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

0

10

20

30

40

50

60

70

2002

2003

2004

2005

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

0

5 000

10 000

15 000

20 000

25 000

2004 2005

All

Top 5 facilities

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

General Community Support

Home Care

Patient and Treatment supporter

Clinical

Team

COMMUNITY PREPAREDNESS- Support Groups, Advocacy Groups, - Education & destigmatisation

- Normalisation of HIV- Scale up Testing & Counselling

HOME PREPAREDNESS *Family members and visiting carers prepared for supportive

and palliative care, nutritional support, adherence support

INDIVIDUAL PREPAREDNESS-Patient/client self-management

-Treatment supporters for one-on-one support

- Psycho-social support- Other adherence support

ADVANCED INDIVIDUAL CAPACITY

* Expert patients as trainers* ART aid

Help with facility management*Weigh, triage for self-limited illness & side effects

Community Intervention in HIV/AIDS Services

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

Request for WHO SupportAdaptation of clin. guidelines and materials

Socio-cultural adaptation of materialsTraining of Trainers

Training of Clinical Teams

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

0

10

20

30

40

50

60

70

80

90

100

Country Level Regional Office

Bu

dg

et I

mp

lem

enta

tio

n (

%)

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