HEALTH AS A DEMOCRATIC ACHIEVEMENT
1988 Constitution: landmark for health
The Unified Health System (SUS)
• UNIVERSALITY – as a fundamental right
• INTEGRALITY – from prevention to treatment
• EQUITY – no distinction with recognition of populations'
specificities
HIV CONTINUUM OF CARE (Cascade) Brazil 2012
80%
74%
61%
44%
33%
COMBINATION HIV PREVENTION
CLASSIC PREVENTION STRATEGIES
CONDOMS
HARM REDUCTION
STRUCTURAL INTERVENTIONS
Focus on Key Populations
•33 supported projects HIV Screening with Oral
Fluid RT technology
• Trans
• Gays and MSM
• PUD
• SW
STRUCTURAL INTERVENTIONS
Social Name
Transgender and Transsexuals,
you deserve a friendly service
“You can be served in public health system
with the name you chose. Order SUS card
with your name that you decide to use and
exercise your right.”
STRUCTURAL INTERVENTIONS
President Dilma Roussef receives the LGBT Movement
June, 2013
STRUCTURAL INTERVENTIONS
International Drug
Simposium: “From
Coersion to
Cohesion”
December, 2013
Keila Simpson,
Human Rigths
Award, by President
Dilma Roussef
TREATMENT AS PREVENTION
“The results have galvanized efforts to
eliminate the global AIDS epidemic”
Dr. Bruce Alberts, Science’ Editor
FIRST STEP: NEW TESTING ALGORITHMS
NEW GOVERNMENT DIRECTIVE (DECEMBER 2013)
 Introduces 5 new algorithms aimed at increasing access to
testing and diagnosis
 Algorithms 1
screening + confirmation - > RT finger prick
 Algorithms 2 - screening
RT finger prick + confirmation Oral
Fluid
 Algorithms 3 screening 3rd generation
immunoassays +
confirmation VIRAL LOAD quantification
FIRST STEP: NEW TESTING ALGORITHMS
Algorithms 4
- 4th generation immunoassays as
screening + confirmation VIRAL LOAD quantification
Algorithm 5 - combines 3rd generation
immunoassay screening followed by Western
Blot/Imunoblot confirmatory test.
SECOND STEP: NEW TREATMENT PROTOCOL
The new Clinical Protocol and Therapeutic Guidelines (CPTG) for
Treatment of HIV Infection in Adults was discussed with an
Advisory Board of experts, submitted to a public consultation for
30 days, and published in a Government Directive no. 27, of
November 29, 2013.
* SVS: Health Surveillance Secretariat
Both the complete document (in Portuguese) and
the Quick Consultation Guide are available in PDF
and in an on-line version at www.aids.gov.br/pcdt
SECOND STEP: NEW TREATMENT PROTOCOL
A highlight among the main new items of the
CPTG
is
the
recommendation
to
start
antiretroviral therapy for all HIV positive
people, regardless CD4, based on the possible
impact on morbidity and mortality, but also in
the reduction of HIV transmission. A Public
Health Approach.
TREATMENT 2.0
Optimize
drug
regimens
POC and
other
simplified
Mobilize
communities
TREATMENT
2.0
Adapt
delivery
systems
monitoring
Reduce costs
TREATMENT PROTOCOL - APP
 IOS (Apple) and Android platforms
 Smartphones and Tablets
 Free of charge
 Offline access to national guidelines
PCDT HIV
 Updates – downloadable new contents and modifications
 New functionalities will be added: ie: interactions of ARV
and other drugs.
WHAT ELSE?
• We are customizing the response working in the concept of
Hot Spots (two initial Task Forces: RGS and Amazon) ;
• Starting a National Study on PREP in Public Health Services in
4 different sites (2 SP, 1RJ and 1 RGS);
• Intensifying PEP at least in the hot spots;
• Enhancing the universal and free of charge access to
Hepatites B and C Treatment (including triple therapy with
first generation of antivirals);
• Has lead the 2014 WHO/WHA resolution on universal
treatment for Hepatites.
HIV CONTINUUM OF CARE (Cascade) Brazil 2012
80%
74%
61%
44%
33%
HIV CONTINUUM OF CARE (Cascade) Brazil 2012
578
20
HIV CONTINUUM OF CARE (Cascade) Brazil 2012
HIV CONTINUUM OF CARE (Cascade) Brazil 2012
Community of Portuguese Language Countries - CPLP
Thematic Research and Development Networks (Rides CPLP )
are part of the CPLP Strategic Plan in Health, focusing the
following themes:
• Network in STI - AIDS
• Network in Malaria
• Network in Tuberculosis
Community of Portuguese Language Countries - CPLP
• Brazil was elected to be the executive secretary of the “STI,
AIDS Rides/CPLP” for the 2014-2016 period .
• Joint Work Plan (STI/AIDS Rides; Rides Mal ; TB Rides):
“Elimination of MTCT transmission by 2017”.
Implementation of national PMTCT plans under the
perspective of the B + Recommendation (WHO).
This initiative also includes HIV/TB co-infection diagnosis
and treatment, as well as malaria testing and treatment (as a
risk factor for HIV transmission during pregnancy).
OBRIGADO!
Fabio Mesquita – Director
fabio.mesquita@aids.gov.br
Marcelo Freitas – Treatment Coordinator
marcelo.araujo@aids.gov.br
Cristina Raposo – Head of International Cooperation
cristina.raposo@aids.gov.br