Australian Treatment Cascade

At the beginning of January I wrote about New Year resolutions for our HIV management. That got me thinking about the treatment cascade. You may not have heard of it, so let me explain.

The HIV care and treatment cascade is a graph which helps us visualise the proportion of:

  • people with HIV in Australia,
  • those diagnosed,
  • linked to care,
  • retained in care,
  • receiving ART (treatment) and
  • having an undetectable viral load (UVL).

The Kirby Institute calculate of the 100% of people in Australia who are HIV-positive about 86% of people know they are living with HIV. 78% & 76% are linked and retained in care. 66% are receiving HIV treatment and 62% have an UVL.

Or as I like to describe:

72% who know they are HIV-positive are accessing HIV treatment and have an UVL’.

poz in oz figure 1

Figure 1: Estimates HIV care and treatment cascade in Australia at the end of 2013

 

So how are we doing compared to other countries?

Well at a conference in Glasgow in 2014 Raymond et al. presented an abstract on ‘Large disparities in HIV treatment cascades between eight European and high-income countries: analysis of break points.’ Or in other words, ‘How do treatment cascades from high income countries compare?’

Australia came in 1st place! We are estimated to have the highest proportion of people living with HIV on treatment with an UVL. I was surprised to find the United States at the bottom of the list, with only 25% having an UVL. This is lower than some sub-Saharan African countries where an estimated 29% of PLHIV have an UVL. Clinicians and public health officials can use these ‘cascades’ to help focus efforts and improve successes, such as increasing HIV testing or better referral pathways.

poz in oz figure 2

Figure 2: Treatment cascade in high-income countries

In Australia it looks like our 2015 HIV management resolutions are already in full swing. Now lets aim for the UNAIDS ambitious targets of 90:90:90. 90% of all people living with HIV knowing their HIV status, 90% of all people diagnosed with HIV receiving HIV treatment and 90% of all people receiving HIV treatment having an UVL.

References:

Estimated HIV care and treatment cascade in Australia (best estimate and uncertainty bounds of plausible limits) “HIV in Australia: Annual Surveillance Report 2014 Supplement”

“Australia performs best in HIV treatment cascade – 62% with undetectable viral load”

New Year Resolutions

new yearLove them or hate them, stick to them or ditch ‘em, New Year resolutions are common talk around this time of year. We promise ourselves acts of self-improvement or doing something nice for others, yet whether they last really depends on our level of motivation.

I consider managing my HIV to be a worthy resolution. Every year I promise myself to remain engaged in clinical care and adhere to my HIV medication. It might seem like a no brainer, but for me after years and years of living with HIV it really does take a back seat to what’s going on in the rest of my life.

Wherever you are on your HIV journey perhaps you can make a New Year resolution about managing your HIV in 2015?

Things you can do to get on and stay on track:

    • Start HIV treatment (if you haven’t already). Studies prove starting treatment regardless of CD4 count has significant benefit to your health, reducing viral load and onward transmission.
    • Adhere to your medication, set an alarm (if like me you get a bit forgetful)!
    • Write down scheduled hospital and GP appointments in your diary, calendar or smartphone. If you’re worried someone might look you could write these in code, i.e. Coffee with Fiona (aka Fiona Stanley Hospital).
    • Work out in advance medication refills. Nothing is worse than stressing you don’t have enough tablets to get you through to Monday!
    • Keep up with regular blood tests, typically every time you collect a new script. This is the only way of knowing the HIV medication is working correctly and you have an undetectable viral load (UVL)
    • Foster a good relationship with a HIV clinician/GP, one where you feel there is a partnership and are confident having a two-way conversation.
      Get help & support for other concerns such as financial vulnerability, mental health, substance use or unstable housing in order to help you fully engage with medical care and adhere to HIV treatment.

Perhaps if you need some help to get started you could schedule an appointment with a support officer at WAAC on 9482 0000. Good luck and let’s kick start our HIV management with a bang in 2015!!!