MOPDC0104 - Poster Discussion
Treatment as prevention in a country with high ART coverage: the Namibia example
R. Kamwi1, N. Hamunime1, M. Odiit2, J. Gweshe1, A. Muadinohamba1, E. Shihepo1, H. Van Renterghem2, A. Jonas1, M. De Klerk1, M. Mahy3, N. Forster1, K. Kahuure1
1Ministry of Health and Social Services (MOHSS), Windhoek, Namibia, 2UNAIDS, Windhoek, Namibia, 3UNAIDS, Geneva, Switzerland
Background: A recent randomized control trial demonstrated that antiretroviral therapy (ART) can reduce the sexual transmission of HIV among sero-discordant couples by over 95%. We assessed the trends in HIV incidence and ART coverage in Namibia, and project the coverage of ART through 2015 under WHO-recommended eligibility criteria and an alternative criterion of a CD4 level below 500 per mm3.
Methods: ART data was obtained from the electronic Patient Management System (ePMS) for people receiving HAART, PMTCT data from the HIS and HIV prevalence among pregnant women from biennial ANC sentinel surveillance. These data were used in Spectrum software to estimate the number of people newly infected with HIV and the number of people eligible for ART. ART coverage was projected per WHO-recommended ART eligibility criteria (including CD4< 350) and an alternative criterion of CD4< 500 per mm3.
Results: Namibia has rapidly scaled up ART to 92,134 by March 2011, corresponding to 84% (76%-97%) of those eligible per the 2010 WHO treatment guidelines. If the eligibility threshold is increased to < 500 CD4 cells per mm3 in 2012, the number of adults eligible for ART is estimated to increase by 20% (Fig 1). There has been a rapid decline in new HIV infections from 23000 (19000-29000) in 2000/01 to 9000 (6000-13000) in 2000/11, a 61% reduction. At the current rate of scale up, Namibia targets 150000 people on ART by 2015/16 which corresponds to >95% of eligible people per WHO-recommended criteria and >80% per an alternative CD4< 500 ART criterion.
Conclusions: In Namibia, ART coverage has reached high levels and incidence is declining rapidly in the past decade. Namibia is ready to further expand ART to reduce morbidity and mortality and realize the target of a 50% reduction in sexual transmission by 2015, resulting from the scale-up of prevention and treatment programmes.
[Figure 1: Adults and children receiving ART]
[Figure 2: Trends in new infections]
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