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An operational package for Integrated Management of HIV/AIDS prevention, treatment and care

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. Type of service delivery points Malawi, Mid 2005. 4 central hospitals (tertiary)

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An operational package for Integrated Management of HIV/AIDS prevention, treatment and care

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  1. An operational package for Integrated Management of HIV/AIDS prevention, treatment and care ICASA - Abuja, Nigeria 5 December 2005

  2. ART service delivery points, and patients on ART. Malawi, 2002-2005

  3. 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

  4. Number of people started ART, Malawi, 2004-2005

  5. Challenges (1) : Rapidly Scaling-up comprehensive HIV/AIDS services • Coordinating actions of many stakeholders • Strengthening weak health systems • Operating in an emergency mode

  6. 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

  7. 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

  8. Levels of care for ART

  9. Community Intervention in HIV/AIDS Services ADVANCED INDIVIDUAL CAPACITY * Expert patients as trainers* ART aid Help with facility management*Weigh, triage for self-limited illness & side effects Clinical Team INDIVIDUAL PREPAREDNESS-Patient/client self-management -Treatment supporters for one-on-one support - Psycho-social support- Other adherence support Patient and Treatment supporter HOME PREPAREDNESS *Family members and visiting carers prepared for supportive and palliative care, nutritional support, adherence support Home Care COMMUNITY PREPAREDNESS- Support Groups, Advocacy Groups, - Education & destigmatisation - Normalisation of HIV- Scale up Testing & Counselling General Community Support

  10. Strategies (1) • Build on existing ART initiatives • Development of normative tools and guidelines • Strengthening regional capacity and partnerships • Support strengthening of health systems

  11. Countries with ART Scale-up Plans, 2003-2005 2003 2004 2005

  12. Number of countries with 3 by 5 Officers 2004 - 2005 2005 2004

  13. Implementation of IMAI in the African Region

  14. M & E systems and Patient Monitoring Systems Patient monitoring systems ART Scale-up M&E

  15. 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

  16. 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

  17. Allocation of CIDA Funds

  18. Implementation Rate for CIDA Funds

  19. 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

  20. 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

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