achap symposium - international aids conference washington dc, usa 23 rd july 2012
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Partners in Innovation – Informing Botswana’s HIV/AIDS Response: Successes and Lessons Learned by the ACHAP Public Private Development Partnership (PPP). ACHAP Symposium - International AIDS Conference Washington DC, USA 23 rd July 2012. Presented by:Themba L Moeti. Presentation outline. - PowerPoint PPT PresentationTRANSCRIPT
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Partners in Innovation – Informing Botswana’s HIV/AIDS Response: Successes and Lessons Learned by the ACHAP Public
Private Development Partnership (PPP)
ACHAP Symposium - International AIDS ConferenceWashington DC, USA
23rd July 2012
Presented by: Themba L Moeti
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Presentation outline
• Some key facts about Botswana
• ACHAP ; The Partnership
• Achievements, lessons learnt
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Some key facts about Botswana
•Population – 2,038,228 (2011 Census)•Life expectancy – 54.4 years (67 years before HIV/AIDS)
•Persons living below the Poverty Datum line 20.7% in 2009/10; previously 30.3% in 2002/3 (CSO, 2011).
•25% population aged 15-49 years HIV+ (BAIS III 2008).•30.4% pregnant women aged 15-49 years HIV Positive.
•National HIV prevalence 17.6% (BAIS III 2008).•2011 HIV+ Population – 363,105 (Stover 2008).
Washington D.C., USA, 22-27 July 2012www.aids2012.org
African Comprehensive HIV/AIDS Partnerships (ACHAP)
• Public-private development partnership: Govt of Botswana, Bill & Melinda Gates Foundation and Merck/The Merck Company Foundation. Established 2001– Country priorities inform strategic direction – Private sector resources leverage government efforts: greater impact,
fill capacity or /resource gaps– ACHAP financial, technical, human resources, infrastructure, and
logistical support– Catalyze interventions, innovative solutions to program challenges– Equal partnership: Govt strategy & policy guidance, in kind contribution – Consultative approach, agreed governance structure; mutually agreed
priorities
Washington D.C., USA, 22-27 July 2012www.aids2012.org
A strategic Partnership: – Key HIV Challenges 2001• 36.2% of pregnant women aged 15–49 HIV+. • No public sector treatment programme• Access to less than 5% in need • AIDS leading mortality cause: 4 fold increase over 10 yrs in
adults• Predicted decrease in economic growth; 24–38% by 2021
(BIDPA 2000) • Profound impact on deaths among young people: access to
treatment an urgent priority; major gap in response – major questions on operational feasibility, affordability, sustainability – external development assistance greatly reduced with middle income
status• Public private partnership important opportunity for national HIV/AIDS
response and helping sustain development gains
Washington D.C., USA, 22-27 July 2012www.aids2012.org
ACHIEVEMENTS: Impact of Treatment Program 2002 - 2011
By end 2011; • Total of 178,684 patients on
treatment (95% needing ART) • Treatment available in every district;
– 32 main ART sites – 212 satellite dispensing clinics
• Mortality – halved in 5 years; > 53,000 deaths averted 2002 – 2007*
• High treatment adherence > 90%• Decentralisation of lab diagnostic
and monitoring capacity:• High treatment coverage
contributing to reduction in HIV transmission (052)
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
Total patients on ART by year and need for ART
Adult Need for ARTReceiving ART
MOH Program data and NACA 2008* : HIV/AIDS in Botswana: Estimated Trends and Implications Based on Surveillance and Modeling
Washington D.C., USA, 22-27 July 2012www.aids2012.org
ARV Programme capacity development and health systems strengthening
Training – (Partnership: ACHAP, BHP, MOH)
• Preceptorship & KITSO AIDS Training Program • > 8000 health workers and >1600 lay personnel:
private and public sector• Training; now mainly by locally based personnelInfrastructure: 35 Infectious disease care
clinicsHuman resource support > 250 HCW in
various disciplines: doctors, nurses, lab, pharmacy, counsellors
• Treatment rolled out to 32 hospitals, catalysed roll out to > 200 primary care facilities, all districts
• > 75% of positions supported absorbed into govt establishment
Nurses
& Nurse M
idwive
s
Doctors
Pharm
acists
& Pharm
acy Tech
Social W
orkers
Lab T
echnic
ians
Others
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%
AIDS Clinical Care Fundamentals Training Breakdown
Charles Hill Satellite Clinic 2008
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Prevention Benefits of Improving Access to HIV Testing and Counseling
•MTCT rate reduced from > 30% to less than 4%
33
25
7 6
76.7
92.095.0
0
10
20
30
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1995
1996
1997
1998
1999
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2002
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2004
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2006
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2008
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2010
2011
2012
2013
2014
2015
MTCT rate
PMTCT Coverage
Estimate (%) of HIV+ women receiving ART for PMTCT
Source: Botswana HIV Prevention Modes of Transmission Analysis: NACA 2010
Prior 2004, slow treatment & PMTCT uptake•Issues; stigma, counselling capacity, •Routine HIV testing policy discussion 2003, introduction Jan 2004. •Positive advocacy for policy, test kit provision, (govt and NGOs) data management support, early infant diagnosis•Training & support lay counsellors for PMTCT
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Catalytic support for Blood Safety & Youth HIV Prevention
• High HIV prevalence - challenges meeting blood requirement.• Support provided to national blood service 2003 – 2007 to
improve safety of blood supply.• Unique youth HIV prevention programme “Pledge 25” to 2009.• Collaboration with Safe Blood for Africa & MOH
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Num
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Blood Collected and HIV Trends (1997 - 2006
Blood collectedHIV Prevalelnce
• Blood donations increased 78%
• Discard rate due to TTI and HIV infection reduced from 11.8% 2003 to 2.5% 2010
Washington D.C., USA, 22-27 July 2012www.aids2012.org
TB/HIV Co-Epidemics Trends in Botswana (1997-2008)
19901992
19941996
19982000
20022004
20062008
0100200300400500600700
0510152025303540
TB notification rates
HIV prevalence %TB incidence
Time (Years)
TB N
otific
ation
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HIV
prev
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preg
nant
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19971998
19992000
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20052006
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80
100
120
42
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3946
TB mortality rate
Year
Mor
talit
y ra
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00 p
op
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Support for Broader National HIV Response
• Development of the National Strategic Frameworks (2003-2009, and 2010 - 2016) (NSF)
• HR support to address critical shortage of skilled staff; • Prevention Support:
– HIV testing and counseling capacity development & support– Support to NGOs working in prevention: HR, logistics, programming
and infrastructure support– Safe Male Circumcision
• TB/HIV• BCC capacity dev; MOH, NACA, BCC strategic plan
support; • Research, Monitoring and Evaluation Support
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Scaling up effective prevention interventions: Safe Male circumcision
• Policy discussion & advocacy 2007• Decision to implement 2008• 2008: Collaboration with Futures Institute
on “Cost and impact of Male circumcision in Botswana”• Modelling predicted circumcising 80%
of eligible men by 2012 could avert 70,000 new infections by 2025 at a cost of US$689 per HIV infection avert
• could avert 60,000 new infections with target year of 2015
• Programme launched April 2009
*Bolinger et al; The cost and impact of male circumcision on HIV/AIDS in Botswana JIAS 2009
• Support ACHAP, CDC/PEPFAR & implementing partners
• Approx 42 000 SMC’s to date
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Lessons Learnt • SMC: a programme with great promise; challenging to implement
• demand creation, complex interplay socio-cultural challenges and opportunities
• Scale up in sparsely populated setting • Each setting unique: challenges & solutions• Key lessons learnt past two years • On threshold of testing of promising SMC devices e.g. PrePex
• Treatment: major success of country response and partnership• Saved a generation; averted impending development disaster• Development significance appreciated – macro level to “man in the street” • Important prevention investment• Sustainability challenges • Looking forward; innovating to optimise access: Point of Care CD4, Viral
load testing, linkage to care and prevention programmes