Presentation is loading. Please wait.

Presentation is loading. Please wait.

LESSONS AND CHALLENGES IN HIV/AIDS SCALING UP ART IN THE WESTERN CAPE PROVINCE OF SOUTH AFRICA ODI 7 June 2006.

Similar presentations


Presentation on theme: "LESSONS AND CHALLENGES IN HIV/AIDS SCALING UP ART IN THE WESTERN CAPE PROVINCE OF SOUTH AFRICA ODI 7 June 2006."— Presentation transcript:

1 LESSONS AND CHALLENGES IN HIV/AIDS SCALING UP ART IN THE WESTERN CAPE PROVINCE OF SOUTH AFRICA ODI 7 June 2006

2 2 Unless treatment reaches significant numbers of people living with AIDS its public health impact will be severely limited

3 3 PROJECTED AIDS CASES (SA)

4 4 PROJECTED HIV POSITIVE PERSONS (SA)

5 5 PROJECTED NUMBER HIV INFECTED BY STAGE OF DISEASE (SA)

6 6 AIDS RELATED DEATHS (SA) UNDER VARIOUS TREATMENT SCENARIOS

7 7 Describing the intervention HIV infection 7.5 – 9.1 yearsStage 4 – 1.47 – 1.8 years FL – 2.68 years SL – 1.78 years Failing 1.6 years Median survival from initiating treatment of 4.5 years if two regimens offered, mean 6.06 years, mean benefit of 4.46 years

8 8 SCALING UP ART IN THE WESTERN CAPE PROVINCE

9 9 HIV EPIDEMIOLOGY Antenatal prevalence – 15.4% District level surveys show range of 1% - 33% – HIV positive 5-10% need HAART 25% of all hospital admissions by % of all PHC visits by 2010 ANTENATAL PREVALENCE 15.4%

10 10 BACKGROUND TO THE WESTERN CAPE HEALTH SERVICE 252 fixed and 131 mobile clinics 64 community health centres 36 district and regional hospitals 3 tertiary referral hospitals (1 for children) Population 5 million spread over km 2

11 11 PRIMARY HEALTH CARE SERVICES Chronic understaffing Poor management and organisation Lack of computerisation 8 million visits per year to clinics 4 million visits per year to community health centres

12 12 LEVELS OF CARE Clinic level – nurse driven, VCT, minor ailments, ongoing counseling, workup including CD4 count Community health centre or district hospital OPD initiation and maintenance of HAART Secondary referral for sputum negative TB, immune reconstitution, major side effects Special arrangements for children, pregnancy, psychiatry

13 13 HAART is a simple and feasible intervention, appropriately implemented at PHC level, requiring the engagement of a doctor for treatment initiation, entirely affordable within the SA context The entire discussion on HAART must always aim at finding the balance between treating as many people as possible and protecting against drug resistance

14 14 SPEED Using the budget as a policy and planning tool Pharmacy management (parallel systems Mobiising GFATM resources Staff and infrastructure NGO Partners and Partnership management (cant scale up alone)

15 15 PLANNING AND BUDGETING Estimate numbers of patients by site Allocate budgets for drugs and labs, counselors, nutrition, community psycho social support Allocate staff on a subjective basis All other costs to be met by general facility budget

16 16 WITHIN THE METROPOLITAN AREA (start in the districts with the highest burden and where infrastructure exists) 93 clinics 48 community health centres Majority of hospital beds and all 3 tertiary hospitals Two thirds population 72% depend on the public sector

17 17 PHARMACY ARV programme is pharmacy intensive Separate supply chain with customised new central store Forecasting drug utilisation Multiple suppliers New tender NVP based first line R80 per month

18 18 Forecast vs Consumption: Stavudine 30mg (Adult: Protocol 1) Change

19 19

20 20 NGO Partners Khayelitsha (MSF) Gugulethu (DTHC, CRUSAID) Langa (CCT, MTCT PLUS) Groote Schuur Hospital (1 to 1 FOUNDATION, KIDZPOSITIVE) Red Cross Hospital (UCT) Tygerberg Hospital (clinical trials) GF Jooste Hospital (NMF, SAMA)

21 21 SCALE ACHIEVED OVER TWO YEARS PMTCT universally available using dual and triple therapy regimens (fast track for pregnant women with CD4 < 200) Vertical transmission < 5% HAART rolled out to all major towns (45 sites) patients on HAART (65% coverage) 75% of children on treatment

22 22 LIMITING DRUG RESISTANCE Regimen selection (public health, protocol driven approach) Site and patient selection Adherence support, drug literacy Secondary referral (raises quality of medical care)

23 23 SITE SELECTION Llimit liberal prescribing practice Treatment initiation by medical officer District hospital or community health centre ideal setting for ARV treatment GPs, NGOs, hospices ??

24 24 PATIENT SELECTION Clinical and biological criteria Psycho social criteria – residency, history of adherence, alcohol/drug dependency Factors promoting adherence Global decision by team Excessive pressure to favour treatment Ethical but also public health issue

25 25 PSYCHO SOCIAL SUPPORT FOR ADHERENCE Site based counselling Sign up to support groups Community based adherence support Drug literacy Proximity to health facility Outsourced to NGOs

26 26 ADHERENCE SUPPRT MODELS Clinic based counselors Community models Dedicated ARV counselors, paid, 1 for every 20 – 30 patients Home based care DOTS Treatment coach or advocate

27 27 Duration (months) Grand Total DEATH RATE FOR ADULTS ON ART

28 28 PERCENTAGE OF PATIENTS WITH CD4 COUNT LESS THAN 50 CELLS/ul AT THE TIME OF ENROLLING ON ARV

29 29 PERCENTAGE OF PATIENTS ON SECOND LINE TREATMENT STRATIFIED BY DURATION OF TREATMENT

30 30 VIRAL SUPPRESSION TIME ON TREATMENTADULTS After 36 months 90.10% After 24 months 94.20%

31 31 PMTCT/ART interventions provide the most powerful impact on all mortality indicators. Only large numbers at scale deliver the outcomes that we all desire. Early analysis of mortality statistics shows a significant decreases in infant, child and maternal mortality and significant decrease in overall adult mortality for the Province. IN CONCLUSION


Download ppt "LESSONS AND CHALLENGES IN HIV/AIDS SCALING UP ART IN THE WESTERN CAPE PROVINCE OF SOUTH AFRICA ODI 7 June 2006."

Similar presentations


Ads by Google