Scaling-up HIV Prevention, Care and Antiretroviral Therapy at Primary Health Centers

1
Scaling-up HIV Prevention,Care and
Antiretroviral Therapy at Primary Health Centers

• A WHO/PEPFAR Collaboration

2
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Organizing Committee

• Adult Treatment Technical Workgroup
• Tedd Ellerbrock - CDC
• Bob Ferris- USAID
• Department of HIV/AIDS, WHO
• Sandy Gove
• KJ Seung
• Global AIDS Program, CDC
• Mary Lou Lindegren
• Louise Perry
• Tonia Poteat
• Alexandra Zuber

3
Scaling-up HIV PreventionCare and
Antiretroviral Therapyat Primary Health
CentersA WHO/PEPFAR Collaboration

• The Rationale

4
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers

• As of September 30, 2006, a total of 822,000
  adults and children in the 15 focus countries
  were on antiretroviral therapy (ART) in programs
  supported by the Emergency Plan
• The Emergency Plan treatment goal is to provide
  ART for 2 million persons by September 2009
• Consequently, we need to initiate ART for about
  1.2 million persons during the 36-month period,
  October 2006 September 2009

5
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers

• Most ART programs currently supported by the
  Emergency Plan are located at tertiary or large
  secondary medical facilities in urban areas
• To expand access and assure long-term adherence
  to HIV care and treatment, services need to be
  provided at health centers and district hospitals
  in semi-urban and rural areas within walking
  distance of patients homes

6
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers

• If we assume that we can provide ART for an
  average of about 300 persons at each of these
  health centers or district hospitals, we will
  need to provide support for about 4,000
  facilities to initiate ART for 1.2 million
  persons
• Thus, we need to help initiate HIV care and
  treatment programs at about 110 sites per month
  during the 36-month period, October 2006 -
  September 2009

7
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers

• Initiating programs for 110 facilities per month
  appears achievable because an average of 93 sites
  initiated ART programs per month during FY2006
• To support this scale-up, we have proposed a
  WHO/PEPFAR collaboration to standardize
  operational and clinical guidance and patient
  monitoring systems for delivery of HIV services
  at primary health centers

8
Scaling-up HIV PreventionCare and
Antiretroviral Therapyat Primary Health
CentersA WHO/PEPFAR Collaboration

• The Proposal

9
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers

• The collaboration is designed to achieve 4
  objectives
• Development of an Operations Manual for Primary
  Health Centers
• Development updating of clinical monitoring
  tools
• Country adaptation of operational, clinical, and
  monitoring tools
• Implementation of the operations manual and the
  updated tools

10
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Objective 1 Development of Operations Manual
for Primary Health Centers

• The operations manual will include recommended
  clinical services, integration of services,
  physical infrastructure, drug and supply
  management, lab services, patient monitoring,
  human resources, quality management, and
  community services
• The manual will be based on normative guidelines
  and use country-adapted clinical guidelines
  (e.g., IMAI and IMCI) and patient
  monitoring tools developed by WHO, USG, and
  other partners

11
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Objective 2 Development and updating of
clinical and monitoring tools To support
decentralization to primary health centers,
standardized clinical and monitoring tools will
need to be developed, updated, and improved.
For example,

• IMAI/IMCI clinical guidelines and training for
  nurses and clinical officers at primary health
  centers will be updated to reflect current
  evidence
• Standardized patient monitoring tools will be
  updated for ART and HIV care systems, including
  TB/HIV and PMTCT

12
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Objective 3 Country adaptation of operational,
clinical and monitoring tools The goal is to
update a customized set of tools for scale-up
at primary health centers in each country, which
are approved by MOH, WHO, and all partners,
including

• Development of a standardized adaptation guide
• Sociocultural adaptation of patient education
  materials, including strengthening prevention
  messages
• Providing support for country adaptation of
  operations manual, clinical tools, and patient
  monitoring systems

13
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Objective 4 Implementation of the operations
manual and the updated tools Funding will be
needed for implementation activities, e.g.

• Training, mentoring, and supervision of health
  workers in clinical care and district
  coordinators in supervision
• Providing staff in selected countries to support
  MOH and partners to adapt tools
• Expanding the South to South technical network
  to share experiences and provide training in
  using tools
• Management support for technical
  assistance/oversight

14
Scaling-up HIV Prevention, Care and ART at
Primary Health Centers
Funding

• The Adult Treatment Technical Workgroup was
  notified by the Office of the Global AIDS
  Coordinator (OGAC) on May 4, 2007, that the
  proposal for the collaboration was approved for
  1.5 million during FY2007
• USAID will be the funding agency
• The funding mechanism will be the USAID World
  Health Organization Umbrella Grant

15
Collaboration for HIV Prevention, Care and ART
at Primary Health Centers
Selected Organizations of Participating Experts

• WHO (Headquarters, regional, and country offices)
  
• USG Agencies CDC, USAID, HRSA, DOD, Peace Corps,
  Dept of State, Dept of Labor (Headquarters
  country)
• USG-Implementing Partners Columbia, AIDS Relief,
  EGPAF, Harvard, FHI, HAI, JSI, UMD, BASICS, MSH
• Ministries of Health
• PLHIV client groups ITPC, ICW, TAC, and others
• Other Partners Clinton Foundation, APCA, MSF,
  REACH, Engineers without borders, Anneca, DFID,
  GTZ
• Other multilaterals UNICEF, World Bank, GFATM,
  ILO

16
Collaboration for HIV Prevention, Care cand ART
at Primary Health Centers
Progress to Date

• During approximately the past 6 months, more than
  250 experts were organized into 10 writing teams
  and 13 expert panels
• The second complete draft of the Operations
  Manual has been completed and will soon be
  disseminated for broader review and early
  country adaptation and use
• Patient monitoring and clinical tools are being
  updated

17
(No Transcript)