Scaling up ART in Sénégal: specifics needs for strategic information

1. Scaling up ART in Sénégal: specifics needs for strategic information Mame Awa Toure MD, MSc AIDS/STI Division, MOH Senegal

2. Introduction • Senegal: a west African country • Area: 196.722 km² • Population estimated to 10 millions • 11 regions and 30 departments/ provinces. • Resources constrained settings: GDP of 500$ US. • Concentrated HIV epidemic • Low HIV prevalence in general population less than 2% • 5-20% in high risk group

4. The Senegalese Initiative for Access to ARVs : ISAARV • A Governmental initiativelate 1997 • Political commitment : increasing annual subsidy • Collaboration of ANRS: technical support, project design • First step : Pilot study • Building up a model according limited resources • Evaluation before extension (collaboration with ANRS) • Second step : scale up for nationwide access

5. 2000- 2006Accelerating phase of ISAARV • Political comittement • Government subsidy increased • Subsidy included to the national budget line • Credit IDA : MAP • Expanding Fund and Partnership for ARV program • government, • WB, GF, USAID/FHI, UE, GTZ, UN agencies… • Decrease of the of financialparticipation • Increasing demand

6. Increasing government budget

7. Financial participation • Government subsidycon’t • October 2000: ACCESS Program • Levels of financial participation • SES assessed by a social workers team • A package including drugs, CD4 count and viral load • Low income: $30- $7 per month • Government officers $60- $15 • About 80% of patients treated free of charge

8. ISAARV managerial structures • Health facilities level: hospital/treatment centers • Medical committees • Enrollment and medical follow up • PEP documentation and management • Psycho-social support committees • Adherence support, accompaniment counseling… • PLWHA clubs • Coordination level: HIV/AIDS Division, MOH • Drugs and reagents management committee • PMTCT management committee • VCT piloting committee

9. Services delivery package • District level : operational level • Counseling, certain OI management, • * PMTCTservices, • Referral functional system, • Monitoring ARV (next step) • Hospital level : district + ARV • ARV entry point • Rapid functionality of structures

10. Needs, coverage • ISAARV components • prior Conditions: • HIV testing available/ VCT • ARV Treatment Centers • Counseling, treatment of OI, use of Cotrimo… • Laboratories capacity : CD4, routine exams • Training of health personals • ARV monitoring committees

11. Needs, coverage (2) • Monitoring ART • Adults,Children, • PMTCT • Post Exposure Prophylaxis • Psycho-social and adherence support • Supportive research: • Monitoring drugs resistance • Promoting clinical trials

12. Chain of distribution • National procurement pharmacy • Treatment centersRegional procurementpharmacy Fann Pharmacy Regional hospital/ Districts HPD, IHS

13. ISAARV up to date • 1350 patients included Period Aout 98 - may 2003 • 5 out of 11 regions involved • Active local sponsorship in process • Extension to the remaining regions by end of 2003

14. How does the data collection work? • Patient monitoring • Detailed patient data base for the first 100 naives patients enrolled to the pilot phase, • Database on 80 patients enrolled in the two clinical trials ANRS1204/ ANRS1206 • Few initiatives on the remaining • Data not being collected regularly • Lack of systematized data collection

15. Strategic objectives • Nationwide access to ARV drugs planned • Strenghten capacities in the 11 regions • Increasing number of PLWHA treated • 7000 patients by 2006 •  M&E system urgently needed!!! • Weak part of the program to be improved

16. M&E approach • M&E system already in place • For other priority diseases • except HIV/AIDS new strategies (PMTCT, ART..) • Building up process for HIV/AIDS: • Capacity building** • M&E Unit: NACA, MOH, and other ministries • Strengthening technical resources: training

17. M&E approach (2) • M&E plan developed • Workshop in June 2003: set of indicators for each components ** (UNGASS/MAP) • M&E tools and Operational guidelines to be developed • training • Data collection plan

18. M&E approach (5)

19. M&E approach(4)next steps by end of 2003 • Workshop series • Update and reinforce competencies in M&E within targeted sectors (health, education, youth…) • Priority for the Health sector • TOT, training series • M&E tools development • Data collection plan • Data collection forms • Defining evaluation system and calendar • M&E sub- units to be set up at the regional level, • Contracting services ???

20. Specifics needs • Lack of technical resources : • Urgent need to • Strenghten HR capacities in M&E • Recruit human resources for M&E units at each level • More use of available data • Systematisation of information, • Regular data collection • For patient monitoring and program monitoring

21. Specifics needs • ARV delivery system to be improved • Logistical issues • Better planning of Evaluations for all ISAARV components • Evaluation of the pilot phase (ANRS 02) • More in-dept Cost-effectiveness analysis • External expertise needed