1. IAC Presentation on Selected Findings Community Access to Treatment, Care, and Support Study (CAT-S) Sushil Koirala, MA. MPH. Program Manager, APN+

2. Background  National PLHIV Networks in Asia and the Pacific region consistently shared that the national authorities do not adequately document and share the barriers/enablers to PLHIV’s access to treatment, care and support  Information gathered through health system delivery and ad-hoc studies were not adequate to capture the real problems faced by PLHIV in the community  In February 2010, a meeting among 11 National PLHIV Networks from Asia and the Pacific region identified a need to monitor, document and share information related to the level of access to effective HIV treatment, care and support services in the region.  Asia Pacific Network of People Living with HIV/AIDS (APN+) facilitated the submission of a Rd. 10multicounty (7contries) proposal to the The Global Fund  Of which a small portion (10%) was approved in February 2011 for the design and implementation of community centric, community driven and community led study that captures real life experiences that are hindering/enabling access treatment, care and support among PLHIV in the region

3. Study objectives  The overall objective of this study is to monitor and document the issues related to PLHIV's access to HIV treatment, care, and support services in Asia and the Pacific region  Assess the HIV treatment-related issues such as access to pre- ART care, ART, ART adherence, treatment literacy, disclosure and stigma, high risk behaviours health seeking behaviours, financial burden, etc.  Develop baseline to measure longitudinal changes in the key issues (identified through phase I) in access to HIV treatment, care and support

4. Framework BangladeshLao PDRNepalPakistanPhilippinesVietnamIndonesiaConsolidated Sample size6005301,5985251,3201,6151,6557,843 Number of data collectors 1511141114151898 Ethical approvalMedical Research Council (BMRC) Center for HIV/AIDS and STI (CHAS) Nepal Health Research Council (NHRC) Bridge Consultants Foundation DOH Ethics Committee (DREC) Ha Noi School of Public Health Atmajaya University Start interview date 26-Nov-124-Jan-131-Oct-1221-Nov-126-Nov-124-Dec-1217-Nov-121-Oct-12 Latest interview date 30-Apr-137-Mar-1329-Mar-134-Mar-137-May-1321-Mar-1331-May-13 Average time to complete question in minutes 7169647757695364

5. Respondents- Place of enrollment (%)

6. Respondents- Gender (%)

7. Respondents- Risk classifications (main,%)

8. Reasons for HIV test (%)

9. Place of initial HIV test (%)

10. Average baseline CD4 count (cells/mm 3 ) WHO 2010 WHO 2013

11. Average baseline CD4 count (%)

12. Baseline CD4 and clinical referral for HIV test (%) Clinical referral for HIV test included; - Referred by a doctor due to suspected HIV-related symptoms or being sick - Husband/wife/partner/child tested positive - Illness or the death of husband/wife/partner/child

13. Baseline CD4 and NON-clinical referral for HIV test (%)

14. HIV diagnosis & baseline CD4 count Duration of HIV diagnosis BangladeshIndonesiaLao PDRNepalPakistanPhilippinesVietnamConsolidation <1 year268278204335324216408258 1-2 years256252243407341319399312 2-3 years291259177378351317346309 3 years or more 288257171352379293273290 Total281259181361367281292

15. No Viral Load Test (%) ** 7.8% - cannot remember

16. No viral load test vs. change of ART regimen (%)

17. Cost of health care

18. HIV Treatment Literacy

19. ARV regimen RegimenN% Stavudin + Lamuvudin + Nevirapine4948.3 Stavudin + Lamuvudin + Efavirenz2985.0 Ziudovudine + Lamuvudin + Nevirapine231839.0 Ziudovudine + Lamuvudin + Efavirenz136723.0 Ziudovudine + Lamuvudin + Lopinavir/Ritonavir871.5 Staudinger + Lamuvudin +Lopinavir/Ritonavir210.4 Lamuvudin+Tenofovir + Nevirapine3586.0 Lamuvudin +Tenofovir + Efavirenz5799.7 Lopinavir + Ritonavir + Tenofovir280.5 Others1542.6 Don't know2414.1 5,945 100% Still using Stavudin: Indonesia- 6.7%, Laos 16.7%, Nepal 29.4%, Pakistan 20.4%, Philippines 9% Vietnam 16.6%, Bangladesh 0%

20. Self-reported ART Adherence Countries % with > 95% adherence % never missed a dose % missed an appointment of HCP Bangladesh 99.678.82.6 Indonesia 78.548.211.4 Lao PDR 49.383.79.1 Nepal 72.770.43.6 Pakistan 83.363.618.1 Philippines 88.258.29.9 Vietnam 70.160.312.7 Consolidated 76.362.99.7

21. Conclusions  Low self initiated HIV testing, indication of late diagnosis, low CD4 at diagnosis  Monitoring of viral load is almost non-existent in 5 out of 7 countries  Despite large scale funding- cost of care is still a burden  Mixed level of treatment literacy, some countries have lower treatment literacy levels than others.  Self-reported adherence is lower than 80% in 4 out of seven countries. Less than 50% self-reported adherence in Laos  Stavudine is still used in 6 out of 7 countries

22. Ways forward  Data driven specific and clear message to the stakeholders at the country level  Use of data for prioritization and funding (esp. NFM)  Continue expanding database- recognize and include community stories (things that most designs skip but are very important)  Expanding alert reporting, human right violations, service mapping and monitoring of quality of care  Continue to build an engagement platform for the community to interact, share and learn  Design country specific study for phase II and monitor “changes” over time

23. Acknowledgement  Asar Alo Society, Bangladesh  National Association of People Living with HIV, Nepal  Pinoy Plus, Philippines  Association of People Living with HIV, Pakistan  Lao Network of People Living with HIV, Lao PDR  Vietnam Network of People Living with HIV, Vietnam  GWL- INA, Indonesia Full report and presentation can be downloaded at apnmata.org For questions, comments etc get in touch at sushil@apnmata.org aor@apnmata.org Thank you!