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Public-Private Partnerships in ART Patient Management – A Down Referral Model in South Africa

Public-Private Partnerships in ART Patient Management – A Down Referral Model in South Africa. Authors: Shuabe Rajap, John Sargent, Ernest Darkoh, Wendy Townsend, Ebrahim Variava IAS Conference 2010 Vienna, Austria. BroadReach Healthcare Park Lane Office Park

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Public-Private Partnerships in ART Patient Management – A Down Referral Model in South Africa

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  1. Public-Private Partnerships in ART Patient Management – A Down Referral Model in South Africa Authors: Shuabe Rajap, John Sargent, Ernest Darkoh, Wendy Townsend, EbrahimVariava IAS Conference 2010 Vienna, Austria BroadReach Healthcare Park Lane Office Park Block B, Lobby 1, First Floor cnr Alexandra Road & Park Lane Pinelands, 7405 Cape Town South Africa

  2. Health Systems Strengthening Operational Re-engineering Leadership and Management Training Clinical Outcomes, Resource Utilization & Disease Management Patient Education and Community Mobilization Public Private Partnerships Strategic Consulting Services Distribution Networks Procurement and Distribution Management Services Last Mile Distribution Services at Point of Care 3 1 2 4 5 Overview of BroadReach Healthcare Key Service Offerings Countries & Regional Experience • Botswana • Burkina Faso • Caribbean • China • Ethiopia • India • Kenya • Mozambique • Namibia • Nigeria • South Africa • Tanzania • Vietnam

  3. Introduction Public health facilities overburdened – HIV Prevalence rate (16.9%) BroadReach Healthcare and North West Department of Health introduced a public-private partnership that engages Private Practitioners to meet the demand for HIV services Financing PEPFAR funding • Overall program management • Overall financial management including paying GPs consultation fees • Monitoring, Evaluation & Reporting • GP and patient training Management BRHC & NW DoH Memorandum of Understanding signed in 2005 • Doctor Network • Monthly HIV care and Clinical monitoring • Refer patients for complications, OIs, antenatal care, regimen changes to Hospital • Distribute ARVs dispensed by Hospital • Initiates patients on ART, Down refers stable patients • Provides care for referred patients • Pharmacy procures and distributes ARVs to GP practices • Lab monitoring by NHLS Private General Practitioners (PP) Klerksdorp-Tshepong Hospital

  4. Results and Conclusion Results • Between November 2005 and December 2009, 1695 patients were down-referred to PPs • A total of 1349 patients are active on Down Referral Program • After 12 months on the program, an average of 92.5% (979/1058) of patients reported an undetectable viral load • The program has proven highly effective with a patient retention rate of 96% • A total of 290 patients transferred out of the program back to the public hospital for management of pregnancy, TB co-infection or complications • A total of 12 patients (0.7%) were lost to follow up • A total of 39 patients died and 5 defaulted on their treatment Conclusion • Utilization of private sector as “care extenders” can greatly improve the capacity of governments to deliver HIV/AIDS care and treatment in a cost effective manner with outstanding clinical outcomes • Average costs on the DR program is higher but has proven to be much more cost effective than the public sector down-referral model based on a study by Dr. Peter Navario • Patient retention rate on the DR program is high (96%)

  5. Lessons Learned Program success depends on: • Commitment by both Government and Private GPs to mitigate the impact of HIV and relieve burden on public healthcare resources • Clear understanding and agreement of each stakeholder’s roles and responsibilities, memorialized in a legal document such as a Memorandum of Understanding • Strong clinical outcomes monitoring system • On-going capacity building of PPs • Clear cost sharing mechanisms and use of public and private healthcare resources

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