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Current Status of ARTCurrent Status of ARTOpportunities & Opportunities &

ChallengesChallenges

Kibrebeal Melaku,MDKibrebeal Melaku,MDAssociate Professor of MedicineAssociate Professor of Medicine

December, 2005December, 2005


Current Status of ART in Ethiopia: Current Status of ART in Ethiopia: Opportunities & ChallengesOpportunities & Challenges

Ethiopia is one of sub-Saharan countries hard hit by the HIV pandemic. Ethiopia is one of sub-Saharan countries hard hit by the HIV pandemic. According to the 2005 projection of Federal Ministry of Health’s Fifth According to the 2005 projection of Federal Ministry of Health’s Fifth reports of “AIDS in Ethiopia”, the HIV national adult prevalence rate is reports of “AIDS in Ethiopia”, the HIV national adult prevalence rate is estimated to be 4.7%, of which 12.5% are urban and 3.0% rural. The estimated to be 4.7%, of which 12.5% are urban and 3.0% rural. The cumulative number of people living with HIV/AIDS is about 1.7 million out of cumulative number of people living with HIV/AIDS is about 1.7 million out of which more than 286,200 are AIDS cases in need of ART. How ever it is which more than 286,200 are AIDS cases in need of ART. How ever it is quite disturbing to note that there is still a huge gap between the number of quite disturbing to note that there is still a huge gap between the number of patients eligible for ARV with the number of patients who are currently patients eligible for ARV with the number of patients who are currently receiving HAART (286,200 Vs 21,200).receiving HAART (286,200 Vs 21,200).

The Ethiopian government adapted the policy of ARV drug supply and use The Ethiopian government adapted the policy of ARV drug supply and use for the first time in July 2003.Such move paves the way for more initiatives for the first time in July 2003.Such move paves the way for more initiatives towards facilitating access to free and low cost ARV drugs. Subsequently towards facilitating access to free and low cost ARV drugs. Subsequently the government launched the free ARV treatment initiative in January the government launched the free ARV treatment initiative in January 2005,which has given access to significant number of patients in a very 2005,which has given access to significant number of patients in a very short period of time.short period of time.

In the following section, we will further discuss the current situation of ART In the following section, we will further discuss the current situation of ART in Ethiopia. The existing challenges and the available opportunities to scale in Ethiopia. The existing challenges and the available opportunities to scale up and expand the ART program will be discussed as well in depth.up and expand the ART program will be discussed as well in depth.


ObjectivesObjectives

Provide an overview on the Current Provide an overview on the Current Status of ART Implementation in Status of ART Implementation in EthiopiaEthiopia

To discuss on Opportunities and To discuss on Opportunities and Challenges on implementing ART in Challenges on implementing ART in EthiopiaEthiopia


Administrative DivisionAdministrative Division


AIDS in Ethiopia, Fifth AIDS in Ethiopia, Fifth EditionEdition

Number of adult PLWHA in 2003.......... 1.5 millionNumber of adult PLWHA in 2003.......... 1.5 million

Number of adult PLWHA in 2004......... 1.6 millionNumber of adult PLWHA in 2004......... 1.6 million

People eligible for ARV drugs People eligible for ARV drugs

In 2004…… …………….... 265,358In 2004…… …………….... 265,358


Ethiopia’s ResponseEthiopia’s Response Developed ART Policies and ARV guidelinesDeveloped ART Policies and ARV guidelines Trained ART providers (Trained ART providers (~ 800).~ 800). Launched ART program (July 2003)Launched ART program (July 2003) Physician-centered, Out-of pocket basis.Physician-centered, Out-of pocket basis. Currently: Currently: ~~ 21,200 21,200 patients are on ARTpatients are on ART

((~ 6,200 – Free)~ 6,200 – Free)

((Fee based - 15,000)Fee based - 15,000) In 35 (25 public, 10 private) hospitals In 35 (25 public, 10 private) hospitals In 7 regionsIn 7 regions

Total PLWHA are on ARTTotal PLWHA are on ART


National ConsensusNational Consensus Strengthen and expand the National ART ProgramStrengthen and expand the National ART Program

Goal:Goal: Implement Implement safe, effectivesafe, effective, equitable and , equitable and accessible ART program while strengthening the accessible ART program while strengthening the health care systemhealth care system

Scaling-up efforts will be coordinated and Scaling-up efforts will be coordinated and integratedintegrated

Country partners: Country partners: MOH, HAPCO, DACA, EHNRI, AAUMOH, HAPCO, DACA, EHNRI, AAU

Regional Health Bureaus, Private sector, Media, FacilitiesRegional Health Bureaus, Private sector, Media, Facilities

Supported by USG partners, UN, WHO, Others.Supported by USG partners, UN, WHO, Others.


ART Rollout PlanART Rollout Plan

PHASED ApproachPHASED Approach FY ’ 04 - 05: FY ’ 04 - 05:

Free ART will be started in 20 HospitalsFree ART will be started in 20 Hospitals Then will be expanded to Then will be expanded to 50 hospitals 50 hospitals

FY’05 – ‘08:FY’05 – ‘08: 126 hospitals126 hospitals


ART ART

OpportunitiesChallenges


ChallengesChallengesTechnical & ProgrammaticTechnical & Programmatic



Weak health systems Weak health systems

Competing National priorities on Competing National priorities on financial resources financial resources

Stigma - serious challengeStigma - serious challenge

Supply Vs Demand - EligibilitySupply Vs Demand - Eligibility


ChallengesChallenges Human resources:Human resources:

MD, HO, RN, Pharmacy. P., Laboratory P.MD, HO, RN, Pharmacy. P., Laboratory P. Training – StandardizationTraining – Standardization

Infrastructure:Infrastructure:– Space, esp. pharmacySpace, esp. pharmacy

Lab equipment and supplyLab equipment and supply

Systems: HMIS, QC/QASystems: HMIS, QC/QA



ProcessesProcesses Standardization – Services, TrainingsStandardization – Services, Trainings Integration - CoordinationIntegration - Coordination Ownership: National, Regional, FacilityOwnership: National, Regional, Facility Strengthen Referral LinkagesStrengthen Referral Linkages

Mechanisms of Procurement, Mechanisms of Procurement, Storage & DistributionStorage & Distribution

– Assuring uninterrupted supplyAssuring uninterrupted supply



Long term Mx of Chronic Infection:Long term Mx of Chronic Infection: Practice Set-upPractice Set-up Monitoring Safety & EfficacyMonitoring Safety & Efficacy Adherence - RESISTANCEAdherence - RESISTANCE

““Site Readiness – Minimum Package”Site Readiness – Minimum Package”

““Accreditation”Accreditation”

Sustainability - AIDS FundSustainability - AIDS Fund


OpportunitiesOpportunities



1. National Commitment1. National Commitment Strategic Plan & ManagementStrategic Plan & Management ARV Policy, ARV GuidelinesARV Policy, ARV Guidelines ART Implementation GuidelineART Implementation Guideline

Provision of Safe & effective ART.Provision of Safe & effective ART. Capacity BuildingCapacity Building

Strengthen the health care delivery systemStrengthen the health care delivery system



2- Access to care/ART2- Access to care/ART::

Negotiations with the pharmaceuticalsNegotiations with the pharmaceuticals

Local Generic drug productionLocal Generic drug production



3- 3- Global initiatives and opportunities:Global initiatives and opportunities:

PEPFAR [ETAEP]PEPFAR [ETAEP] GFATM GFATM World BankWorld Bank OthersOthers


PEPFAR TargetsPEPFAR Targets

TreatTreat more than more than 2 million2 million with HAART with HAART

Prevent 7 millionPrevent 7 million New Infections New Infections

Care Care forfor 10 million10 million HIV-infected persons HIV-infected persons and those orphaned by HIVand those orphaned by HIV

2 - 7 - 102 - 7 - 10


PEPFAR Five Year Country PEPFAR Five Year Country Goals: ETHIOPIAGoals: ETHIOPIA

Total # NewHIV Infections

Averted

Total # HIV+Patients

Under Care

HIV+ PersonsReceiving ARV

700,000 1,050,000 210,000


PEPFAR/ETAEP SupportPEPFAR/ETAEP Support

Target: 15,000 patients on ART first Target: 15,000 patients on ART first yearyear

20 hospitals20 hospitals

80 health centers80 health centers


Global Fund (GFATM) Global Fund (GFATM) SupportSupport

Target: 20,000 patients first yearTarget: 20,000 patients first year

20 – 30 hospitals20 – 30 hospitals

90 health centers90 health centers


Other ART ProgramsOther ART Programs

MSF HollandMSF Holland ENAHPAENAHPA Red CrossRed Cross RATSONRATSON


Ingredients for Successful Ingredients for Successful ART ProgramART Program

Individual commitment to fight HIV Individual commitment to fight HIV Total health professional commitment to Total health professional commitment to

treat HIV/AIDStreat HIV/AIDS National commitment to curb the raging National commitment to curb the raging

epidemic for the collective goodepidemic for the collective good Political will to commit resources & Political will to commit resources &

effortsefforts Collective commitment to take care of Collective commitment to take care of

people with HIV/AIDS with sensitivity people with HIV/AIDS with sensitivity and dignityand dignity


ART ART

Challenges

Opportunities


Then Power of ART will be Then Power of ART will be Realized!Realized!

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