dr sam phiri: hiv and aids situation in malawi
DESCRIPTION
7th September 2011GCL: The Prevention and Management of HIV and AIDS in Scotland and MalawiTRANSCRIPT
HIV and AIDS Situation in Malawi: Towards Universal
Access
Dr Sam Phiri
Executive Director
Lighthouse Trust
Global Community Links
Presentation outline
•HIV situation and national
response
•ART program
•The Lighthouse Initiative
•Challenges
Global Community Links
HIV and AIDS Situation In Malawi •Current statistics:
– Population – 13 Million – 12% HIV prevalence among 15-49 years – 1.6% HIV Incidence – 900, 000 people living with HIV/AIDS
•Impact of AIDS: – About 70,000 adult and child deaths annually – 700,000 orphans directly related to AIDS
•HIV Prevalence in most at risk populations – FSW – 70.7% (2006) – MSM – 21.4% (2009)
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HIV Prevalence by Age
• Content
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17.10% 15.30%
19.00%
11.30%
13.80%12.30%
8.00%
0.00%2.00%
4.00%6.00%8.00%
10.00%
12.00%14.00%16.00%
18.00%20.00%
Less than 15
15 - 19
15 - 24
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45+
HIV Prevalence by Education
• Content
Global Community Links
14.9%16.6%
15.5%
13.9% 14.2%
17.5%
0.0%2.0%4.0%6.0%8.0%
10.0%12.0%14.0%16.0%18.0%20.0%
Non
e
Std
1 -
5
Std
6 -
8
Form
1 -
2
Form
3 -
4
Pos
t sec
onda
ry
HIV Prevalence by Marital Status
• Content
Global Community Links
17.30%
13.30%14.80%
32.60%
42.90%
22.60%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Single Cohabiting Married Divorced Widowed Separated
National HIV Prevalence by
Year
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18.5
16.9 17
1513.5
0
5
10
15
20
1998 2001 2003 2005 2007
% P
revale
nce
Malawi Median
HIV Prevalence by Locality
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11.2 10.7
14.513 12.3
20.9 21.1 20.8
17
15
25.3
22.521.7
20.4
17.6
0
5
10
15
20
25
30
1998 2001 2003 2005 2007
% p
revale
nce
Rural
Semi-Urban
Urban
Prevalence trends in 15-19 and 15-24 age groups
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14.315.2
10.39.5
19.118.3
14.3
12.3
0
5
10
15
20
25
1998 2003 2005 2007
% P
reva
lence
15 - 19
15 - 24
Malawi National HIV and
AIDS Response
• Prevention and behaviour change
•Treatment, care and support
•Impact mitigation
•Mainstreaming and decentralisation
•Research, monitoring and evaluation
•Resource mobilisation and utilisation
– Main funding from Global Fund and other partners
•Policy and Partnerships
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ART Scale Up Plans (2004-2005) and (2006-2010) • Phased selection of facilities
•Free ART to HIV-positive eligible patients
•One first-line ART regimen only “Lamivudine + Stavudine + Nevirapine”
•“Push” system of ART supply to facilities
•Standardized system of monitoring/reporting
•Quarterly structured supervision
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Progress in cumulative
patients alive on ART in public and
private sector
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National outcomes (cumulative analysis) March 2011
•
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Number %
Enrolled to ART 365, 191
Alive on ART 264, 512 72
Dead 42, 549 12
Lost to Follow Up 66, 662 16
Stopped ART 1, 761 <1
Malawi’s response to new WHO
recommendations •Eligibility
– Stage 3 or 4 – CD4+ cell < 350 – PMTCT Option B+ - All pregnant and lactating HIV
infected women •Regimen •Tenofovir + Lamivudine + Efavirenz (TDF – 300 + 3TC 300 + EFV 600) single FDC •Challenge
– Round 10 application to Global fund not successful •Phased approach
– Maintain current regimen except • New pregnant and lactating women • New TB/HIV co-infected patients • First line alternative for severe lipodystrophy
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Challenges - Opportunities
•Slow behaviour change response
•Inadequate professional human resource
•Residual social and cultural practices
•Maintaining sustainable financial support
•Balancing HIV agenda with general health agenda
•Early mortality among patients initiated on ART
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Public Trust Initiative to complement Government
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Lighthouse Strategic Approach
Client-centered care based on 3-prong technical
approach:
•To expand high-quality, integrated HIV and AIDS
prevention, treatment, care and support services
•To promote innovative approaches for HIV
prevention, treatment, care and support through
program development, piloting, evaluation and
dissemination;
•To build and strengthen capacity for HIV and AIDS
treatment, care and support in Malawi.
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The Lighthouse Trust •Centre of Excellence for integrated continuum of HIV prevention, treatment, care and support •2 clinics: MPC and Lighthouse
1. HIV Testing and counselling including 31 HC in Lilongwe 2. ART service provision
• 10,000 patient visits/month • > 15,000 patients alive on ART • Integrated with TB, FP, STI, and PMTCT
3. Home- and community-based care 4. Capacity building
• National trainers in HTC, ART, palliative care • Supports MOH in Supervision, mentoring and coaching
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HIV Testing and Counseling
(HTC)
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HTC Services
Lighthouse urban HTC sites : – Lighthouse and Martin Preuss Centre clinics – Kamuzu Central Hospital medical wards, paediatric
wards, antenatal – STI clinic – Maula prison – Chinsapo
Rural health center outreach 31 rural Lilongwe HTC sites supported for HTC to ANC
mothers Increasing links to prevention of mother to child
transmission services
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HIV Testing and Counseling
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Total HTC client visits
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HTC Cummulative Encounters
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Jan-0
1
Jul-01
Jan-0
2
Jul-02
Jan-0
3
Jul-03
Jan-0
4
Jul-04
Jan-0
5
Jul-05
Jan-0
6
Jul-06
Jan-0
7
Jul-07
Jan-0
8
Jul-08
Jan-0
9
Jul-09
Jan-1
0
Jul-10
Jan-1
1
Jul-11
Cli
en
ts T
este
d
Clients Testing Positive Clients Testing Negative
The Lighthouse Clinic
A Specialist Clinic for
HIV and AIDS
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Clinic Registration
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Clinical Care •Free, public HIV/AIDS clinic
– 15,000 on ART by December 2010
– 56% female
– 91% on first line medications
– 9% children under 15 years
•Routine follow-up visits include:
– Regular appointments at intervals of 1, 2, or 3 months
– Diagnosis and treatment of opportunistic infections
– Initiation and maintenance of prophylactic therapy
– Referral to other services especially at KCH
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Clinical case review
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Lighthouse Trust cumulative outcomes: Q4, 2010
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Number % of ever enrolled
Ever enrolled in ART 24,590
Alive on ART 14,293 59%
Dead 1,771 7%
Defaulted 3,310 13%
Stopped ART 440 2%
Transferred-out 4,766 19%
Total Clinic Reviews
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0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Apr-
01
Nov-0
1
Jun-0
2
Jan-0
3
Aug-0
3
Mar-
04
Oct-
04
May-0
5
Dec-0
5
Jul-06
Feb-0
7
Sep-0
7
Apr-
08
Nov-0
8
Jun-0
9
Jan-1
0
Aug-1
0
Mar-
11
Clin
ic C
lien
t V
isits
New Patients
Follow-ups
Lighthouse Centre
Opens
Free
ARVs
Limits
Imposed
MPC Opened
Electronic Data Management •Lighthouse and MPC implemented a real-time electronic data system (EDS) in 2005 •Collection of patient level information on all ART patients
– Registration, vitals, nurse visits, clinical care, and dispensing records
•Uses touch screen technology •Label scanners and printers facilitate easier monitoring and supervision for blood samples and drug dispensing. •Near completeness of patient level data from 2006 onward. •All patient EDS data is accessed through an Access database for effective monitoring and evaluation
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The Lighthouse Community Home Based Care
Quality Care at Home
for the Chronically Sick
in Lilongwe City
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Home based care (HBC) program
•Leader in promotion of Palliative Care
– End of life care for terminal and dying patients
•Works through existing community groups to encourage ownership and sustainability
•Patients identified through:
– Lighthouse or MPC referral
– Community volunteers
– Local hospitals
•Dedicated, well-trained community nurses provide quality care
– 150 patients, on average, per month
– Patients receive 2 nurse visits/week for medication and follow-up
– Patients receive visits from community volunteers for psycho-social support
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Community Home Based Care
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Total Ndife Amodzi client uptake
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Ndife Amodzi
0
1000
2000
3000
4000
5000
6000
7000N
ov-0
5
Feb-0
6
May-0
6
Aug-0
6
Nov-0
6
Feb-0
7
May-0
7
Aug-0
7
Nov-0
7
Feb-0
8
May-0
8
Aug-0
8
Nov-0
8
Feb-0
9
May-0
9
Aug-0
9
Nov-0
9
Feb-1
0
May-1
0
Aug-1
0
Nov-1
0
Feb-1
1
May-1
1
Clie
nts
Re
gis
tere
d
HBC CV LH LHMPC (Bottom) HC Other
Capacity Building Role
•MoH certified Training Courses:
– ART, HTC, and palliative care
– Over 1,000 clinicians and nurses trained in ART provision
•Provides clinical attachment for ART & HTC
•National supervision teams for HTC and ART
•Mentoring for new ART/HTC sites
•Leader in national policy development and piloting
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Challenges…
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Space challenges in clinic reception
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Lighthouse challenges •Balancing service quality with overwhelming demand
•Balancing service delivery with capacity building
•Balancing service delivery with operational research
•Maintaining high community volunteer retention
•Financial support for human resource
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A cross section of the Lighthouse Team
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•
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