Pioneering IMAI: Developing an integrated approach in Uganda Dr Elizabeth Madraa, Program Manager National STD/AIDS Control Program MOH - UGANDA 5 th Dec.

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Presentation transcript:

Pioneering IMAI: Developing an integrated approach in Uganda Dr Elizabeth Madraa, Program Manager National STD/AIDS Control Program MOH - UGANDA 5 th Dec 2005, ICASA, Abuja, Nigeria

2 Uganda Population 27 M people High burden of HIV/AIDS First cases detected in 1982 Prevalence: 7% 1.1 million PLHA 120,000 AIDS cases “3x5 target” 60, testing & counseling sites/district 3-4 PMTCT sites per district 2-3 ART sites/district Decentralized health care system

35 th Dec 2005, ICASA, Abuja, Nigeria Pre-IMAI Treatment and care available in 5 centres of excellence Number of patients on ARVs about 8,000 (out-of pocket) No standardized services and training UNAIDS drug access initiative (1998) Formation of National Advisory Board Upgrading of infrastructure (Regional referral hospitals)

45 th Dec 2005, ICASA, Abuja, Nigeria Pre-IMAI …continue Additional partners on board JCRC, MSF, GTZ, AHF, Mildmay..etc It became clear that treatment is possible, but through integrated approach Draft national treatment guidelines (comprehensive, 2001/2)

55 th Dec 2005, ICASA, Abuja, Nigeria Introduction of IMAI December 2003: Introduction, national consensus building and clinical adaptation Jan-Feb 2004: TOT and first training of clinical teams in Masaka Region April 2004: On site post-training visit started June 2004 launching of Universal Access to ART National training plan

6 IMAI tools adapted to serve scale up plan Based on: Existing health system- already implementing IMCI Adapted IMAI tools and service delivery model used to prepare: Regional and district coordination Involve communities and PLHA Prepare clinical teams (training and mentoring) Key considerations: Integration with other care programmes Involvement of key partners

75 th Dec 2005, ICASA, Abuja, Nigeria Strategies for Scaling up Expansion of ART services in the public sector Strengthening collaboration for provision of HIV services with partners and private sector Development of the national human resource capacity to expand HIV services Ensure continuous supply of HIV drugs and commodities

85 th Dec 2005, ICASA, Abuja, Nigeria The National Scale-up Plan for ART services in Uganda Expansion of ARVs is in 4 Phases Phase I: Regional Referral Hospitals Phase II: District and other Hospitals Phase III: HC IVs Phase IV:Lower level facilities/community

95 th Dec 2005, ICASA, Abuja, Nigeria PHASE 1 PHASE 2 District hospitals PHASE 3 Health Centre 4s PHASE 4 Lower facilities & Communities Regional hospitals National Scale- up Plan for ART services

105 th Dec 2005, ICASA, Abuja, Nigeria The National Scale-up Plan for ART services in Uganda Expansion of ARVs is in 4 Phases Phase I:– Completed by Dec 2003 Phase II: Completed by June 2005 Phase III: In progress (50) Phase IV: In progress (within HSD)

Training for ART scale-up Strengthening regional referral hospitals capacity to train and supervise lower health facilities Training and establishment of clinical teams in each facility: 1 medical 1 clinical officer 2-3 Nurses, 2-3 Counselors pharmacist/ dispenser lab person Strengthening referral network across a continuum Improving coordination of stakeholders 5 th Dec 2005, ICASA, Abuja, Nigeria

125 th Dec 2005, ICASA, Abuja, Nigeria Breakdown of IMAI-trained health personnel (Total = 1,570)

135 th Dec 2005, ICASA, Abuja, Nigeria Trends in ART provision IMAI Adaptation 3 x 5 target

145 th Dec 2005, ICASA, Abuja, Nigeria Number of new ART service delivery points by year, Uganda ( ) Total ART sites = 150

155 th Dec 2005, ICASA, Abuja, Nigeria Lessons Learned Strong political will and support Technical and financial support from WHO Coordination of support from partners: PEPFAR, World Bank, Global Fund, MSF, AHF, JCRC, Mildmay, etc Linkages with academic and research institutions Strengthening of existing health systems Integration of health care systems (PMTCT, TB, drug logistics, lab services, etc)

165 th Dec 2005, ICASA, Abuja, Nigeria Challenges Resources Human Financial Drugs and commodities Coordination With many partners and different curriculae With the private sector Special issues Paediatric diagnosis and care Food and nutrition HIV orphans care Sustainability Adherence support Patient tracking and monitoring Continuining care

175 th Dec 2005, ICASA, Abuja, Nigeria Next steps Prepare more HC 4s and 3s for ART Recruit more HWs for HSD facilities Scale-up community mobilization and sensitization Strengthen M&E: establish system for monitoring adherence, resistance and toxicity to ART Strengthen coordination within facilities/districts

185 th Dec 2005, ICASA, Abuja, Nigeria Acknowledgements This has been made possible by: PLHA and their families and friends WHO technical assistance PEPFAR World Bank Global Fund TASO JCRC AHF Academic Alliance Other partners Thank you, but we have exceeded our 3x5 target!

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