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Planning Comprehensive HIV/AIDS Care and Support with ART

Planning Comprehensive HIV/AIDS Care and Support with ART. Eric van Praag, MD, MPH Director, Technical Support Care Family Health International Institute for HIV/AIDS evanpraag@fhi.org. USAID-SOTA Technical Conference October 2002. CONTENT. The synergy between prevention and care

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Planning Comprehensive HIV/AIDS Care and Support with ART

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  1. Planning Comprehensive HIV/AIDS Care and Support with ART Eric van Praag, MD, MPH Director, Technical Support Care Family Health International Institute for HIV/AIDS evanpraag@fhi.org USAID-SOTA Technical Conference October 2002

  2. CONTENT • The synergy between prevention and care • Comprehensive responses in care and support • The Continuum of Care • Integrating ART and scaling up

  3. Comprehensive HIV/AIDS Programs Care Prevention Clinical Mgt. Home/community Refer. Network Palliative Nutritional OI, ARV VCT MTCT Psycho-social Behavior Change STD Mgmt. Condoms Harm Reduction Blood Safety M & E BCC Infrastructure Development Impact Mitigation Human Capacity Dev. Drugs & Commodities Resource Mgmt. OVC Policy Stigma reduction

  4. AIDS-Defining Illnesses Among AIDS Patients >10 Years of Age, 1994-1998,as reported to Thailand MOH % Suwat et al, Clinical Infectious Diseases, 2001; 32:955-962.

  5. Manifestations of Stigma in Health care setting • Often stigma start before the HIV test in most occasions. • Denial of appropriate level of care. • Inability to break the news. • Selective use of universal precautions • Immediate discharge after laboratory results. • Withholding results until discharge. • Overlooking/Covering of AIDS diagnosis. • Labeling. • Segregation/Isolation

  6. Vicious Cycle of an Unnamed Disease INEFFECTIVE COUNSELLING SEROSTATUS NOT ACCEPTED NOR REVEALED TO OTHERS HCW RELUCTANCE TO GIVE TEST RESULT FEAR AND NEGLECT IN HOSPITAL & COMMUNITY CONSPIRACY OF SILENCE WITHIN HEALTH & SUPPORT SYSTEM

  7. Medicine-- 58% Emotional Support & hope-- 40% Financial-- 34% Helping hand/ company-- 30% Transport-- 13% Education/Information/ Hygiene-- 11% Other materials/ shelter-- 9% Food-- 5% NCHADS/KHANA/WHO/International Alliance, 2000 Needs of PLHAn=100Phnom Penh, Cambodia

  8. Elements of Comprehensive Care and Support • Socioeconomic Support • e.g.: • Material support • Micro-credit • Food support • Human Rights and Legal Support • e.g.: • PLHA participation • Stigma & discrimination reduction • Succession planning PEOPLE AND FAMILIES AFFECTED BY HIV/AIDS • Medical & Nursing • Care • e.g.: • VCT • Preventive therapy • OI treatment and HAART • Palliative care • Psychosocial Support • e.g.: • Counseling • Spiritual support • Follow-up counseling • Community support Supportive Policy and Social Environment Updated - August 2002

  9. Intervention Package to reduce MTCT and meet Care needs • VCT • AZT short course and/or NVP mother/child • Safe labour practices • Infant feeding choices • Follow-up counseling and Family Planning • Referral to appropriate HIV care and support • Comprehensive care: p.t.; o.i. management; HAART; palliation; for mothers and children • Partnership of care services across a continuum from community to program/institution • Stigma reduction in health institutions: - role model; U.P. and PEP; Care for the carers

  10. Acceptance of Serostatus and coping Planning for future orphan care; Will preparation Early management of OIs and STDs; Eligibility for ARV Voluntary Counseling Testing Referral to social and peer support Reduces mother-to-child transmission Normalizes HIV/AIDS Facilitates behavioral change Preventive therapy (TB and OI’s) and contraceptive advice

  11. The HIV Care Continuum

  12. STANDARD CARE SERVICES FOR HIV/AIDS* Palliative Care Home-based Care Prevention of Mother to Child Antiretroviral Therapy Transmission Post Exposure Opportunistic Infections and Related Illnesses Prophylaxis Diagnosis, Treatments, Preventive Therapies, Pyscho-Social, & Spiritual Support : . . . . . . . . . Individual & Family Care providers Bereavement Orphans VCT Prevention . . . STI Services, Behavior Change Communication, Education, universal precautions Uninfected People Exposed People People Living People Living with Terminally Ill and with HIV AIDS beyond

  13. Objectives of HIV Care/ART Programme: • Reduce HIV related morbidity and mortality • Improve quality of life of affected families • ART to complement and enhance comprehensive HIV care and support programmes and vice versa

  14. Natural History of Untreated HIV-1 Infection 1000 800 600 400 200 0 Early Opportunistic Infections CD4Cells + Late Opportunistic Infections 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Infection Time in Years

  15. Antiretroviral Drugs - 2001

  16. The Health Systems Requirements • Access to quality VCT • Norms and Standards T, PT, ARV regimens, eligibility • Capacity to manage/prevent O.I.s and HIV related illnesses • Referral system to social support and home care • Reliable drug management and regulatory system • Functional laboratory for HIV T, monitoring side effects and alternatives? to CD4 • HIS, clinical records OPD,IP • Communication programs (complimentary to care and • prevention) financial resources • Training and regular updating carers and patients

  17. Mutual Program Support • HIV Care-ART and Health Care programs staff, infrastructure and HIS • HIV Care-ART and TB Programs lifelong/private sector/confidentiality • HIV Care-ART and RH/MCH/MTCT Programs referral system • HIV care-ART and Essential Drug and PHC Programs regulation and management • HIV care-ART and Prevention Programs complementarity

  18. Two Extreme Scenarios For Access To ARVs Orderly and controlled accessUncontrolled Access Hospitals–clinics–VCT Sites Drug sellers-pharmacies-dealers Monitoring and supervision Secrecy and stigma remains high Increased demand for testing Decreased demand for VCT; prefer to buy directly OTC Strengthened HIV Care -ARV mostly men prophylaxis presumptive Rx

  19. FHI approach to Comprehensive HIV Care and Support • To meet medical, psychological and social needs of people and families living with HIV/AIDS. • To synergize between prevention and care. • To enable rapid scaling up through national/local standardized approaches. • To develop interventions while strengthening health and community systems. • To build capacity through local partners.

  20. From Intervention To System: The Rwamagana Case in Rwanda

  21. The Progress of the Start Program -Ghana VCT Training Communications (BCC) Strategy Workshop Clinical Assessment Planning Headquarter Staffing Complete Stakeholder Meetings in Ghana Interviews for Ghana Staff Start staff Orientation Program Development Workshop 6 BCC/Communications sub-contracts with NGOs Developed Start Documentary Various funding proposals developed May 2002 January 2002 November 2001 March 2002 April 2002 December 2001 February 2002 June – Sept. 2002 6 Clinical sub-contracts finalized OI curriculum development (on-going) Private Sector Dinner (Ghana) Stakeholder Program Presentation Program Launch National ARV Workshop OI Training ARV Training Stigma Training NGO technical Training Hired 6 staff for Start Ghana Offices

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