1. METODOLOGY FOR THE ESTABLISHMENT OF REGIONAL 2020 TARGETS MÓNICA ALONSO GONZÁLEZ PANAMERICAN HEALTH ORGANIZATION PRIMER FORO LATINOAMERICANO Y DEL CARIBE SOBRE EL CONTINUO DE ATENCIÓN DEL VIH CIUDAD DE MÉXICO, 26 A 28 DE MAYO DEL 2014

2. OUTLINE OF THE PRESENTATION 1. Why do we need new targets?and why use the framework of the cascade of the continuum of care? 2. What is the operational definition of each target and the methodology to monitor the targets?

3. WHY THE NEW TARGETS AND WHY USE THE CASCADE FRAMEWORK? New evidence and new polocies  not yet reflected in new targets. Ambitious targets supported by evidence Regional targets refer to programatic outcomes and results. We are using the cascade frameowrk because : Guide to immediate actions to be conducted by programs Reinforces the concept of interrelated actions and outcomes Adoption/adaptation at country level. Sum of all countries will permit La suma de todos los países reaching regional targets. Process at global and regional level

4. GOAL 1. INCREASING PERSONS WITH HIV THAT KNOW THEIR DIAGNOSIS By 2020, 90% of persons with HIV know their status. 2013 baseline: Cumulative HIV cases from HIV case base dsurveillance (source: HIV Surveillance system), Substract HIV deaths (adjust for subregister) (subregister based on IHME or other study; i.e 30%). Alternatively, countries can use other methods with special studies. Note: Diagnosis in HIV exposed children should follow targets established by the elimination initiative (all HIV exposed children should have a definitive diagnosis) 90

5. GOAL 2. DECREASING LATE DIAGNOSIS By 2020, 10% or less of persons have a first CD4 count under 200 cel/mm 3. 2013 Baseline will be the percent of persons with first CD4 < 200 cel/ml in relation to all persons with baseline CD4 that year. Improvement in availability of data: routine program data. Alternatively, signs and symptoms indicative of advanced HIV infection at the moment of diagnosis may be used (OI…)

6. GOAL 3. INCREASING PERSONS ON ANTIRETROVIRAL TREATMENT By 2020, 90% of the estimated eligible persons for treatment will be on ART. That should represent 81% of estimated PLWH. 2013 Baseline: Total number of persons on Art in 2013, come from program data. The denominator comes from Spectrum estimates of persons eligible for treatment. Subtarget: By 2020, 90% of children (0 a 14 y.o) eligible for treatment are receiving ART. 90

7. GOAL 4. INCREASING PERSONS ON TREATMENT WITH UNDETECTABLE VIRAL LOAD. By 2020, 90% of persons on ART are virally suppressed (viral load <50 copies/ml). It should represent 73% of estimated PLWH. 2013 baseline: Persons on ART with undetectable VL, from progra/lab registers in relation to all persons on ART with a VL (last VL) in a specific year (2013). Alternatively: a special study with a representative sample can produce this information. If using programatic data: The coverage of yearly VL tests needs to be high in order for the value of the indicator to be acceptable to use. An acceptable coverage value is >70% of patients on ART have a VL in the year. 90

8. THANK YOU