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Mechanisms for planning and implementing TB/HIV interventions at district level

This paper explores the planning and implementation of TB/HIV interventions at the district level, focusing on areas of collaboration between TB and HIV/AIDS programs. It discusses the functions of day care centers (DCC) for people living with HIV/AIDS (PHA) and the importance of peer support in ensuring effective care and support. The paper also emphasizes the need for a partnership mechanism at the district level to sustain and strengthen the delivery of HIV/AIDS care.

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Mechanisms for planning and implementing TB/HIV interventions at district level

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  1. Mechanisms for planning and implementing TB/HIV interventions at district level Masami Fujita WHO Western Pacific Regional Office THE 3rd GLOBAL TB/HIV WORKING GROUP MEETINGMONTREUX, SWITZERLAND4- 6 JUNE 2003

  2. ?? Bottleneck: HIV/AIDS Care TB/HIV: Areas for Collaboration TB Program DOTS Strategy AIDS Program Prevention and Care Policy / Strategy Management / Coordination Service Delivery WHO-WPRO; HIV Care

  3. Care for asymptomatic and symptomatic HBC Referral and TB/HIV care TB Program AIDS Program TB diagnosis TB treatment VCT WHO-WPRO; HIV Care

  4. ARV treatment as driving force to establish HIV/AIDS care • Increasingly available even in developing countries • However, it is NOT easy WHO-WPRO; HIV Care

  5. Effective ARV treatment requires … • Acceptable selection process for ARV enrollment • Educational support • Psychosocial and economic support including counseling • Continuous supply of quality ARV drugs • Mechanism to ensure adherence and follow-up • Capacity to monitor treatment & manage side-effect • Capacity to prevent and treat OI • Reduced stigma and discrimination, etc. Most of these requirements are beyond capacity of “clinical services” in most developing countries WHO-WPRO; HIV Care

  6. PHA/peer support played critical roles in countries where major progress was made in HIV/AIDS care facilitated/supported by NGOs and health workers e.g. Thailand, Uganda, Brazil WHO-WPRO; HIV Care

  7. An approach to develop continuum of carein resource poor settings Day care center (DCC) for/by PHA • Place where PHA conduct various care & support activities, facilitated and supported by health workers. • Attached to health facilities, but open to community • Many are located at district level (e.g. Northern Thailand) - Not too far (transport) or not too close (stigma) - Sufficient number of PHA to form groups - Medical capacity to provide OI services and ARV WHO-WPRO; HIV Care

  8. DCC can be launched with a room and a staff, without capital investment WHO-WPRO; HIV Care

  9. Functions of DCC1) Peer support WHO-WPRO; HIV Care

  10. Functions of DCC2) Individual and group counseling3) Spiritual support WHO-WPRO; HIV Care

  11. Functions of DCC4) Health education for PHA and family on self-care, home-care, health promotion, nutrition, and prevention WHO-WPRO; HIV Care

  12. Functions of DCC5) Base for home based care: (Capacity building of PHA and family, Home visit) WHO-WPRO; HIV Care

  13. Functions of DCC 6) Base for learn and work with community WHO-WPRO; HIV Care

  14. Functions of DCC7) Occupational promotion 8) Support for orphans WHO-WPRO; HIV Care

  15. Functions of DCC9) Health check-up including early TB detection WHO-WPRO; HIV Care

  16. Functions of DCC10) Clinical service • Comprehensive care and support • User-friendly one stop service (short waiting time, intimate staff) improve adherence of • OI prophylaxis and treatment TB, PCP, Cryptococcosis • ARV treatment WHO-WPRO; HIV Care

  17. WHO-WPRO; HIV Care

  18. Hospital where IPT is managed separately from DCC Remark: “Defaulter” is defined as missing appointment for more than 45 days. CDC 10 MOPH Thailand WHO-WPRO; HIV Care

  19. Hospital where IPT is integrated in DCC services Remark: “Defaulter” is defined as missing appointment for more than 1 month CDC 10 MOPH Thailand WHO-WPRO; HIV Care

  20. Day Care Center - Peer support - Psychosocial - Occupational - Medical/Health - Link with hosp/HC service (VCT, Health promotion, Counseling, Home visit Sympt/Palliative care, OI, ARV) DCC • - Link with home (Family training, counseling) • - Link with community (Anti-discrimination, Home visit, Orphan) DCC as “Heart” / “Hub” of HIV/AIDS care Dist Hosp PHO Prov Hosp OPD/AIDS Clinic Other sectors DHO OPD NGO HC Com. org HC PHA PHA PHA WHO-WPRO; HIV Care

  21. ART DOT or Buddy system could not be developed and sustained in the vacuum. • The partnership mechanism at the intermediate (district) level is essential. WHO-WPRO; HIV Care

  22. Reinforce Oper.Dist with DCC function (“MMM”) Link with hosp/HC Link with home Link with community Example: Cambodia Dist Hosp PHO Prov Hosp Other sectors HIV office PHA group Funding from abroad Com. org NGOs HC HC PHA PHA PHA WHO-WPRO; HIV Care

  23. DCC functions at Dist Health Center Link with hosp/HC Link with home Link with community Example: Viet Nam Dist HC PHO Prov Hosp Other sectors HIV in Prev.Med PHA group HC Com. org HC PHA PHA PHA WHO-WPRO; HIV Care

  24. Care for asymptomatic and symptomatic HBC Referral and TB/HIV care TB Program AIDS Program TB diagnosis TB treatment VCT WHO-WPRO; HIV Care

  25. HIV/AIDS care as program is essential for effective TB/HIV interventions TB Program DOTS Strategy AIDS Program Prevention and Care Policy / Strategy Management / Coordination Service Delivery WHO-WPRO; HIV Care

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