1. Philippe Chiliade, MD, MHA Technical Advisor, Clinical Care, FHI 12 August 2008 Family Health International Implementing HIV Care & Treatment Progress to date and future plans

2. Overview Adult and pediatric ART scale-up data Expansion to PHC Task shifting approaches Chronic care model & primary health care FHI Children’s Initiative MARPs in Sub-Saharan Africa

3. Background FHI supports ART programs in 11 countries Funding support: - Mainly USG (USAID, CDC) - GFATM - Private sector

4. Adult & pediatric ART scale up

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7. Expansion to PHC Decentralization of care from the district hospital (initiation of 1 st line ART and ART care follow up at PHC, referral to district hospital for complex care, CD4 support at the district hospital lab) Mobile ART care team (ART care team from the district hospital delegated weekly to PHC) “HAST model” (integrated prevention and care programs for HIV/AIDS, STI, and TB at the PHC and community levels)

8. Task shifting Nurse ART providers pilot project (Rwanda) - Trained and supervised nurses authorized to stage HIV, start 1 st line ART, and monitor uncomplicated care. Trained community volunteers as lay counselors, Adherence Support Workers and PMTCT motivators (Zambia) - Many of these community volunteers are PLWHA

9. Chronic Care Model Primary Health Care HIV is a chronic disease that requires: –Patient health literacy –Patient active involvement in their care –Regular monitoring (retention) and strict adherence to ARV treatment –Long-term management of complications of the HIV disease and its treatment –On-going prevention with positive services –On-going assessment of FP, nutritional, and psycho- social needs This will require strengthening of Primary Health Care Services

10. FHI Children’s Initiative Comprehensive 5 year global commitment to reclaim a generation of children - Rapidly expending treatment & prevention - Addressing social needs of children and families Areas of initial focus: - Working closely with communities and local, regional, and national authorities to develop leadership and ownership - Investing in HR (training, mentoring) - Mobilizing strategic partners - Increasing identification of HIV-infected children - Leveraging existing prevention, care, and treatment sites - Laying the groundwork to develop the empowered communities concept - Establishing targets / performance indicators -Identifying knowledge gaps

11. MARPS in SSA Expending activities targeting MARPs MSM FSW and MSW IDU Mobile populations Displaced populations Incarcerated populations