Mövenpick Royal Palm Hotel Dar es Salaam, Tanzania August 4-6, 2009 The 7th Annual Track 1.0 ART Program Meeting

The Latest Treatment Numbers and Transition Highlights Tedd V. Ellerbrock, MD, FACOG Co-Chair, Adult Treatment Technical Workgroup Team Leader, HIV Care and Treatment Global AIDS Program, NCHHSTP U.S. Centers for Disease Control and Prevention

Track 1.0 ART Program The Track 1.0 ART Program is funded and administered by Global AIDS Programs at CDC and Health Resources and Services Administration (HRSA) Four partners received Track 1.0 ART awards AIDSRelief (Catholic Relief Services Consortium) Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Harvard School of Public Health (Harvard) Mailman School of Public Health of Columbia University (Columbia) The program was funded in February 2004

Program Year Annual Funding (millions) No. of Countries No. of Partner Programs No. of Treatment Facilities 1 ( )$ ( )$ ( )$ ( )$ ( ) $ ,030 6 ( ) $ Track 1.0 ART Program Funding, Countries, Partner Programs, and Facilities, by Program Year Total Funding since February 2004 = $1.6 billion

Track 1.0 ART Program The Emergency Plan for AIDS Relief Program Totals

Countries where Partners have Implemented Track 1.0 ART Programs, as of March 31, 2009 Country by PartnerAIDSRELIEFEGPAFHARVARDCOLUMBIATOTAL Botswana X 1 Cote d’Ivoire X X2 Ethiopia X1 GuyanaX 1 HaitiX 1 KenyaX X2 MozambiqueX X2 NigeriaX XX3 RwandaX X2 South AfricaXX X3 TanzaniaXXXX4 UgandaX 1 ZambiaXX2 TOTAL

Number of Track 1.0 Treatment Sites by Country and Partner, as of March 31, 2009 Country by PartnerAIDSRELIEFEGPAFHARVARDCOLUMBIATOTAL Botswana1*1 Cote d’Ivoire Ethiopia45 Guyana33 Haiti66 Kenya Mozambique Nigeria Rwanda South Africa Tanzania Uganda19 Zambia TOTAL ,030 *Indirect Support

Number of Persons Currently on ART by Country and Partner, as of March 31, 2009 Country by PartnerAIDSRELIEFEGPAFHARVARDCOLUMBIATOTAL Botswana 8,729*8,729 Cote d’Ivoire 33,7271,48935,216 Ethiopia 25,979 Guyana727 Haiti2,651 Kenya30,8019,40440,205 Mozambique 12,20741,22453,431 Nigeria25,22744,65719,79689,680 Rwanda3,23715,82019,057 South Africa20,53573,56730,117124,219 Tanzania25,05331,36726,21514,42097,055 Uganda22,044 Zambia24,21875,34799,565 TOTAL154,493226,21579,601158,249618,558 *Indirect Support

Number of Children (<15 years) Currently on ART by Country and Partner, as of March 31, 2009 Country by PartnerAIDSRELIEFEGPAFHARVARDCOLUMBIATOTAL Botswana n/a*0 Cote d’Ivoire 1,317531,370 Ethiopia 2,123 Guyana59 Haiti180 Kenya3,5811,1524,733 Mozambique 9173,7544,671 Nigeria1,2441,8161,2184,278 Rwanda4221,8432,265 South Africa1,4788,1462,84212,466 Tanzania1,8682,5932,5891,0338,083 Uganda1,973 Zambia2,2564,8987,154 TOTAL13,06117,8714,40514,01849,355 *Indirect Support

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program As of March 31, 2009: 1,666,943 ever enrolled in palliative care 979,685 (59%) currently in palliative care 860,661 ever started on ART 618,558 (72%) currently on ART Of those on ART, 49,355 (8%) were children Of adults on ART, 66% were females Of children on ART, 49% were females

Track 1.0 ART Program The Emergency Plan for AIDS Relief Number of Persons on ART by Partner and Quarter

Number of Persons on ART by Partner and Quarter, as of March 31, 2009 AIDSRelief 208,913 Ever Started On ART 74% on ART 10,995 patients/quarter

Number of Persons on ART by Partner and Quarter, as of March 31, 2009 EGPAF 16,324 patients/quarter 310,163 Ever Started On ART 73% on ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009 Harvard 69% on ART 6,068 patients/quarter 115,287 Ever Started On ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009 Columbia 70% on ART 11,910 patients/quarter 226,298 Ever Started On ART

Number of Persons on ART by Partner and Quarter, as of March 31, 2009 Program Totals 72% on ART 45,298 patients/quarter 860,661 Ever Started On ART

Track 1.0 ART Program The Emergency Plan for AIDS Relief Program Outcomes A Few Examples

Track 1.0 ART Program The Emergency Plan for AIDS Relief Program Outcomes Retention on ART

EGPAF Project HEART: Percentage of Patients Ever Started on ART Who Were Currently on ART, as of March 31, 2009

2-year Cumulative Risk of Death, Lost to Follow-up, and Lost to Program for ART Patients (ICAP-Kenya) 123

CD4 at ART Start and Active Status in Patients Randomly Sampled Through the Quality Improvement Program: CD4 baselineActive LTFU Dropped Out Transferred Deceased Total < %455% 364%91%15418% %475% 212%192%11013% %584% 312%221%1107% %744% 261%251%593%1805 > %313% 20.2%141%263%953 Total519285%2554% 1162%891%4598%6111

Track 1.0 ART Program The Emergency Plan for AIDS Relief Program Outcomes Change in CD4 Count

Increases in median CD4+ cell counts among cohorts of patients initiating ART CD4 Cell Count (cells/ul) n = 5,712n = 10,581n = 22,936 n = 9,162 n = 7,628 n =7,153 N = 97, n = 7,759 n = 26,178

EGPAF Project HEART: Median CD4 Count at Baseline and at end of 12-Month Follow-Up Period, as of March 31, 2009

Change in CD4 Count during 48 Months on ART Harvard MDH Program in Tanzania* Months on ART 1 1 *Shaded area = 95% CI (n=13,575)

Track 1.0 ART Program The Emergency Plan for AIDS Relief Program Outcomes Proportion with Undetectable Viral Load

N=335 N=285 N=222 Proportion of patient with suppressed HIV RNA in Rwanda national program sample % of patients 123

Time to Virologic Failure in Nigeria Patients at > 12months ART; Virologic failure = >1000 copies/ml JUTH =4009; 68MH=875; NIMR= 1723; UMTH=1945 APIN Plus/Harvard PEPFAR 123 (n=8552)

On Treatment, Viral Suppression in Randomly Selected Patients, Year Combined Total No. of Samples No. of Countries

Track 1.0 ART Program The Emergency Plan for AIDS Relief Transition Highlights

Track 1.0 ART Program Transition Activities to Date January 2009 Track 1.0 transition plans submitted Internal technical review of plans Independent PEPFAR panel review of plans February 2009 CDC and HRSA request revised plans March 2009 Track 1.0 Transition Planning Workshop with CDC country teams in Uganda June - July 2009 Revised transition plans received Additional guidance from HHS on transition August 2009 Track 1.0 Annual Meeting in Tanzania with focus on the transition January - October 2009 CDC & HRSA transition planning site visits in: Côte d’Ivoire, Uganda, Nigeria, Tanzania, South Africa, Rwanda, Mozambique, & Kenya

Track 1.0 ART Program Early Transition Successes South Africa AIDSRelief has transitioned to 3 local partners – South African Catholic Bishops’ Conference, the Institute for Youth Development, and St. Mary’s Hospital EGPAF plans to transition McCord Hospital program to direct funding Nigeria Harvard expands financial and program transition to APIN+

Track 1.0 ART Program Early Transition Successes Rwanda Columbia begins transition of components of their program and funding to MOH through TRAC+ and other MOH units Botswana Harvard-Botswana MOH partnership transition planned to local NGO-MOH partnership