Upload
hilary-wells
View
213
Download
0
Embed Size (px)
Citation preview
Mass HIV screening of general population (not high-risk groups)
Centralized and Compartmentalized
HIV system
Bureaucracy, stigmatization,
paternalism
Lack of evidence-based approach
Workforce shortage, high staff turnover
Challenges to AIDS Control in the Region
1. Targeted to high-risk groups outreach rapid testing with linkage2. Decentralized ART, integrated care (HIV, TB) in one location close to client3. Simplified procedures, staff education on service provision and client-orientation4. Implementation of 12 Principles, regular data collection and quality review5. Task-shifting, payment to staff based on performance
AHF Europe Care Model As a Response to ChallengesAHF Europe Care Model As a Response to Challenges
Targeted advocacy to bring political priority and adopt the model
HIV is not a priority for the Governments
•7 European countries
•More than 100 testing sites
•More than 45 000 people tested since the beginning of year
•More than 1800 positive results since the beginning of year with targeted linkage
•More than 1 000 000 condoms distributed
RAPID TESTING PROGRAM
AHF SUPPORTED MODEL: DRAMATICALLY INCREASED IDENTIFICATION OF HIV+ CLIENTS
4
* Leningrad Oblast, 8 months of 2013
Most of them would not be identified by state-run provider-initiated testing model
•37 PIT sites in the most affected by HIV areas + outreach/mobile testing
•Target groups: IDUs, SW, MSM, general population, young people, migrants
•More than 17 000 people tested*
•Seropositivity rate 3.4%
•More than 180 000 condoms distributed** Since the beginning of year
UKRAINE
•21 testing sites across country + outreach/mobile testing
•Target groups: IDU, SW, MSM, General Population, Young People
•Almost 5 000 people tested*
•1.5% seropositivity
•More than 75 000 condoms distributed** Since the beginning of year
LITHUANIA
•33 testing sites throughout the country + outreach/mobile testing
•Target groups: IDUs, SW, MSM, general population, young people, migrants
•More than 4 500 people tested*
•4.2% seropositivity
•More than 65 000 condoms distributed** Since the beginning of year
ESTONIA
•40 testing sites in Krasnoyarsk, Tatarstan, Yekaterinburg and the region, St Petersburg, Leningrad region + outreach/ mobile testing
•Target groups: IDUs, SW, MSM, general population, young people, migrants
•More than 15 000 people tested*
•Up to 14% seropositivity
•112 000 condoms distributed*
* Since the beginning of year
RUSSIAN FEDERATION
•Currently 12 ART sites in Russia: Leningrad oblast, StPetersburg, Krasnoyarsk region
•21 decentralized ART sites in Ukraine: Kiev and oblast, Odessa and Oblast, Mykolayv and Lughansk oblasts (Crimea: 2009/2014)
•Linda HIV Foundation clinic in Narva, Estonia (EU)
CLINICAL PROGRAM
MODELS OF SUPPORTING CLINICAL OPERATIONS (AT GOVERNMENT-OWN SITES)
Model 1 (Public healthcare in Russia and Ukraine) Model 2 (NGOs in Russia and Ukraine)
Model 3 AHF Europe Bureau result-based management system:
top ups tied to team performance on clinical indicators (revised quarterly)
Doctor 1 Doctor 2 Nurse Social worker Peer Doctor 1 Doctor 2 Nurse Social worker Peer
Doctor 1 Doctor 2 Nurse Social worker Peer
Other financial sourseAHF salary
AHF SUPPORTED MODEL:– REDUCTION IN MORTALITY
13
*including Kiev Boyarka site (TB/HIV Clinic with MRD TB) !!!
KIEV BOYARKA – UNIQUE AHF PROJECT• Situated in Kiev Regional TB Hospital• 20% of patients – pulmonary TB • 80% - extrapulmonary TB, including nearly 50% with TB meningoencephalitis• 25% of patients – with confirmed MDR-TB
Before AHF support:0% of patients tested for HIV0% of patients tested for CD40% of patients on ARTNo OI testing and treatment
With AHF support100% of patients tested for HIV95% of patient tested for CD4+85% of patients on ARTOI testing and treatment availableDocumented 25% mortality decrease in 2013 vs 2012
LINDA CLINIC – FIRST COMMUNITY OWN AND OPERATED HIV CLINIC IN EUROPE
• Situated in most affected by HIV town in EU – Narva (Estonia)
• 3000 HIV positive people
• 80% are current or former IDUs
• Low ART coverage
LINDA CLINIC
• Currently patients get ARVs at the city or regional hospital• Linda Clinic currently provides all required medical care and psychosocial support, including lab tests as required
by EACS guidelines• Court decision on providing the clinic with ARV was in favor of the clinic
DATA MANAGEMENT SYSTEM• Own database with all key information (GlobalTrack)
• Bi-weekly quality inquiries to sites concerning:- Missed appointments,- Eligible but not on ART patients- Causes of death- CD4 and VL testing- Lost-to-follow-up patients
• AHF global benchmarks - Percentage of eligible patients not on ART- Percentage of lost-to-follow-up patients- Percentage of patients who have had CD4 test doen in the last 12 months- Percentage of patients who initiated ART within 14 days after being eligible- Mortality rate
Country
Mortality rate for 2013
Percentage of eligible clients on
ART (Q4 2013)
Percentage of clients who are
LTFU during 2013
Percentage of clients who have had a CD4 count
test in 2013
Percentage of clients who are linked into care within 1 month
Percentage of clients initiated on ART within
14 days
Benchmarks target < 50/1000 > 80% < 20% 100% > 80% >80%Europe Bureau Ukraine 26.5 78.2% 11.2% 88.4% no data no dataRussia 14.6 85.9% 7.4% 92.1% no data no dataEstonia 0 66.7% 4.2% 95.9% 100% no data