Transcript HLM on HIV/AIDS: Medical/Humanitarian perspectives

HIV Programmatic Training
Cape Town, March 2013
Summary Rreview
Roger Teck
27th January, 2014
Main changes:
Content
• More space for program contexts with other operational priorities
requiring integration of HIV/TB
–
–
–
–
Reference in several sessions
Presentation on PMTCT integration
Review session on minimum and extended package for HIV/TB
Session on distinct contexts: unstable context; emergency intervention;
migrants
– One group work case study: Paoua/CAR
• Session on key populations: prison & IDUs; CSW & clients; MSM.
• Tools: updated OCB CD-rom (Guidelines and tools: WHO, MSF, …)
Main changes:
Agenda and Dynamics
• Agenda: +1 day
• Days finished by 18.00 PM (except for 2 debate evenings)
• Introduction session before start (+ expectations)
• Interactive/participatory exercise(s) in most sessions
• Half day field visit & feedback in each week (linked to subjects of that
week)
• Group work on case studies; one feedback session at end of each week
• Evaluation formalized: written per session; interim after first week;
written at the end; final oral evaluation referring to expectations.
Evaluation and recommendations
• Overall very positive: balanced content; not overloaded.
• Much more participation
• Accommodation
•
•
•
LESS participants: OC quota not used
Unbalanced participation in facilitation/presentation by OCs
Some difficulties for some participants
–
–
•
French speakers ?
2 non-medical
Still late preparation for some sessions & case studies
 Recommendations:




Organization of DR TB care and treatment; …
Organization of daily summaries ?
Pre and post test Quiz ?
…
16 Participants:
Not enough, OC quota not used
OCs
OCA 2 – OCB 5 – OCP 3 –
OCG 4 - OCBA 2
Experience
Yes: 7
No: 9
Training
9 MD – 2 CO – 3 nurses
background 1 socio – 1 psychologist
Responsibility 1 HOM – 8 MedCo/dep
2 FieldCo – 2 MTL –
3 Focal Points HIV/TB
Program contexts of Participants
MIX: Vertical & projects integrating HIV/TB
-Eshowe - KwaZulu Natal/SA,
8 Vertical projects
-Shiselweni/Swaziland
(high prevalence and low -Gutu/Zimbabwe
prevalence settings)
-Maputo/Mozambique
-Chiradzulu/Malawi
-Guinea Conakry
-Myanmar
-Sana/Yemen.
6 projects integrating
HIV/TB
-Ogaden/Ethiopia
-Katanga/DRC
-Paoua & …. / CAR
-Mali
-Agok / South Sudan
-Dadaab/North-east Kenya
Facilitators/Presenters:
SAMU/OCB dependent; less external presenters
but less training-specific travelling
External
3
SAMU/OCB
9
OCB SA & Lesotho
4
OCG & OCG/SAMU
2
OCA
1
Epicentre
1
MSF South Africa
2
AAU/OCB
1
Total
23
AWG
TB WG
1
1
1
2
1
Context/Response – Role - Needs Assessment
• Context – Response – Role of MSF
 New WHO recommendations
 MSF strategic framework; priorities & ongoing discussion






Integration in non-HIV/TB
gaps/unmet needs & coverage ?
accelerated earlier treatment ?
Prevention ?
Follow-up on implementation of new WHO recommendations ?
HIV advocacy priorities ?
• Needs assessment & priority setting
 Draft checklist
 Use of Spectrum modeling for estimates and projections
 Dashboard for priority setting: vision/operations/OR/advocacy
Cascade
– Concept
– M&E
– HIV Testing & Linkage to Care
• New WHO recommendations
• Case studies: KZN and Shiselweni
– Pre-ART
– ART treatment:
• July 2013 WHO recommendations,
• VL monitoring
– Patient support: enhanced adherence counselling
– Organisation of services: simplification - taskshifting,
patient flow, infection control, patients with complications.
– Community based models: CAG & Khayelitsha Tr. clubs
Integration of HIV with TB services
– Integration: rationale; barriers; options
– HIV and TB detection and prevention (5 I’s)
– Management of HIV/TB and MDR TB co-infection
PMTCT – Children and Adolescents
• PMTCT
–
–
–
–
Options: with emphasis on option B/B+
Cascade
Management of exposed infants
Integration of PMTCT in Reproductive health programs
• HIV/TB services for children and adolescents
– Key elements of paediatric HIV/TB care and treatment
– Patient support; children (disclosure) & adolescents
– Adolescent clinic services.
Prevention
• “new” biomedical strategies, incl. TasP
• medical male circumcision (perspectives for nonsurgical methods)
Laboratory - Supply
• Laboratory
- tools for integration/decentralisation
- use of information and communication technology
- Update with regard to VL: Lab based and POC, sample
pooling, FP DBS
• Supply Chain
– Emphasis on role of MSF with regard to national supply:
whistle blower – contingency stock ?
– Case studies: Eastern Cape intervention; Shiselweni
contingency stock
M& E, Supervision & Mentoring
• M&E
• Principles and requirements
• Available tools: three-tier paper/electronic, FUCHIA,..
• Cascade: unlinked & linked
• Supervision & Clinical Mentoring
• Tools
M& E, Supervision & Mentoring
• M&E
• Principles and requirements
• Available tools: three-tier paper/electronic, FUCHIA,..
• Cascade: unlinked & linked
• Supervision & Clinical Mentoring
• Tools
Operational Research
HIV environment analysis/advocacy
• Operational Research
• Current priorities – contextual exercise
• HIV Environment analysis: national and
international
• Civil society activism
• HIV Advocacy: national and international
• Current reflection on priorities
Handover/Exit
– Dashboard Tool
– Case studies:
• Thyolo (partial handover, in process)
• Zambia (full handover, completed, and with follow-up) – to be reviewed
Field visit
First week (Thursday)
• Health centre (Ubuntu):
– HIV/TB services; organisation/integration
– Second-line ART (with OR on outcome of routine
VL/enhanced adherence counselling)
• Treatment clubs: concept, organisation, tools
Feedback session at noon
Field visit
Second week (Tuesday)
• Health centre: integration of PMTCT with MCH
services
• Youth Clinic: concept and services
• Youth treatment club
Feedback session in the afternoon
Debates
• Access to HIV testing when access to HIV care
cannot be guaranteed
• Focus on ACCESS (gaps of unmet needs:
humanitarian approach)
Versus
Focus on COVERAGE (impact: public health
approach)
Group work on case studies
• High HIV/TB – rural: Gutu/Zimbabwe 2011
• High HIV/TB - urban: Maputo/Mozambique
2006
• Unstable context: Paoua/CAR 2010
• Low HIV - concentrated in key populations:
Ukraine 2011