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Wim Van Damme Professor Public Health & Health Policy Institute of Tropical Medicine

HIV/AIDS – community-based interventions IAS conference Washington 26 July 2012. Setting the stage …. Wim Van Damme Professor Public Health & Health Policy Institute of Tropical Medicine Antwerp, Belgium. 30 years of HIV interventions. Hospital. Community. prevention. treatment. care.

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Wim Van Damme Professor Public Health & Health Policy Institute of Tropical Medicine

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  1. HIV/AIDS – community-based interventionsIAS conference Washington26 July 2012 Setting the stage … Wim Van Damme Professor Public Health & Health Policy Institute of Tropical Medicine Antwerp, Belgium

  2. 30 years of HIV interventions Hospital Community

  3. prevention treatment care Hospital Community

  4. treatment Hospital Community

  5. Community-based = …. Community health workers (CHWs)? Households? Churches? Assoc PLWHA? Schools? Peer support groups? Youth groups? CSOs & CBOs?

  6. Now: era of scaling-up evidence-based priority interventions (ARVs) • On scaling-up; using public health approach • 3 dimensions • Decentralisation! • Task shifting! • Integration?? • 2 specific topics: • HIV/AIDS as a chronic lifelong condition (CLLC) • Role of IT

  7. Scaling-upusing public health approach Scaling-up: from pilot projects to national programmes Public health approach = quality care for individuals, combined with population perspective (coverage) From doctor-patient relationship to health systems perspective

  8. Scale-up: How? 3 dimensions • Geographical: decentralisation! • Human resources: task shifting! • Organisational: Integration(?) = context- and path-dependent!! Key enabling factor: Simplification / standardisation

  9. Simplification / standardisation • Simplified lab monitoring • Simplified treatment (e.g. FDC) • Protocol-based decisions >> individualised decisions

  10. Decentralisation

  11. Integration??? Linked!!!

  12. ART functions Dis-integration???

  13. Focus:Chronic Lifelong Conditions (CLLC)

  14. Chronic lifelong conditions (CLLC) Have in common: • Adults • Slow progress • Nasty complications and early death • “Management” = relatively “simple”, but lifelong!!! • “Coping” needed (=self-management): • Treatment • Behavioral change • Finding new “balance”

  15. Alternative delivery models!! taking into account • “person living with …” • “chronic” • “condition” • “lifelong coping”

  16. Seize new opportunities • Expert patients ==> new balance • … members of peer support groups & networks • … robust & cheap technologies • Diagnostics & monitoring tools • Medicines • … empowered by ICT

  17. Technological changes

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