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Ethiopia

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Ethiopia

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  1. Ethiopia Unlocking the confines of Illness pMTCT Project Fekadu Chala Dabi, Christine Groff Nadia Nijim, Rebecca Noe, Cynthia Pearson

  2. Ethiopia

  3. A Regional Glance: Population

  4. A Regional Glance: GDP per Capita

  5. Health System Structure • Budget $150 million US ~ 1.7% of GDP • 3 medical schools train 200 doctors a year, but highest rate of brain drain in Africa • Physician to population ratio: 1 : 38,619 • Health care facility to population is 1:172,000 • Health stations 1 : 27,456 persons • Hospitals 1 : 658,305 persons

  6. Basic Health Determinants

  7. Ethiopia and HIV/AIDS • 2,100,000 Ethiopian living with HIV/AIDS • 52% women; 38% men; 10% children • 6.4% HIV/AIDS prevalence • Urban 13.7% rural 3.7% • 87 % of all HIV/AIDS infections result from hetero-sexual transmission. • 990,000 estimated orphans Sources:UNAIDS,U.S.Census Bureau 7/2002

  8. Ethiopia

  9. The City: Nazret • Capital city of the largest region - Oromia • Population: 130,000 • Worst health conditions in Ethiopia • 75% of the endemic disease are communicable • Respiratory, Diarrhoeal • Malaria/TB • STI/HIV/AIDS

  10. Legend Church School Mosque Pharmacy FGAE Hospital/MOH Factory Clinic Health Structure of Nazret Unpaved roads Railroad Highway

  11. Major pMTCT Interventions • Improved Maternal Child Health (MCH) Services • Voluntary Counseling & Testing (VCT) • Safe infant-feeding choices • Safe Motherhood practices • Antiretroviral drugs (ARV): Nevirapine http://www.coregroup.org/working_groups/hiv_resource_materials.pdf

  12. Project Objectives 1. Offer voluntary counseling and STI testing (VCT) to all (100%) women who are receiving antenatal care (ANC). 2. Increase the acceptance of VCT from 50% to 80% of ANC participant. 3. Increase acceptance/delivery of nevirapine from 20% to 80% of HIV infected mothers who received ANC and who have accepted VCT.

  13. Community Partners • Provision of VCT and pMTCT • MOH hospital, 3 private clinics, 1 RH clinic • Training and program implementation • Family Guidance Association • Community groups for follow-up support: • 3 religious groups (2 Christian, 1 Muslim) • 4 NGOs • 1 PLWA group • 1 women/mother’s support group, and • 1 youth group

  14. Input: Time - 3-year program • Training: VCT counselors – 2 weeks Clinics: ARV – 3 days • 1-day refresher training every 6-months • Training for replacement VCT counselors and clinic staff • Bi-weekly visits by VCT and pMTCT trainers and supervisors (later monthly) • Every 3 months overall project meeting

  15. Input: Staff • Trainer of trainers - 1 • Trainers: 2 VCT; 2 clinic pMTCT • Project coordinator: 1 • Supervisors: 1 VCT; 1 pMTCT • VCT staff: 6 (2-hospital, 1-RH clinic, 3-private clinic) • pMTCT clinic staff (~14) doctors, nurses, midwifes

  16. Input: Other Resources • Funding • Training materials (rooms, lunch, supplies, kits) • VCT and pMTCT guideline manuals for all participants • Space to ensure VCT can be provided and will be confidential • Supply of HIV rapid test kits, Nevirapine • 6 months inventory maintained on hand at local hospital warehouse

  17. Present Model of VCTService Delivery Pre-test counseling Testing (as desired by the client and after informed consent is provided Post-test counseling (more than one visit if needed) Individual risk assessment & risk reduction planning

  18. Model for Nevirapine Delivery • Sustainable HIV kits/drug supply • Strengthen delivery infrastructure • Nevirapine HIV+ pregnant women • To women at the onset of labor: 200mg • To baby within 72 hrs. of delivery: 2mg/kg body weight

  19. Process (1) • Develop plan: initial training manuals • Train VCT counselors and pMTCT clinic staff • Monitor quality of training and quality of teaching • Teach trainees to use the manual as a resource • Initial follow-up: bi-weekly trainee meeting to discuss barriers/problems

  20. Process (2) • After 6 month in field – secondary training • Ongoing support and feedback • Monthly site visits by supervisors • Monthly reports from project supervisors to coordinator • Consumer satisfaction feedback

  21. Outputs and Outcomes: • Trained 6 VCT counselors; 14 clinic staff in pMTCT • Track quality • Pre-post-test • % Increase in knowledge • Areas to improve curriculum • Focus groups at 6-month training • Availability of HIV test/Nevirapine • % Of time in 3 years with no shortage of HIV test kits or Nevirapine

  22. Outputs and Outcomes: (2) • Use of pre-test counseling: • % of women who received counseling [initial use] • Use of HIV testing/post-counseling: • % of women who received HIV testing during pregnancy [Measures initial use &continuity] • Use of Nevirapine: • % of women who HIV+ and request treatment and receive course [measures continuity of service]

  23. VCT/ARV Impact • 100% ANC participants offered VCT • 80% acceptance of VCT services • 100% of HIV + women identified through VCT will have access to Nevirapine • 80% of these (HIV + mothers & newborn) will complete Nevirapine regimen.

  24. Amesegnalehu (Thank you for your attention)