”

STRUCTURAL INTERVENTIONS

“The results have galvanized efforts to eliminate the global AIDS epidemic”

Dr. Bruce Alberts, Science’ Editor

TREATMENT AS PREVENTION

 NEW GOVERNMENT DIRECTIVE (DECEMBER 2013)Introduces 5 new algorithms aimed at increasing access to

testing and diagnosis

Algorithms 1 screening + confirmation - > RT finger prick

Algorithms 2 - screening RT finger prick + confirmation Oral

Fluid

Algorithms 3 screening 3rd generation immunoassays +

confirmation VIRAL LOAD quantification

FIRST STEP: NEW TESTING ALGORITHMS

Algorithms 4 - 4th generation immunoassays as

screening + confirmation VIRAL LOAD quantification

Algorithm 5 - combines 3rd generation

immunoassay screening followed by Western

Blot/Imunoblot confirmatory test.

FIRST STEP: NEW TESTING ALGORITHMS

The new Clinical Protocol and Therapeutic Guidelines (CPTG) for Treatment of HIV Infection in Adults was discussed with an Advisory Board of experts, submitted to a public consultation for 30 days, and published in a Government Directive no. 27, of November 29, 2013. * SVS: Health Surveillance Secretariat

Both the complete document (in Portuguese) and the Quick Consultation Guide are available in PDF and in an on-line version at www.aids.gov.br/pcdt

SECOND STEP: NEW TREATMENT PROTOCOL

A highlight among the main new items of the

CPTG is the recommendation to start

antiretroviral therapy for all HIV positive

people, regardless CD4, based on the possible

impact on morbidity and mortality, but also in

the reduction of HIV transmission. A Public

Health Approach.

SECOND STEP: NEW TREATMENT PROTOCOL

TREATMENT2.0

Adapt delivery systems

Mobilize communities

POC and other

simplified monitoring

Optimize drug

regimens

Reduce costs

TREATMENT 2.0

IOS (Apple) and Android platforms

Smartphones and Tablets

Free of charge

Offline access to national guidelines

Updates – downloadable new contents and modifications

New functionalities will be added: ie: interactions of ARV and other drugs.

PCDT HIV

TREATMENT PROTOCOL - APP

• We are customizing the response working in the concept of

Hot Spots (two initial Task Forces: RGS and Amazon) ;

• Starting a National Study on PREP in Public Health Services in

4 different sites (2 SP, 1RJ and 1 RGS);

• Intensifying PEP at least in the hot spots;

• Enhancing the universal and free of charge access to

Hepatites B and C Treatment (including triple therapy with

first generation of antivirals);

• Has lead the 2014 WHO/WHA resolution on universal

treatment for Hepatites.

WHAT ELSE?

80% 74%

61%

44%

33%

HIV CONTINUUM OF CARE (Cascade) Brazil 2012

2020

578

HIV CONTINUUM OF CARE (Cascade) Brazil 2012

HIV CONTINUUM OF CARE (Cascade) Brazil 2012

HIV CONTINUUM OF CARE (Cascade) Brazil 2012

Community of Portuguese Language Countries - CPLP

Thematic Research and Development Networks (Rides CPLP ) are part of the CPLP Strategic Plan in Health, focusing the following themes:

•Network in STI - AIDS •Network in Malaria •Network in Tuberculosis

Community of Portuguese Language Countries - CPLP

• Brazil was elected to be the executive secretary of the “STI, AIDS Rides/CPLP” for the 2014-2016 period .

• Joint Work Plan (STI/AIDS Rides; Rides Mal ; TB Rides): “Elimination of MTCT transmission by 2017”.

Implementation of national PMTCT plans under the perspective of the B + Recommendation (WHO).

This initiative also includes HIV/TB co-infection diagnosis and treatment, as well as malaria testing and treatment (as a risk factor for HIV transmission during pregnancy).

Fabio Mesquita – Director

[email protected]

Marcelo Freitas – Treatment Coordinator

[email protected]

Cristina Raposo – Head of International Cooperation

[email protected]

OBRIGADO!