Overview of HIV/AIDS in Ethiopia

Unit 1HIV Care and ART: A Course for

Healthcare Providers

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Learning Objectives

Describe the national HIV/AIDS epidemiological profile

Describe the Ethiopian national AIDS strategies, guideline for implementation of ART, and roadmap to accelerate care and treatment for PLWHA

List the major achievements, challenges and opportunities during the implementation of the ART program in Ethiopia

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Learning Objectives (2)

Explain the Ethiopian National Policy on ARV drugs, supply and use

Convey the current status of the ART program in Ethiopia

List prevention strategies to reduce the spread of HIV infection in the country

Global and Ethiopian Summary of HIV/AIDS Epidemic

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Global Summary of the AIDS Epidemic, December 2005

PLWHA 40.3 million (36.7 – 45.3) Adults 38.0 Million

(34.5-42.6) Women 17.5 Million

(16.2-19.3) Children <15 yrs 2.3

Million (2.1-2.8)

New infections 4.9 million (4.3–6.6) Adults 4.2 Million (3.6-5.8) Children <15 yrs 700,000 (630,000 – 820,000)

AIDS Deaths 3.1 million (2.8 – 3.6) Adults 2.6 Million (2.3 – 2.9 million) Children <15 yrs (570,000-670,000)

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Global Picture of HIV/AIDS

Source: UNAIDS, 2006

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Est. Number Newly Infected With HIV During 2005: 4.9 Million

North America44,00044,000

Caribbean53,00053,000

Latin America240,000240,000

Western Europe21,00021,000

North Africa& Middle

East92,00092,000

Sub-Saharan Africa

3.1 million3.1 million

Eastern Europe

& Central Asia210,000210,000 East Asia &

Pacific290,000290,000

South & South-

East Asia

890,000890,000Australia

& New Zealand5,0005,000

Source: UNAIDS/WHO

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Est. Adult and Child Deaths From HIV/AIDS During 2005: 3.1 Million

North America16,00016,000

Caribbean36,00036,000

Latin America95,00095,000

Western Europe65,00065,000

North Africa& Middle

East28,00028,000

Sub-Saharan Africa

2.3 million2.3 million

Eastern Europe

& Central Asia60,00060,000 East Asia

& Pacific51,00051,000South

& South-East Asia490,000490,000

Australia & New Zealand

700700

Source: UNAIDS/WHO

9Source: UNAIDS/WHO 2004

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Ethiopian Prevalence

National prevalence for 2003 ......... 4.4% National Prevalence for 2005 ........... 4.7%

Women….5.0% Men….3.8%

Urban prevalence in 2003...................12.6% Urban prevalence in 2005...................12.5%

Rural prevalence in 2003 .................. .2.6% Rural prevalence in 2005................... .3.0%

Addis Ababa prevalence in 2003 ........14.6% Addis Ababa prevalence in 2005 ........14.5%

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HIV/AIDS Indicators in Ethiopia (2005)

Number of PLWHA 1.7 million Estimated AIDS cases 143,129 PLWHA requiring ARVs 286,258 Annual AIDS deaths 134,124 Adults and Children on ART 20,477

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HIV/AIDS Indicators in Ethiopia (2005) (2)

AIDS orphans 678,936 Total orphans

4,801,219 Children living with HIV/AIDS 111,903

New HIV infections………39,886New AIDS cases…………29,359

Annual AIDS deaths in children 28,693 Children newly needing ART 58,718 Children on ART 654

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Age & Sex Distribution of Reported AIDS Cases (1986 - June 2003, Ethiopia)

Source: AIDS in Ethiopia, 5th ed., MOH, July, 2004

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Pregnant Women Testing HIV Positive: Urban, 2001

Source: Aids in Ethiopia, 4th ed., MOH, October 2002

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Pregnant Women Testing HIV Positive: Rural, 2001

Source: Aids in Ethiopia, 4th ed., MOH, October 2002

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HIV Prevalence Among Pregnant Women by Age, Urban 2001

Source: Aids in Ethiopia, 4th ed., MOH, October 2002

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Impact on Rural Households

Loss of income (50% or more)Loss of laborLoss of skilled manpower and knowledgeLoss of landLoss of remittances

Reduction in savings and investmentExpenses for treatment, funeral, teskarNeed to sell livestock to meet expenses

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Impact on Industry

Loss of workersExpenses for recruiting and training replacementsReduced productivity in cases of skilled workers or

managers

Lost work days due to sickness and funeral leave

Increased health care costs50% illness due to AIDSLoss of skilled professionals

HIV/AIDS Treatment in Ethiopia

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Historical Overview of HIV/AIDS in Ethiopia

1984: The first evidence of HIV infection in Ethiopia

1986: The first two AIDS cases reported to the Ministry of Health

1989: HIV/AIDS surveillance started March, 2005: Free ART program started Currently, approximately:

129 surveillance sites73 ART sites658 VCT sites

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VCT Site Distribution by Region, 2005

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ART Site Distribution by Region

Total =73

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Regional Distribution of ART

Tigray9%

Amhara19%

Addis Ababa48%

Others6%

SNNPR6%

Oromia12%

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PMTCT Site Distribution, by Region

Total site = 129

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National Response

HIV/AIDS Policy formulated by MOH and adopted by the Council of Ministers in 1998Enabled HIV/AIDS prevention and controlSupplemented existing health, women’s, and

education and training policyCalled for a multisectoral responseGuaranteed rights of PLWHA

ARV Drugs Supply & Use Policy formulated July 2002

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National Response (2)

HIV/AIDS Prevention & Control Office (HAPCO) established June 2002Restructured from NACS (April 2000)Sits under Prime Minister’s OfficeEstablished at all levels of government

Runs the daily activities of NACResource mobilizationAdvocacyCoordination of the sectoral responses

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National Response (3)

HIV/AIDS Strategic plan for five years2004 - 2008

Social mobilization & community involvementCommunity ownership

Scaled up ART programAIDS fund was initiatedFree ART program was scaled up

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HIV/AIDS Intervention Strategies

PreventionSocial mobilization

• IEC/BCCHIV counseling and testing

• Voluntary (VCT)• Provider initiated (PIHCT)

STI prevention and controlCondom promotionInfection preventionPrevention of mother to child transmission (PMTCT)Post exposure prophylaxis

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HIV/AIDS Intervention Strategies (2)

Care and TreatmentPalliative care Community home based careOpportunistic infection treatmentTuberculosis treatmentTreatment of AIDS patients

Support forOrphans and vulnerable children (OVC)People living with HIV/AIDS (PLWHA)

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Major Achievements

National HIV/AIDS Policy National AIDS Council Secretariat Five editions of “AIDS in Ethiopia” National ARV Policy (revised and published in

January 2005) Roadmap to accelerate access to HIV/AIDS care

and treatment M&E framework

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Major Achievements (2)

Five-year strategic plan revised & updatedUsed as main input for the National Strategic

Framework adopted by NACContains strategic outline of interventions at federal

and regional levels

Key guidelines developed:HIV Surveillance GuidelineHIV Surveillance Training ManualVoluntary Counseling & Testing Guideline

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Major Achievements (3)

Key guidelines (continued):AIDS Case Management GuidelineSTI Management GuidelineHome-Based Care Guideline Private HIV Labs Licensing GuidelinePMTCT GuidelineHome Care Training ManualCounseling Training ManualARV GuidelineUniversal Precautions & Post Exposure Prophylaxis

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Major Achievements (4)

658 VCT sites established 129 sentinel surveillance sites established MOH has been the primary advocate for a multi-

sectoral response to HIV/AIDS:Formulated and disseminated HIV/AIDS and ARV

Drugs Supply & Use PoliciesActs as a catalyst for several multi-sectoral HIV/AIDS

committees that pre-dated the NAC

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Major Achievements (5)

Integrating HIV/AIDS into health programs:Reproductive healthMother and child healthHospital hygieneHealth educationIntegrated disease surveillanceTB/HIV Initiative

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Limitations

Synchronizing pharmacy & patients reports Absence of laboratory reports Inadequate Pre and ART registers Employing ART coordinators and Data

managers Sending reports to RHBs and MOH AIDS patients on waiting lists

Policy of ARV Supply and Use in Ethiopia

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Introduction

Care and support of PLWHA plays an important role in preventing the spread of HIV/AIDS

ART is an important component of care for PLWHA

ARVs also have an important place in PMTCT and PEP

ARVs have enormous benefits, but affordability, toxicity, adherence and resistance are challenging

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National ARV Policy

Policy approved in July 2002 Objectives of the policy:

Reduce MTCTProlong and improve the quality of lives of PLWHAReduce accidental HIV infection within health

institutions

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General Policy

Determines type of ARVs that will be used in health care services

The Government of Ethiopia:Coordinates & facilitates the supply of ARVsBuilds capacity for making available safe, effective

and quality antiretroviral drugs, and for ensuring proper use of these drugs

Ensures sustainable supply of ARVs by encouraging involvement of all stakeholders

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General Policy (2)

The Government of Ethiopia (cont):Nurtures international partnerships to strengthen

sustainable supply and use of ARVsEncourages research on modern and traditional

HIV/AIDS treatmentEstablishes strong systems to monitor ARV supply

and use

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General Strategies

1. Selection of ARVs Determine the type of ARVs to be used in Ethiopia Incorporate selected ARVs into the national drug list Permit the import of ARVs that are not included in

the national drug list

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General Strategies (2)

2. Supply of ARVs ARVs for ART:

• Exempted from taxation• Supplied at reduced prices through government

negotiation with manufacturers, importers and distributors

• Purchased by a system of bulk and generic substitution

Local production of ARVs encouraged Benefaction of ARVs facilitated by the Ethiopian

Government Ethiopian Government supplies ARVs for PMTCT

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General Strategies (3)

3. Drug Use Prepare and implement standardized prescription

paper Prepare and implement national guidelines for safe

and effective use of ARVs Sustainable public education on ARV drugs

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General Strategies (4)

4. Research and Development Government of Ethiopia encourages research on

modern and traditional HIV/AIDS treatment Government of Ethiopia shall make efforts to

strengthen the capacity of research institutions Rights and benefits of citizens that enroll in research

studies shall be respected National and international ethical norms and values

in human experimentations shall be observed

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Scaling up ART Uptake

Need capacity development to:Initiate treatmentHelp patients adhere to their treatment regimensMonitor the efficacy and toxicity of the regimens Diagnose treatment failureMonitor overall resistance in society

ART program must be implemented at Health Center level

Nursing initiative to prescribe ARVs is being piloted

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Key Points

AIDS is a global, regional, and national crisis The national HIV seroprevalence rate in Ethiopia

is 4.7% Urban rate is 12.5% Rate in Addis Ababa is 14.5%

Approximately 20,500 people in Ethiopia are currently receiving ART

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Key Points (2)

ARV guidelines have been written, policies have been adopted, and training is being conducted in Ethiopia

ARVs have enormous benefits and challenges. The challenges include:Developing capacity to initiate treatmentSupporting adherenceMonitoring efficacy and toxicityDiagnosing treatment failureMonitoring resistance