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Scaling-up ARV Therapy For HIV

26/09/2012. History of ARV Therapy in Zambia. HAART became available in the private sector in Zambia as early as 1996 soon after it became available in the west.The number of patients on HAART in Zambia by 2002 was estimated at just over 1,000 patients.. 26/09/2012. History of ARV Therapy in Zambia

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Scaling-up ARV Therapy For HIV

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    1. 26/09/2012 Scaling-up ARV Therapy For HIV/AIDS In Zambia progress report 2002-2004 V.C. Mtonga Director Clinical Care and Diagnostic Services-CBOH

    2. 26/09/2012 History of ARV Therapy in Zambia HAART became available in the private sector in Zambia as early as 1996 soon after it became available in the west. The number of patients on HAART in Zambia by 2002 was estimated at just over 1,000 patients.

    3. 26/09/2012 History of ARV Therapy in Zambia In 2002 the government took a policy decision to introduce HAART in the public hospitals. 12 billion kwacha was made available to purchase ART for up to 10,000 PLWHA. This programme involved the phased implementation of the programme starting with Lusaka and Ndola(2002) and spreading to all provincial capitals(2003).

    4. 26/09/2012 What Is the Current Status of the GRZ Programme? To date 52 centers are operational. National treatment guidelines and training manuals have been developed. HR capacity building undertaken – teams trained(Dr,Nurses,Lab,Pharm,counsellor, nutritionist) –ART,

    5. 26/09/2012 What Is the Current Status of the GRZ Programme? HR cap. Building contd OI training –use Diflucan in severe fungal infection Logistic Management – DILSAT Local Study tours undertaken ART national trainers has been trained and will soon be conducting trainings across the country

    6. 26/09/2012 What Is the Current Status of the GRZ Programme? Laboratory Support Medical supplies & reagents – centers using hosp. Allocation & supplement using cost sharing funds The programme has with the help of JICA began introducing dynabeads technology for CD4 monitoring of patients on HAART at all the provincial centers

    7. 26/09/2012 What Is the Current Status of the GRZ Programme? Documentation & Accountability Various record forms & registers developed Draft M & E tool developed Operational Research -Resistance tracking -ART Work force & costing studies done

    8. 26/09/2012 What Is the Current Status of the GRZ Programme? An estimated 8,000 patients are already accessing HAART through this programme.

    9. 26/09/2012 Emerging Issues   Logistic management of drugs needs to be strengthened: - Drug order form not authenticated on time, therefore cause delay for one hospital for additional supply. - National ART Drug Stock Levels: See annex 11 – Some combinations expiring by August 2004. (See appendix II1 for action taken).  

    10. 26/09/2012 - ART drugs packaging too large e.g. Eferverenz and Indinavir – 3 boxes and 12 boxes per month respectively.

    11. 26/09/2012 Cost sharing   Cost-sharing: - Difficulties experienced in effecting exemptions therefore some patients not accessing care due to lack of funds.  - Review of cost sharing guidelines required to possibly reduce the contribution from the patient. - Orientation to cost sharing guide for institutions - Public debate on social criteria for accessing ART

    12. 26/09/2012 Monitoring & Evaluation --- Data management – Data collecting tools and reporting formats need to be harmonized - Patient Tracking  Computerization of patient records necessary Requires robust system that ensures patient confidentiality, with password access and accessible from any part of Zambia.

    13. 26/09/2012 Community mobilisation Needs strengthening- some IEC materials available Active community radio programmes Requires communication for social change

    14. 26/09/2012 WAY FORWARD 1. Increase access to ART Increasing ART centres - training under way:started 11.04.04 targeting 30 districts nationally, 33 new centres opened distribution ART to hospices, Defence forces, Mines, Private sector, mission hosp

    15. 26/09/2012 Way forward contd Distribution & sales of ART to designated private clinics and pharmacies thro’ MOUs Follow-up request to NZPplus & ZNAN to access ART

    16. 26/09/2012 Way forward contd 2. Develop & implement communication strategy Development of strategies from recommendations of partners meeting on CSC held on 31st March –2nd April 04 Develop & Disseminate ART IEC materials including treatment literacy

    17. 26/09/2012 Way forward contd 3. Dev. MTCT plus guidelines, pocket size HIV guidelines 4.Finalize M& E tool (M&E TWG NAC) and operationalise computerised patient records

    18. 26/09/2012 Way forward contd 5 conduct operation research Contd Resistance tracking(UTH-Virology) Adherence studies -community based DOTs & HAART -community education & referral;supporting adherence to ART & prevention for PLWHA

    19. 26/09/2012 Way forward contd 6 Disseminate cost sharing guide 7 Approval of finalized implementation plan and Policy operational guidelines

    20. 26/09/2012 ART SCALE UP IMPLEMENTATION PLAN

    21. 26/09/2012 Scaling up ARV Therapy From 10,000 to 100,000 PLWHA Of the estimated 900,000 PLWHA in Zambia, between 150,000 to 250,000 required to be on HAART. Thus the current programme will only provide HAART to approx 10% of patients requiring HAART.

    22. 26/09/2012 Scaling up ARV Therapy From 10,000 to 100,000 PLWHA Zambia has embraced the global 3 by 5 target, that aims to have 3 million people worldwide on antiretroviral treatment by the end of the year 2005.

    23. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan The goal of scaling-up ART is to provide universal access to treatment for all people in Zambia who need it. The immediate target is to put 100,000 people in Zambia on antiretroviral treatment by the end of 2005.

    24. 26/09/2012 Strategic Objectives an Activities Under the Implementation Plan Objective # 1 Develop a conducive supportive environment to rapid ART scale-up Activities Enabling policy/legal environment Dev public-private partnership

    25. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 2 Expand provision of ART services in all sectors in Zambia. Activities Expand identification of people advanced HIV infection. Identification and assessment of new ART sites. Build capacity of health facilities to deliver ART.

    26. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Develop/update ART guidelines & protocols Certify ART delivery centres. Provision ART by all certified ART centres.

    27. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 3 Dev national HR capacity to deliver ART Activities Put in place national HR plan Produce new health professional graduates competent in ART delivery

    28. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Provide practising health professionals with competencies ART delivery. Training of trainers. Training for ART Teams. Training for specific areas. Training for communities Train non health agents to support ART delivery Recruit, motivate &retain health care providers.

    29. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan motivate &retain non health agents Promote public-private partnership

    30. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 4 Strenghen infrastructure & laboratory capacity for ART scale-up. Activities Draft national minimum standards for infrastructure, lab pharmacy& imaging facilities Refurbishment/upgrading to meet national min standards  

    31. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 5 Strengthen the role of communities in provision of ART. Activities Develop national ART communication strategy Conduct Treatment Awareness Education Provide input ART into anti-stgma activities.

    32. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Support media to adequately address ART issues. Provide tools for districts to suport ART capacity for community support groups

    33. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 6 Strengthen ART procurement, storage & distribution Activities. Strengthen ART drugs & medical supplies logistic management ststems. Ensure availability of food for indigent patients starting ART

    34. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Ensure a continuous availability & Quality of ARV drugs and other supplies. Ensure rational use of AIDS drugs & medicines

    35. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 7 Strengthen ART program monitoring, evaluation & research Activities Institute national M&E for ART Put in place national ARV drug resistance surveillance system

    36. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Carry out operational research to guide ART scale-up Adherence Tracking emergence HIV drug resistance strains & minimising emergency Role of DOT for ART Health outcome & quality of life

    37. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Objective # 8 Strengthen programme management, coordination & resource mobilisation. Activities Strengthen coordination & supervision of national ART program .

    38. 26/09/2012 Strategic Objectives and Activities Under the Implementation Plan Utilise TA of CPs for information collection on areas of comparative needs & advantage, database of partner mandates & technical specialisation Mobilize adequate resources for ART scale-up

    39. 26/09/2012 Implementation Plan 2004 to 2005 Implementation of the plan will begin in early 2004 with the official launching of the programme. The first quarter of 2004 will be devoted to finalizing guidelines and developing the various systems required for the programme.

    40. 26/09/2012 Implementation Plan 2004 to 2005 The second quarter will be for initiating training activities, equipping facilities, mobilizing communities and opening new ART centres. The third and fourth quarters will focus on strengthening recruitments to ensure that centres are operating at full capacity. In 2005, the focus will be on increasing the number of ART sites and the numbers of people using them.

    41. 26/09/2012 THANK YOU FOR LISTENING

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