access to care and treatment for plwha rc/rc service delivery model

Access to care and treatment for PLWHA

RC/RC service delivery model

International Federation of Red Cross and Red Crescent Societies

Objectives of the mission

The objectives are to : assess capacity, major gaps and

opportunities get insight on the political commitment and

level of preparation develop Federation service delivery model

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Countries visited

EGYPTLIBYAALGERIA

MOROCCO

NIGERMAURITANIA

WESTERNSAHARA

MALI

CHADSUDAN

ZAIRE

ANGOLA

NAMIBIA

SOUTHAFRICA

BOTSWANA

ETHIOPIA

SOMALIA

NIGERIAGUINEA

TUNISIA

ERITREA

CENTRALAFRICAN REPUBLIC

MADAGASCAR

TANZANIA

GABON

BURKINA

GHANA

COTED'IVOIRE

ZAMBIA

ZIMBABWE

CAMEROON

TOGO

BENIN

UGANDAKENYA

MOZAMBIQUE

LESOTHO

SWAZILAND

CONGO

SENEGAL

THE GAMBIA

GUINEA-BISSAU

SIERRA-LEONE

LIBERIA

EQUATORIAL GUINEA

ANGOLA

RWANDABURUNDI

MALAWI

DJIBOUTI

Criteria for selection of countries:

NS experience in HIV/AIDS related programmes particularly HBC

Burden of HIV/AIDS Ongoing ART initiatives by government

or other organizations Demonstrated government commitment Ongoing ART programmes by RC (Congo)

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Method used in the study

Combination of empirical (observational)and examination of documents conducted through :

Organizing visits to selected organizations and dialogue with key informants (>100)

Collection of pertinent information from organizations using pre-designed format

Site visits to ART pilot areas

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Conclusion

Governments are strongly on the move for provision of ARVs

ART implementation in resource-limited countries is feasible

RC/RC NSs are well placed to collaborate in ART provision

The biggest constraint is funding at community level

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Framework of service delivery model

Multiple intervention vital for successful ART

Nutritional support vital Community preparedness and

treatment literacy

Core elements shaping the model/approach include:

a) Holistic approach

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Framework of service delivery model- continue

b) Continuum of care: Systematic linkage of services from

hospitals to home and vice versa ART must be integral part of continuum of

care, treatment and prevention

c) Phased approach: Gradual expansion VCT – PMTCT/ART

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Framework of service delivery model -continue

d) Use of existing structure –government/ private: Base on existing technical competence Consider long term management

e) Partnership: Need of multisectoral approach (food, IEC, counselling etc.) Magnitude of the problem Concerted effort

f) NS niche: Define entry point based on competence and experience

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g) Focus on vulnerable groups: Target the marginalized ones / poor Include RC/RC NS operation site

h) Advocacy: Universal access Urgency, replacement feeding, PMTCT- plus etc. Sustainable funding, price reduction

i) Resource mobilization: Federation Secretariat & NSs need to exert maximum effort Need for designing innovative approach

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j) Capacity building: Effective intervention and expansion requires capacity It is an ongoing process focusing at all levels

k) Sustainability: Implies continuous resource mobilization Managerial efficiency- drug distribution

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Critical components of effective ART intervention a) Foundation:

Community preparation & treatment literacyVCT – Increased sites and accessible Affordability – proximity, minimize financial barrier

b) Psychological support:Increased number of counsellors neededUse professional counsellors and trained volunteers – lay counsellors

c) Prevention (IEC, protective means):PLWHA and all community members need IECApply peer education, information campaign, mass media, formal

education

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Critical components of effective ART intervention - continue

d) Food security and nutrition: Short term–food parcel for PLWA & family members Education on proper diet Medium term – Agricultural inputs for rural and semi-

urban . Mobilize community support

e) Other support: Provision of potable water-helps replacement feeding too Environmental sanitation Support to OVC (schooling, nutrition, legal support)

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f) PMTCT and PMTCT-plus: Education and sensitization Counselling ART – preventive and HAART Monitor adherence

g) Clinical management - ART and OIs: DX and clinical management as per protocol (country /WHO) Patient selection - clinical and social criteria, committee Simplification of ART regimen – standardization, fixed

combination, involve mid level HCWs

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h) Promotion of adherence to ART:

Minimize pill count – triple combination Family support DOTS approach Nutritional support Community support- destigmatization, peer support Patient education

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j) Drug procurement and distributionDrug selectionSuppliers selectionQuality controlDistribution and rational use of drugs

N/B The procurement of drugs will be done using the already Existing government approved system.

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Federation care and treatment service delivery model

PLWHAFamily

members

HBC, Peer education & wat/ san• Community education- treatment literacy• Anti stigma campaign & preventive measures• Mobilize community support for PLWHA• Support adherence to ART• Food support to PLWHA & family members• Provision of other support: water, OVC etc.

RC providesARVs & OI drugs& infrastructureupgradingSupport toMOH

VCTPMTCT

Testing CounsellingServices

VCTPMTCT

• ART Adherence Monitoring• Patient referral• PMTCT plus

CLINICALMANAGEMENT

• Laboratory service• Diagnosis, care and treatment• Patient follow up• Counselling

RC supportsVCT & PMTCTin testing & counsellingby collaborating withNGO running testingservices

NSs involvement in comprehensive ART intervention

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Role of agencies in holistic ART interventions

IECCommunitytreatmentliteracy

VCTPMTCTAdvocacy

Diagnosis

and

TreatmentART &OIs

Adherence Monitoring

Home based care

Nutritional supporl

Support to OVC

Education families+ patients

Patientselection

Lab. TestVCT

DrugSupply

RC/NSs

NGOsCBOs

PLWHA

M.O.H.Church-WHO/CDCMedical NGO

CHURCHPLWHA organizationsGovn./ authorities

CBOs

RC/NSs

COMMUNITY MOBILIZATION CLINICAL CARE FOLLOW-UP AND SUPPORT

MOH

MOHNGO-medicalRC/NSs

COMMITTEE:-MOH-- PLWHA-- Community

representative


RC/NS running Medical centres

Role of agencies in holistic ART interventions

IECCommunitytreatmentliteracy

VCTPMTCTAdvocacy

Diagnosis

and

TreatmentART &OIs

Adherence Monitoring

Home based care

Nutritional supporl

Support to OVC

Education families+ patients

Patientselection

Lab. TestVCT

DrugSupply

RC/NSs

NGOsCBOs

PLWHA

M.O.H.Church-WHO/CDCMedical NGO

CHURCHPLWHA organizationsGovn./ authorities

CBOs

RC/NSs

COMMUNITY MOBILIZATION CLINICAL CARE FOLLOW-UP AND SUPPORT

MOH


COMMITTEE:-MOH-- PLWHA-- Community

representative


RC/NS running Medical centres

Elements to be considered in programme management

Put in place sound management structure that expedites efficiency. Some aspects to consider include:

a) Coordination : Involve stakeholders from planning to implementation Establish smooth information exchange mechanism Establish small coordination committee

b) Financial administration: Put in place a system that promote transparency and

accountability21

Elements to be considered in programme management continue

c) Reporting: User friendly format that captures relevant information Regularity in reporting based on agreed frequency

d) Monitoring and evaluation: Define process, output and impact indicators Strong monitoring mechanism needs to be in place Mid term evaluation after 2 years and final end 5years

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Elements to be considered in programme management continue

e) Institutional arrangement

Well defined collaborative arrangement is vital; thus the need for MOU which captures:

Areas of responsibility Division of task- areas of implementation Information exchange mechanism Target population Mechanism for expediting collaborative efforts i.e.

committee, etc.

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access to care and treatment for plwha rc/rc service delivery model

Documents

effective intervention

community level

counsellors c prevention

ns experience

prevention c phased

community members

federation secretariat

resourcelimited countries