Technical Briefing Seminar for PSM Consultants for HIV/AIDS, TB and Malaria PRIVATE SECTOR ART PROVIDER NETWORK IN KENYA INITIATIVE OF FHI/KMA Presented by Charles W. Abondo 01/2/2006

Background FHI Institute for HIV/AIDS: FHI Institute for HIV/AIDS: Primary cooperative agency of USAID for ART delivery in Kenya under PEPFAR Primary cooperative agency of USAID for ART delivery in Kenya under PEPFAR Helped establish 28 public comprehensive care centres Helped establish 28 public comprehensive care centres Attention focused on upgrading CCC in public sector for PLWHAs Attention focused on upgrading CCC in public sector for PLWHAs

LESSON LEARNED FROM PUBLIC SECTOR INITIATIVE Comprehensive network approach to care for PLWHAs the way forward Comprehensive network approach to care for PLWHAs the way forward Training all members of the care team in HIV/AIDS care and ART services vs specialized training for clinicians Training all members of the care team in HIV/AIDS care and ART services vs specialized training for clinicians Development of comprehensive HIV/AIDS curriculum vs focusing on ART treatment regimens Development of comprehensive HIV/AIDS curriculum vs focusing on ART treatment regimens Partnership with the government to create a sense of ownership Partnership with the government to create a sense of ownership

MAJOR CHALLENGES Government procurement and supply system still inconsistent and full of leakages Government procurement and supply system still inconsistent and full of leakages Government overwhelmed by those seeking HIV/AIDS care Government overwhelmed by those seeking HIV/AIDS care Expensive ARVs, counterfeits and unregistered drugs in the private sector Expensive ARVs, counterfeits and unregistered drugs in the private sector Quality of laboratory services suspect and expensive in the private sector Quality of laboratory services suspect and expensive in the private sector Few private pharmacies stock ARVs because of: Few private pharmacies stock ARVs because of: government subsidy government subsidy Fear of expiry Fear of expiry Inadequate training of private providers on HIV/AIDS care and ART services Inadequate training of private providers on HIV/AIDS care and ART services

GOAL To expand access to comprehensive and quality HIV care and antieritroviral therapy services in the private sector based on a franchised care model and delivered through networks of accredited providers and technical support partners.

Objectives Strengthen the workplaces ART program Strengthen the workplaces ART program Establish a training and quality assurance system for private providers that conform to MOH requirements Establish a training and quality assurance system for private providers that conform to MOH requirements Establish quality laboratory testing capacity that private partners can access Establish quality laboratory testing capacity that private partners can access Support HMOs to provide ART services to their clients Support HMOs to provide ART services to their clients Establish a network support centre Establish a network support centre

Where are we? Sub agreement with KMA/NASCOP signed Sub agreement with KMA/NASCOP signed Logo for the network developed Logo for the network developed Curriculum with core modules and CME modules developed Curriculum with core modules and CME modules developed Selection of trainers, private practitioners, laboratories, and pharmacies completed Selection of trainers, private practitioners, laboratories, and pharmacies completed All SOPs ready All SOPs ready PSM system in place ( supplier contracted) PSM system in place ( supplier contracted) Network centre established Network centre established Counseling and support centres established Counseling and support centres established

Franchise Benefits Training and opportunities for CMEs for medical practitioners Training and opportunities for CMEs for medical practitioners Sustained access to quality low cost ARVs and lab services Sustained access to quality low cost ARVs and lab services Access to specific government labs Access to specific government labs Access to network support centres Access to network support centres Access to counseling and support centres Access to counseling and support centres Participation of HMOs by providing cover Participation of HMOs by providing cover Access to government CCC for practicum Access to government CCC for practicum

Entry Treatmen t PharmaLabs Steps in initiating care test (CD4/8) test CD4/8 & viral load existing patient HIV test new patients OI drugs & tests malaria quick-tests, ACT, cipro, penicillin, nystatin etc. malaria quick-tests, ACT, cipro, penicillin, nystatin etc. Management of OIs, CPT, IPT Initiation of ART ARVs ARV resupply & management of care ARVs counselingcounseling/support counseling/support

THE BEST WAY TO PREDICT THE FUTURE IS TO CREATE IT Peter Ducker