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Step forward to Health System Strengthening: the impact of scaling up of ART services

Step forward to Health System Strengthening: the impact of scaling up of ART services on TB services in rural settings, Zambia. Christopher Dube , Nangana Kayama, Shinsuke Miyano, Naoko Ishikawa, Ikuma Nozaki, Gardner Syakantu. Background.

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Step forward to Health System Strengthening: the impact of scaling up of ART services

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  1. Step forward to Health System Strengthening: the impact of scaling up of ART services on TB services in rural settings, Zambia Christopher Dube, Nangana Kayama, Shinsuke Miyano, Naoko Ishikawa, Ikuma Nozaki, Gardner Syakantu

  2. Background • Zambia has the 7th highest HIV prevalence (14.3% 1) and the 9th highest TB incidence rate (506 per 100,000 population2) in the world . • Seventy percent of incident TB cases have HIV co-infection.2 • The DOTS strategy has been implemented nationwide in Zambia and achieved 100% DOTS coverage since 2003. • ZDHS, 2007 2.WHO, 2009

  3. Volunteers RHC Background • Antiretroviral therapy (ART) services in Zambia - 2005~ Free of charge at hospital levels - 2007~ Expanded to some rural health centres(RHCs) as “Mobile ART services” Hospital Mobile Team • - ART, Adherence • - Laboratory exam • Capacitate RHC staff Health staff (CO,Ns) Volunteers Health staff (MD, Ns) Clients Long distance Clients

  4. Background • Mobile ART services in Mumbwa district has been supported by Japanese International Cooperation Agency (JICA) in collaboration with the Ministry of Health, Zambia. Kaputa Chiengi Mpulungu Mbala Nchelenge Nakonde Mporokoso Kawambwa Mungwi Mumbwa District Isoka Kasama Luwingu Mwense Chinsali Chilubi Chama Mansa Samfya Mpika Mwinilunga Milenge Chililabombwe Lundazi Solwezi Chingola Mufulira Kitwe Kalulushi Ndola Lufwanyama Luanshya Serenje Chavuma Masaiti Mufumbwe Mambwe Kabompo Zambezi Mpongwe Kasempa Chipata Petauke Kapiri Mposhi Mkushi Chadiza Katete Lukulu Nyimba Kabwe Urban Kabwe Kaoma Chibombo Chongwe Kalabo Mongu Luangwa Kafue Itezi-Tezhi Mazabuka Senanga Namwala Monze Shangombo Siavonga Choma Lusaka (capital) Gwembe Kalomo Sesheke Sinazongwe Kazungula

  5. Objectives • To analyze the impact of the scaling up process of ART services to rural settings on TB services in Mumbwa district, Zambia • To explore the challenges to improve the integration of TB and HIV services in rural settings as a step forward to health system strengthening

  6. Methods • The data of TB clients from July 2006 to September 2009 were obtained through “National TB Treatment Registers” and reviewed retrospectively. • TB clients enrolled to anti-TB treatment in all RHCs in Mumbwa district (8 RHCs with ART services, 15 RHCs without ART services) were included. • The clients categorized as “transfer out” or “unknown” for treatment outcome were excluded.

  7. Results

  8. Discussion Scaling up of ART services to RHCs has resulted in: • Improved DCT for TB patients at RHCs • Improved access to TB/HIV services for male clients • Strengthened clients follow-up system • Improved treatment outcome • Enhanced quality of sputum smear examination for TB/HIV clients

  9. Discussion Challenges remain at: • Linkages between TB and HIV services - weak referral of HIV positive TB clients to preART/ART services • Data management – incomplete recording of TB register

  10. Conclusion • Positive impact of the scaling up of ART services on TB services at RHCs were identified. • Improvement of access to services, case management and laboratory services may well contribute to the overall health system strengthening at/from RHCs level. • Further improvement is needed for integration of TB and HIV services.

  11. Thank you !!

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