DEVELOPING A NATIONAL HIV/AIDS PHARMACY- BASED … · the management of HIV/ AIDS. In many...

DEVELOPING A NATIONAL HIV/AIDS

PHARMACY-BASED

INITIATIVE

Dahlia McDaniel MPH

Objectives

At the end of this presentation participants will be aware of:

ü Procedures which I recommend for the Development of a Pharmacy-Based Initiative

ü A suggested Strategic Framework in which to Develop, Monitor and Evaluate only one of these procedures – A Dissemination Strategy

Goals

q Increasing access to antiretrovirals and treatment programmes, and

q Preventing new HIV/AIDS infections

Goals we wish to achieve include:

q Improving the quality of life of those afflicted with and affected by HIV/AIDS

√ HIV/AIDS Education and Training Programmes for Pharmacists

(a) The Pharmacist is a Receptacle for Drug Information

√ HIV/AIDS Education and Training Programmes for Pharmacists

(b) The Pharmacist is a Counsellor

√ HIV/AIDS Education and Training Programmes for Pharmacists

√ HIV/AIDS Education and Training Programmes for Pharmacists

Caribbean Conference on the Clinical Management of HIV/AIDS: A Multidisciplinary Approach (2004)

1. Have you received training in Pretest Counselling?

Yes - 56% No - 44%

2. Are you satisfied with your competence in pretest Counseling?

Yes - 49% No - 51%

3. Have you received Post Test Counselling Training?

Yes - 52% No - 48%

4. Are you satisfied with your Counselling competence?

Yes - 35% No - 65%

√ HIV/AIDS Education and Training Programmes for Pharmacists

Voluntary Counselling and Testing

……… “ these programmes have been shown to be amongst the most effective prevention tools.”

- Irwin, A., Millen, J. and Fallows, D.( 2003) Global AIDS: Myths and Facts – Tools for Fighting the AIDS Pandemic. Southen Press, Cambridge p.p.66.

“Nowhere is the changing role of the pharmacist more vividly emphasised than in the management of HIV/ AIDS. In many Commonwealth countries the pharmacist is the most accessible, and often the most trusted, of all health professionals. It is this ready accessibility which highlights the importance of the pharmacist, especially the community pharmacist, as a health educator. Communication skill is a common thread woven through pharmacy practice in all Commonwealth countries.”Int’l Conference on HIV/AIDS, Durban South Africa, 2000.

John BellJohn Bell,,

Immediate Past President, Commonwealth Pharmaceutical AsImmediate Past President, Commonwealth Pharmaceutical Association.sociation.

√ HIV/AIDS Education and Training Programmes for Pharmacists

(c) The Pharmacist is a Health Educator and Health Promoter

√ HIV/AIDS Education and Training Programmes for Pharmacists

(d) The Pharmacist is a Person with Attitudes and Emotions which can be Relayed or Transferred

Can we teach ourselves how to feel about persons living with HIV/AIDS?

√ HIV/AIDS Education and Training Programmes for Pharmacists

“Ignorance breeds passivity, pessimism, resignation or a sense that AIDS is someone else’s problem.”

- Farmer, Paul (2003) in Global AIDS: Myths and Facts – Tools for Fighting the AIDS Pandemic. South End Press, Cambridge p.p. xvii.

A Multi-Disciplinary and MultiSectoral Team Approach

q Make an effort to improve the physician -pharmacist relationship

q Seek membership in other professional organizations which have HIV/AIDS on their agenda

√ Create New Partnerships, InterprofessionalCooperation and Collaboration.

Ø Syndromic Management of STI’s

√ Highlight and Exploit the Pharmacist’s Presence in the Community

Ø Information Sharing

q Facilitate ‘Double Protection’

√ Highlight and Exploit the Pharmacist’s Presence in the Community (Cont’d.)

q Facilitate ‘Double Protection’

√ Highlight and Exploit the Pharmacist’s Presence in the Community (Cont’d.)

Ø Facilitate ‘Double Protection’

√ Highlight and Exploit the Pharmacist’s Presence in the Community (Cont’d.)

“Ask your OB/GYN to write you a prescription now, with the option for refills. Then stash the pills and the refill in your medicine cabinet.”

- Rosner, H. and Petrecca, L. (2004) 25 Trade Sectrets of Top OB/GYNs in Prevention –Smart Ways to Live Well Rodale, Inc., USA, p.p. 162, 163.

Ø Volunteers

√ Increase Money and Manpower

Ø Retirees

√ Increase Money and Manpower

Ø Local and Int’l Organisations which provide Financial and other Support

Ø Condom Distribution and Manufacturing Companies

“….steered hundreds of millions in private donations and contributions from governments (such as Canada and Ireland) to AIDS-stricken parts of the world for treatment and PUBLIC EDUCATION.”

- Metro News, New York Edition June 3, 2004.

q Private Sector Organisations

q Policy makers

q Media Houses

q Ministries of Health

q Pharmaceutical Companies

√ Improve Networking Capacity and Political Dexterity

√ Learn From Experience

“You in your small corner and I in mine”?

“Prevention is Better, Especially when there is No Cure.”

DISSEMINATION STRATEGY

- a Science-based Approach

Step 1. – Analyse the Problem

Step 2. – Update Ourselves on the Issues

Step 3. – Analyse the Policy Makers

Step 4. – Aim

Step 5. – Design the Message

Message

MessageMessage

Message

Message

Message

Message

Message

Message

NATIONAL HIV/AIDS PHARMACY-BASED INITIATIVE

Step 6. - Analyse the present Policies and Practices

BOOSTS

HINDRANCES

Step 7. – Analyse the Stakeholders

Stakeholder

- any group or individual who can affect or be affected by the achievement of the project’s objectives, or can influence these objectives.

Harmsworth, S., Turpin, S. et al (2000) Creating an Effective Dissemination Strategy – An Expanded Interactive Workbook for Educational Development Projects. Bridging the Gap Project Digests. Pell and Rees

Analyse the Stakeholders

At-risk Groups (from research results)

Target Audience

Public Sector Organisations

Analyse the Stakeholders

q Dept. of Social Security

q National Family Planning Board

q Dept. of Information

q Dept. of Education

q Dept. of Women’s Affairs

Private Sector Organisations

Analyse the Stakeholders

q Networks of Seropositives (PLWA’s)

q Condom Distribution Companies

q Community Pharmacies

q Pharmaceutical Companies

Mass Media

Analyse the Stakeholders

q Local Radio and Television Stations

q Media Production Firms

q Commercial Advertising Firms

q Marketing Firms

Non-Governmental Organisations

Analyse the Stakeholders

q Federation of International Pharmacists

q Professional Associations e.g. Medical Association

q Commonwealth Pharmaceutical Association

q Faith-based Organisations/ Churches

q Service Clubs

q Youth Groups

cCriteria upon which to Evaluate each Agency:

ü Competence

ü Commitment

ü Clout

ü Coverage

ü Continuity

q Strong technical and management staff

Competence

How to Assess Organisations as Strategic Partners:

q A positive Image and a reputation for high-quality work

q Cash Flow and Reserves

q Experience with similar activities

- Piotrow, P.T., Kinkaid, D.L. et al (1997) Health Communication, Lessons from Family Planning and Reproductive Health. Johns Hopkins School of Public Health, Centre for Communication Programs. Praeger Publishers, Connecticut, pp. 1, 2.

q Endorsement of Reproductive Health Programmes and programmes on HIV/ AIDS

Commitment

- Piotrow, P.T., Kinkaid, D.L. et al (1997) Health Communication, Lessons from Family Planning and Reproductive Health. Johns Hopkins School of Public Health, Centre for Communication Programs. Praeger Publishers, Connecticut, pp. 1, 2.

How to Assess Organisations as Strategic Partners:

q Contact and Access among Policy-makers and Influential People

Clout

- Piotrow, P.T., Kinkaid, D.L. et al (1997) Health Communication, Lessons from Family Planning and Reproductive Health. Johns Hopkins School of Public Health, Centre for Communication Programs. Praeger Publishers, Connecticut, pp. 1, 2.

q Political Support

How to Assess Organisations as Strategic Partners:

q Ability to reach Intended Audience

Coverage

- Piotrow, P.T., Kinkaid, D.L. et al (1997) Health Communication, Lessons from Family Planning and Reproductive Health. Johns Hopkins School of Public Health, Centre for Communication Programs. Praeger Publishers, Connecticut, pp. 1, 2.

How to Assess Organisations as Strategic Partners:

q Length of time in Operation

Continuity

q Comparable Projects Accomplished previously

q Institutional Base and Resources for Sustainability

- Piotrow, P.T., Kinkaid, D.L. et al (1997) Health Communication, Lessons from Family Planning and Reproductive Health. Johns Hopkins School of Public Health, Centre for Communication Programs. Praeger Publishers, Connecticut, pp. 1, 2.

How to Assess Organisations as Strategic Partners:

The Dissemination Strategy -A Multimedia, Multi-Channel Approach

Communication Channels:

Ø InterpersonalØ Group

Ø Mass media

HIV/ AIDS Prevention Dissemination Strategy Timeline 2004 – 2007

Prevention is Better, Especially when there is No Cure

1. Situation Analysis and Rx Training – October, Nov., Dec., 2004

2. Engagement of Partners, Budget Planning and Funds – Jan. – June, 2005

3. Secondary Audience Training – April to June, 2005

4. Campaign Preparations – April to September, 2005

5. Launch of Campaign – September, 2005

6. HIV/AIDS Prevention Campaign - Sept., 2005 to Sept., 2007

A Closer Look at Phase #6Monitoring, Evaluation and Expansion (21 months –

October 2005 – June 2007) - continual

ü Check Pre-Determined Outputs against Proposed Verifiable Indicators

1.

2.

3.

4.

5.

Check List

ü Consistence in condom use, and correct application

Verifiable IndicatorsMonitoring, Evaluation and Expansion (21 months – October

2005 – June 2007) - continual

ü Delay of first sexual activityü Increase in Abstinence

ü Early Health Seeking Behaviour

ü Increase in Condom Sales and Accessibility

ü Reduction in the rates of new HIV infection

ü Increase in Demand for VCT Services

ü Strengthening of the Pharmacist’s Capacity

A Closer Look at Phase #6

Monitoring, Evaluation and Expansion (21 months –October 2005 – June 2007) - continual

ü Check Pre-Determined Outputs against Proposed Verifiable Indicators

ü Execute Focus Group Discussions, In-depth Interviews, and utilise ‘Mystery Clients’

A Closer Look at Phase #7

Phase 7: Pharmacist (Re)Training (October- December 2005 and 2006)

ü Tailored in response to results of monitoring and evaluation .

And FinallyAnd Finally………………………………………………

The HIV VIRUSThe HIV VIRUS

Prevention Is Better, Prevention Is Better,

Especially When There Is Especially When There Is No Cure.No Cure.