1. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 ESTHER initiative : networking for a collaborative response in procurement and supply management of AIDS commodities “The experience of ESTHER Hospital Pharmacists Network”  Dr. Muriel DUBREUIL GIP ESTHER, Paris, France  Dr. Nicolas TERRAIL Hôpital Lapeyronie, Pharmacy, Montpellier, France Representative of ESTHER network XVIth International AIDS Conference, Toronto, Canada, 13-18 August 2006 Skill building Workshop

2. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 ESTHER background (1) Initiative launched in 2001 Initiative launched in 2001 French Ministries of Health and Foreign Affairs « Together for Network Hospital Therapeutic Solidarity » « Together for Network Hospital Therapeutic Solidarity » Hospital twinnings Main goal Main goal Improve access to care and treatment for PLWHIV with a global and operational approach 10 European countries involved 10 European countries involved

3. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Main stakeholders to implement ESTHER Activities National and local health authorities National and local health authorities Hospital teams Hospital teams NGOs NGOs Civil Society representatives Civil Society representatives Private sector Private sector ESTHER background (2)

4. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Activities Implemented by ESTHER Comprehensive care Comprehensive care –Medical Care –Psychosocial Care and Support Training and capacity building for Training and capacity building for –Medical (clinicians, biologists, pharmacists) –Paramedical (nurses, auxiliaries…) –Social (psychosocial counsellors, social workers…) –Technical professionals ( programme designers, technicians,…)

5. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Pharmaceutical sector ESTHER positioning (1) Direct link with national health authorities, hospital administrations and clinical staffs Direct link with national health authorities, hospital administrations and clinical staffs Strengthening existing health facilities within health care systems Strengthening existing health facilities within health care systems Answering to the full range of pharmaceutical technical needs Answering to the full range of pharmaceutical technical needs

6. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Pharmaceutical sector ESTHER positioning (2) 2 main objectives :  Strengthening capacities  Enhancing pharmaceutical competencies  Improving supply and distribution systems  French Hospital Pharmacists network  ReMeD  Answering to ARTs stockouts (stockpile)  CHMP Nairobi

7. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Pharmaceutical sector Key players Pharmaceutical sector Key players  ESTHER Hospitals Pharmacists network  « On site training sessions »  « Mentoring » activities  Specific expertise  Specific partnerships  ReMeD  CHMP

8. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006  Capacity building (ReMeD + CHMP) –« Ad hoc » training modules « organisational support to ARTs management and dispensation »  Selection and quantification  Supply and management  Dispensation and treatment follow up –Partnership with WHO for french adaptation of IMAI pharmaceutical modules  Specific expertise (ReMeD + CHMP)  ART stockpile (CHMP) –A Nairobi based warehouse for storage of ARTs emergency stocks I. ESTHER/ReMeD/CHMP transversal project

9. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006  Continuing education Training courses in local health settings University degrees (DIU Ouagadougou, Ouidah, IMEA,…) Internships in French hospitals pharmacies Training objectives: – –Drugs and pharmacy management – –ARV dispensation – –Compliance and therapeutic education – –Therapeutic drug monitoring  Expertise and knowledge transfer Diagnostic and evaluation Supports to projects and mentoring Specific technical expertise II. ESTHER Hospitals Pharmacists network Intervention fields

10. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 COUNTRIES City 1 (n)* City 2 City 3 City 4 City 5 City 6 City 7 BENIN PARIS (3) BESANCONGRENOBLECHARLEVILLE BURKINA FASO PARIS (1) MONTPELLIERROUENCLERMONT-FdDIJONCHAMBERYREIMS BURUNDI RENNES CAMEROON PARIS (3) MONTPELLIERSTRASBOURGAMIENS CENTRAL AFRICAN REP POISSY/St G IVORY COAST GONESSEBORDEAUXANNECYVANNES GABONMARSEILLENICE FREJUS/St R ANTIBES/Juan GHANAMARSEILLE MALI PARIS (1) MARSEILLEANGERS St DENIS AVIGNON MAROCCO PARIS (1) LYONNICE NIGER St BRIEUC ? SENEGAL PARIS (4) LYONLILLE CHADPERPIGNAN VIETNAM PARIS (1) VERSAILLESBORDEAUXLIMOGESTOULOUSE CAMBODIA TOURSBREST * (n) number of involved Parisian hospitals for the country II. ESTHER Hospitals Pharmacists network Involved hospitals

11. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network Geographical coverage

12. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Software adaptations to identified local needs Software adaptations to identified local needs Co-development between ESTHER hospital partners Co-development between ESTHER hospital partners Involving different type of partners according to each context Involving different type of partners according to each context Examples : Examples : –ADAGIO Calmette Hospital Phnom Penh, Cambodia / Kremlin- Bicêtre Hospital, AP-HP, Paris, France –LOGONE N’Djamena, Chad / Initiative et Développement –Calculator of paediatrics protocols CDG Hospital, Ouagadougou, Burkina Faso / ESTHER projects II. ESTHER Hospitals Pharmacists network Examples of collaborative responses

13. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Main functionalities : ARVs management ARVs management –Stock management –Accountability Patient data files Patient data files –Treatment history Prescription analysis Prescription analysis –Previous prescription –Drugs association –Doses 1. ADAGIO ® software adaptation (1) II. ESTHER Hospitals Pharmacists network

14. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 1. ADAGIO ® software adaptation (2)

15. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 1. ADAGIO ® software adaptation (3) II. ESTHER Hospitals Pharmacists network

16. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 1. ADAGIO ® software adaptation (4)

17. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network LOGONE ® software in Chad

18. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 2. LOGONE ® software (2)

19. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 2. LOGONE ® software (3)

20. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 2. LOGONE ® software (4)

21. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 II. ESTHER Hospitals Pharmacists network 2. LOGONE ® software (5)

22. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Constraints Insufficient involvement of local pharmacists in HIV/AIDS networks, and in other southern countries Few knowledge transmission to fellow- members among trained pharmacists Lack of pharmaceutical resources Lack of qualified staff to manage pharmaceutical activities II. ESTHER Hospitals Pharmacists network Conclusions (1)

23. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 Innovative cooperation methods allow : Valorisation and peer recognition for pharmacists among other HIV/AIDS professionals – –Peer-to-peer transfer of knowledge – –Recognized University degrees (in France and in partner countries) with multidisciplinary teaching – –Mutual exchanges in the field of pedagogy and training Adaptative responses to each context Sharing of emerging difficulties – –Development of techniques and tools for knowledge sharing (website) – –Specific working groups to address key issues II. ESTHER Hospitals Pharmacists network Conclusions (2)

24. XVI th International AIDS Conference, Toronto, Canada, 13-18 August 2006 “The experience of ESTHER Hospitals Pharmacists Network” “The experience of ESTHER Hospitals Pharmacists Network” CONTACTS GIP ESTHER : CONTACTS GIP ESTHER : Muriel DUBREUIL, Drugs focal point muriel.dubreuil@esther.fr Nadine LEGRET, Communication Unit Nadine.legret@esther.fr We would like to address a special thank to all ESTHER partners who contributed to this presentation, specifically : - Agnès Certain, Hôpital Bichat, Paris - Initiative et Développement, Chad and Kremlin Bicêtre hospital team - and the whole Hospitals Pharmacists network Poster THPE 0858 Thursday session