Transcript An operational package for Integrated Management of HIV/AIDS prevention, treatment and care ICASA - Abuja, Nigeria 5 December 2005

An operational package for Integrated Management
of HIV/AIDS prevention, treatment and care
ICASA - Abuja, Nigeria
5 December 2005
ART service delivery points, and patients
on ART. Malawi, 2002-2005
70
60
50
40
30
20
10
05
20
04
20
03
20
20
02
0
Type of service delivery points
Malawi, Mid 2005
•
•
•
•
•
•
•
4 central hospitals (tertiary)
22 district hospitals (out of 24)
20 mission hospitals
3 military (barracks) hospitals & 1 police
1 paediatric hospital
7 (private) clinics
1 rural hospital and 2 health centres
Number of people started ART,
Malawi, 2004-2005
25 000
20 000
15 000
All
Top 5 facilities
10 000
5 000
0
2004
2005
Challenges (1) : Rapidly Scaling-up
comprehensive HIV/AIDS services
• Coordinating actions of many stakeholders
• Strengthening weak health systems
• Operating in an emergency mode
Challenges (2) : Systems for service delivery
• Policy-based
– Human rights/Equity
– Community Ownership/Responsibility
– Health systems adjustments/decentralization
– Task shifts
• Evidence-based
– Best International Standards
– Convincing leaders, service providers and users
– Documenting and adapting knowledge to
different settings
Challenges (3) : Monitoring progress and quality
• At point of service delivery
– Pre ART/ART Registers
• At district level
- Indicators for district and national reporting and planning
• At national level
– Summary indicators for national planning and reporting
Levels of care for ART
Community Intervention in HIV/AIDS Services
ADVANCED INDIVIDUAL CAPACITY
* Expert patients as trainers
* ART aid
Help with facility management
*Weigh, triage for self-limited illness & side effects Clinical
INDIVIDUAL PREPAREDNESS
-Patient/client self-management
-Treatment supporters for one-on-one support
- Psycho-social support
- Other adherence support
Team
Patient and
Treatment
supporter
HOME PREPAREDNESS
*Family members and visiting carers prepared for supportive
and palliative care, nutritional support, adherence support
Home Care
COMMUNITY PREPAREDNESS
- Support Groups, Advocacy Groups,
- Education & destigmatisation
- Normalisation of HIV
- Scale up Testing & Counselling
General Community Support
Strategies (1)
 Build on existing ART initiatives
 Development of normative tools and guidelines
 Strengthening regional capacity and partnerships
 Support strengthening of health systems
Countries with ART
Scale-up Plans, 2003-2005
2003
2004
2005
Number of countries with 3 by 5 Officers
2004 - 2005
2004
2005
Implementation of IMAI in the African Region
Stage of Implementation
Training of Clinical Teams
Training of Trainers
Socio-cultural adaptation of materials
Adaptation of clin. guidelines and materials
Request for WHO Support
M & E systems and Patient Monitoring Systems
ART Scale-up M&E
Patient monitoring
systems
Norms and Standards (1)
 Framework for planning for 3 by 5
 Regional Guidelines and training manuals on
VCT for health and non-health workers
 Strategy and modules for STI prevention/control
 Clinical guidelines for care and treatment
including Community and Home-based Care
 Training materials on Injection Safety/IPC
 HIV Rapid Testing Training Package
 Guidelines for health sector based HIV
prevention
Partnerships for Country support (3)
 USAID/PEPFAR/JSI/SIGN for Infection
Prevention and Control/Injection safety
 UNICEF, CDC & USAID for PMTCT
&paediatric HIV
 UNECA, World Bank for TAP
 GLIA, OCEAC, ECOWAS, SADC, and other
regional bodies intensifies & harmonized
response
Allocation of CIDA Funds
Regional Office
Countries
Implementation Rate for CIDA Funds
100
90
Budget Implementation (%)
80
70
60
50
40
30
20
10
0
Country Level
Regional Office
Staffing
Activities
Lessons learned
 ART scale–up challenges health systems
 Country wide implementation of ART is feasible
 Linking treatment and prevention produce
synergy to mitigate HIV/AIDS impacts
 Cost-recovery policies a barrier to access
 Decentralized & operational services critical
 Efficient Systems to monitor adherence &
outcomes/quality of services
Way Forward
 Implementing interventions to strengthen health
system
 Focus on prevention with links to treatment with
community participation
 Essential package as a core commitment to
universal access to prevention and care