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ARV Program in Indonesia: Advantages, Challenges and the Way Forward

ARV Program in Indonesia: Advantages, Challenges and the Way Forward. Dr. Endang Budi Hastuti National AIDS Program Ministry of Health of Republic of Indonesia. Outline Presentation. HIV/AIDS in Indonesia Overview of HIV/AIDS control system

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ARV Program in Indonesia: Advantages, Challenges and the Way Forward

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  1. ARV Program in Indonesia:Advantages, Challenges and the Way Forward Dr. Endang Budi Hastuti National AIDS Program Ministry of Health of Republic of Indonesia

  2. Outline Presentation • HIV/AIDS in Indonesia • Overview of HIV/AIDS control system • ARV : financing, supply and distribution system • Advantages and challenges of current ARV supply chain management system • Future strategic plans in scaling up ARV program

  3. Estimation of PLWHA in Indonesia, 2012 591.823

  4. TreatmentCascade 2005 - 2012 68% 73% 53% ART Coverage : 31002/178631 = 17.4% Estimation of PLWHA 2012 = 591.823 HIV Treatment Monthly Report, 2005-2012. MoH RI

  5. HIV-AIDS Control Programs

  6. ARV Hospitals • Since 2005 • In all provinces • Complete services • Government and private hospitals 2005 2015

  7. ARV financing system • ARV is produced and procured since 2005 (locally and imported) • Fund source: national budget and GF-AIDS • The ARV budgeting is planned annually, integrated in national budget planning • The budget is managed by MoH: • Forecasting, planning, distribution  NAP • Procurement process  Directorate General of Pharmacy Service, MoH and VPP (GF) • MoH Indonesia is about to develop one gate policy for procurement

  8. ARV financing system • Minister of Health Decree: ARV is fully subsidized by central government since 2005 • Budget allocation from national funding is increasing 26.09 13.51 3.48 1.64 2.3

  9. ARV supply system • The ARV procurement is centalized, and involving MoH (NAP and Pharmacy), GF, Local and Global producers and National warehouse • ARV available: ZDV, TDF, FTC, NVP, EFV, LPV/r, d4T, ABC, ddI • The average cost for 1st line ARV treatment per patient per year 420 - 480 USD

  10. Global Producer Global Fund Voluntary Pooled Procurement National Warehouse ARV Supply System MINISTRY OF HEALTH Purchase Order LOCAL SASWaiver , Tax and Duty Exemption & Custom Clearance IMPORT NAP Bidding Process PHARMACY Local Producer – Kimia Farma

  11. ARV distribution system • ARV distribution system is centralized since 2005 • ARV decentralized distribution is started in 2011 and expanded gradually

  12. ARV distribution system - Centralized (4A) Delivery (2) Confirmation (3A) DO (1) Monthly report HOSPITAL NAP NATIONAL WAREHOUSE 3 months stock (3B) DO (4B) Delivery NAP WAREHOUSE

  13. ARV distribution system - Decentralized (4) Delivery (1) Monthly report (3) DO PROVINCIAL WAREHOUSE (2) Confirmation PHO 6 months stock HOSPITAL 3 months stock (5) Quarterly report (7) Delivery, quarterly (6) DO Quarterly NAP NATIONAL WAREHOUSE

  14. Advantages of current ARV supply chain management system Centralized ARV distribution: • Central government can directly control the ARV distribution in ARV hospitals Decentralized ARV distribution: • simplify the route  minimize ARV stock out in hospital • PHO has ownership in managing the ARV management • Involvement of the local CSO, to monitor the ARV management

  15. Challenges of current ARV supply chain management system Centralized ARV distribution: • Geographic  long route • More ARV hospitals, lack of human resource Decentralized ARV distribution: • Readiness of PHO, capacity of human resource • The existing logistic mechanism is vary among provinces (some are under disease program in PHO and some are under pharmacy program  need strengthening of coordination)

  16. Future strategic plans in scaling up ARV program • HIV testing acceleration: • Offering HIV test to pregnant women, TB patients, STI patients • Strengthening PITC implementation • Mobile clinic • HIV retesting for KAPs every 6 months • ART coverage acceleration: • Start ART • when CD4 count ≤ 350 • Regardless CD4 count for : pregnant women, TB-HIV patients, sero-discordant couple, KAPs, prisoners • Triple FDC • ART initiation at Primary Health Care

  17. Inventory and Order Management System (IOMS)

  18. HIV-AIDS and STI Information System

  19. Terima Kasih

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