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Overview of HIV/AIDS in Ethiopia

Overview of HIV/AIDS in Ethiopia. HIV Care and ART: A Course for Healthcare Providers. Learning Objectives. Describe the global and national HIV/AIDS epidemiological profile

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Overview of HIV/AIDS in Ethiopia

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  1. Overview of HIV/AIDS in Ethiopia HIV Care and ART: A Course for Healthcare Providers

  2. Learning Objectives • Describe the global and national HIV/AIDS epidemiological profile • Describe the Ethiopian national AIDS strategies, guideline for implementation of ART, and roadmap to accelerate care and treatment for PLWHA • List the major achievements, challenges and opportunities during the implementation of the ART program in Ethiopia

  3. Learning Objectives (2) • Explain the Ethiopian National Policy on ARV drugs, supply and use • Convey the current status of the ART program in Ethiopia • List prevention strategies to reduce the spread of HIV infection in the country

  4. Global and Ethiopian Summary of HIV/AIDS Epidemic

  5. Global Summary of the AIDS Epidemic, December 2005 • PLWHA 40.3 million (36.7 – 45.3) • Adults 38.0 Million (34.5-42.6) • Women 17.5 Million (16.2-19.3) • Children <15 yrs 2.3 Million (2.1-2.8) • New infections 4.9 million (4.3–6.6) • Adults 4.2 Million (3.6-5.8) • Children <15 yrs 700,000 (630,000 – 820,000) • AIDS Deaths 3.1 million (2.8 – 3.6) • Adults 2.6 Million (2.3 – 2.9 million) • Children <15 yrs (570,000-670,000)

  6. 45 40 35 30 25 20 15 10 5 0 Estimated number of adults and children living with HIV by region, 1986–2005 Oceania Million North Africa & Middle East Eastern Europe & Central Asia Latin America and Caribbean Number of people living with HIV North America and Western Europe Asia Sub-Saharan Africa 1985 1990 1995 2000 2005 Year Source: WHO/UNAIDS, 2006

  7. Est. Number Newly Infected With HIV During 2005: 4.9 Million Western Europe 21,000 Eastern Europe & Central Asia 210,000 North America 44,000 East Asia & Pacific 290,000 North Africa & Middle East 92,000 South & South-East Asia 890,000 Caribbean 53,000 Sub-Saharan Africa 3.1 million Latin America 240,000 Australia & New Zealand 5,000 Source: UNAIDS/WHO

  8. Global HIV prevalence in adults, 2005 Source: WHO/UNAIDS, 2006

  9. Est. Adult and Child Deaths From HIV/AIDS During 2005: 3.1 Million Western Europe 65,000 Eastern Europe & Central Asia 60,000 North America 16,000 North Africa & Middle East 28,000 East Asia & Pacific 51,000 Caribbean 36,000 South & South-East Asia 490,000 Sub-Saharan Africa 2.3 million Australia & New Zealand 700 Latin America 95,000 Source: UNAIDS/WHO

  10. Source: UNAIDS/WHO 2004

  11. 70 60 50 40 30 20 10 0 Percent of adults (15+) living with HIV who are female 1990–2005 Sub-Saharan Africa Caribbean GLOBAL Percent female (%) Latin America Asia Eastern Europe and Central Asia 1990 1995 2000 2005 Year Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS]

  12. Number of people on antiretroviral therapy in low- and middle-income countries, 2002–2006 1800 1600 People receiving therapy (thousands) North Africa and the Middle East 1400 Europe and Central Asia 1200 East, South and South-East Asia 1000 Latin America and the Caribbean 800 Sub-Saharan Africa 600 400 200 0 Mid- 2006 End 2002 Mid- 2003 End 2003 Mid- 2004 End 2004 Mid- 2005 End 2005 Source: WHO/UNAIDS (2005). [Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.” ] [Updated with 2006 data, WHO/UNAIDS]

  13. Ethiopian Prevalence • National single point estimate (SPE) ......... 2.1% • National Prevalence for 2005 ........... 4.7% • Women….5.0% • Men….3.8% • Urban prevalence in 2005...................12.5% • Urban prevalence SPE in 2006 …… 7.7% • Rural prevalence in 2005................... .3.0% • Rural SPE prevalence 2006 ………….0.9%

  14. HIV/AIDS Indicators in Ethiopia (2006)Bases on single point estimate • Number of PLWHA 929,699 • Estimated new annual infection 122,971 • PLWHA requiring ARVs 244,835 • Annual AIDS deaths 88,997 • Adults and Children on ART • Ever started 122,243 • Current on ART 90,212 • Pediatrics 4484 (January 10, 2008)

  15. HIV/AIDS Indicators in Ethiopia (2006) (2)Single point estimation • Total orphans 5,401,636 • AIDS orphans 656,058 • Children living with HIV/AIDS 61,864 • New HIV infections……… 13,836 • Annual AIDS deaths in children 10,887 • Children newly needing ART 14,396 • Children on ART >4000

  16. Age & Sex Distribution of Reported AIDS Cases (1986 - June 2003, Ethiopia) Source: AIDS in Ethiopia, 5th ed., MOH, July, 2004

  17. Impact on Rural Households • Loss of income (50% or more) • Loss of labor • Loss of skilled manpower and knowledge • Loss of land • Loss of remittances • Reduction in savings and investment • Expenses for treatment, funeral, teskar • Need to sell livestock to meet expenses

  18. Impact on Industry • Loss of workers • Expenses for recruiting and training replacements • Reduced productivity in cases of skilled workers or managers • Lost work days due to sickness and funeral leave • Increased health care costs • 50% illness due to AIDS • Loss of skilled professionals

  19. National response to HIV/AIDS in Ethiopia

  20. Historical Overview of HIV/AIDS in Ethiopia • 1984: The first evidence of HIV infection in Ethiopia • 1986: The first two AIDS cases reported to the Ministry of Health • 1989: HIV/AIDS surveillance started • 2003: Fee base ART started • March, 2005: Free ART program started

  21. Background on • Health Services • 138 hospitals • 650 Health centers • 6175 health posts • Access to HIV/AIDS Services • ART 260 (117 HP & 143 HC) • HCT 889 • PMTCT 390 health facilities are providing HIV services

  22. National Comprehensive and Expanded Response against HIV.AIDS Epidemic • HAPCO was established in 2000 • Policies and Strategy documents that are issued • HIV/AIDS policy in 1998 (currently on revision) • ARV drug supply and use developed in 2002 • 5 Years strategic planning was developed (SPM) with a principle of the three ones (one plan one budget one report) • Road map developed (2007-2010) : As part of the national ART scale up and implemented

  23. National Comprehensive and Expanded Response against HIV.AIDS Epidemic • National M&E Frame developed and implemented • HIV/AIDS Multi Sectoral Response Framework (2001-2005) • Social Mobilization strategy focusing on community response. • Various Program Implementation guidelines and manuals (PMTCT, STI, HCT, pediatrics , Social mobilization etc)

  24. VCT Site Distribution by Region, 2005

  25. VCT Before and After ART VCT not much benefited from free ART program

  26. Missed opportunity - VCT Absence of ART at most Health centers, private sectors, NGO clinics

  27. ART Site Expansion Versus Target 2006 >100%

  28. Why Missed opportunity • Absence of ART at most • Health Centers (Gov.) • Private Health facilities • Lack of knowledge about ART • Poor referral and linkage system • Stigma and discrimination • Poor involvement of community and PLWHA

  29. Regional Distribution of ART

  30. PMTCT – Achievement 105 6 75 4758 37 0 0 53016 1700

  31. National Response • HIV/AIDS Policy formulated by MOH and adopted by the Council of Ministers in 1998 • Enabled HIV/AIDS prevention and control • Supplemented existing health, women’s, and education and training policy • Called for a multisectoral response • Guaranteed rights of PLWHA • ARV Drugs Supply & Use Policy formulated July 2002

  32. National Response (2) • HIV/AIDS Prevention & Control Office (HAPCO) established June 2002 • Restructured from NACS (April 2000) • Sits under Prime Minister’s Office • Established at all levels of government • Runs the daily activities of NAC • Resource mobilization • Advocacy • Coordination of the sectoral responses

  33. National Response (3) • HIV/AIDS Strategic plan for five years • 2004 - 2008 • Social mobilization & community involvement • Community ownership • Scaled up ART program • AIDS fund was initiated • Free ART program was scaled up

  34. HIV/AIDS Intervention Strategies • Prevention • Social mobilization • IEC/BCC • HIV counseling and testing • Voluntary (VCT) • Provider initiated (PIHCT) • STI prevention and control • Condom promotion • Infection prevention • Prevention of mother to child transmission (PMTCT) • Post exposure prophylaxis

  35. HIV/AIDS Intervention Strategies (2) • Care and Treatment • Palliative care • Community home based care • Opportunistic infection treatment • Tuberculosis treatment • Treatment of AIDS patients • Support for • Orphans and vulnerable children (OVC) • People living with HIV/AIDS (PLWHA)

  36. Major Achievements • National HIV/AIDS Policy • National AIDS Council Secretariat • Five editions of “AIDS in Ethiopia” • National ARV Policy (revised and published in January 2005) • Roadmap to accelerate access to HIV/AIDS care and treatment • M&E framework

  37. Major Achievements (2) • Five-year strategic plan revised & updated • Used as main input for the National Strategic Framework adopted by NAC • Contains strategic outline of interventions at federal and regional levels • Key guidelines developed: • HIV Surveillance Guideline • HIV Surveillance Training Manual • Voluntary Counseling & Testing Guideline

  38. Major Achievements (3) • Key guidelines (continued): • AIDS Case Management Guideline • STI Management Guideline • Home-Based Care Guideline • Private HIV Labs Licensing Guideline • PMTCT Guideline • Home Care Training Manual • Counseling Training Manual • ARV Guideline • Universal Precautions & Post Exposure Prophylaxis

  39. Major Achievements (4) • >900 VCT sites established • 163 sentinel surveillance sites established • MOH has been the primary advocate for a multi-sectoral response to HIV/AIDS: • Formulated and disseminated HIV/AIDS and ARV Drugs Supply & Use Policies • Acts as a catalyst for several multi-sectoral HIV/AIDS committees that pre-dated the NAC

  40. Major Achievements (5) • Integrating HIV/AIDS into health programs: • Reproductive health • Mother and child health • Hospital hygiene • Health education • Integrated disease surveillance • TB/HIV Initiative

  41. Policy of ARV Supply and Use in Ethiopia

  42. Introduction • Care and support of PLWHA plays an important role in preventing the spread of HIV/AIDS • ART is an important component of care for PLWHA • ARVs also have an important place in PMTCT and PEP • ARVs have enormous benefits, but affordability, toxicity, adherence and resistance are challenging

  43. National ARV Policy • Policy approved in July 2002 • Objectives of the policy: • Reduce MTCT • Prolong and improve the quality of lives of PLWHA • Reduce accidental HIV infection within health institutions

  44. General Policy • Determines type of ARVs that will be used in health care services • The Government of Ethiopia: • Coordinates & facilitates the supply of ARVs • Builds capacity for making available safe, effective and quality antiretroviral drugs, and for ensuring proper use of these drugs • Ensures sustainable supply of ARVs by encouraging involvement of all stakeholders

  45. General Policy (2) • The Government of Ethiopia (cont): • Nurtures international partnerships to strengthen sustainable supply and use of ARVs • Encourages research on modern and traditional HIV/AIDS treatment • Establishes strong systems to monitor ARV supply and use

  46. General Strategies • Selection of ARVs • Determine the type of ARVs to be used in Ethiopia • Incorporate selected ARVs into the national drug list • Permit the import of ARVs that are not included in the national drug list

  47. General Strategies (2) • Supply of ARVs • ARVs for ART: • Exempted from taxation • Supplied at reduced prices through government negotiation with manufacturers, importers and distributors • Purchased by a system of bulk and generic substitution • Local production of ARVs encouraged • Benefaction of ARVs facilitated by the Ethiopian Government • Ethiopian Government supplies ARVs for PMTCT

  48. General Strategies (3) • Drug Use • Prepare and implement standardized prescription paper • Prepare and implement national guidelines for safe and effective use of ARVs • Sustainable public education on ARV drugs

  49. General Strategies (4) • Research and Development • Government of Ethiopia encourages research on modern and traditional HIV/AIDS treatment • Government of Ethiopia shall make efforts to strengthen the capacity of research institutions • Rights and benefits of citizens that enroll in research studies shall be respected • National and international ethical norms and values in human experimentations shall be observed

  50. Scaling up ART Uptake • Need capacity development to: • Initiate treatment • Help patients adhere to their treatment regimens • Monitor the efficacy and toxicity of the regimens • Diagnose treatment failure • Monitor overall resistance in society • ART program must be implemented at Health Center level • Nursing initiative to prescribe ARVs is being piloted

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