Philippe Chiliade, MD, MHA

Technical Advisor, Clinical Care, FHI

12 August 2008

Family Health International

Implementing HIV Care & Treatment

Progress to date and future plans

Overview

• Adult and pediatric ART scale-up data

• Expansion to PHC

• Task shifting approaches

• Chronic care model & primary health care

• FHI Children’s Initiative

• MARPs in Sub-Saharan Africa

Background

• FHI supports ART programs in 11 countries

• Funding support:

- Mainly USG (USAID, CDC)

- GFATM

- Private sector

Adult & pediatric ART scale up

page 4 in bulletin

Patients on Anti-Retroviral Therapy

21471 25205 24894

42945 3803651415

71233

91391

122928134618

0

20000

40000

60000

80000

100000

120000

140000

160000

Oct 05 - Mar 06(13 Countries)

Apr 06 - Sep 06(14 Countries)

Oct 06 - Mar 07(14 Countries)

Arp 07 - Sep 07(13 Countries)

Oct 07 - Mar 08(13 Countries)

# of individuals NEWLY initiating ART during the reporting period

Total # of individuals receiving ART at the end of the reporting period

page 3 in bulletin

Cumulative Patients on Antiretroviral Therapy, by Ages 0-14 & 15+

3502 5328 7633 9999 10418

5518479731

112386135557

155681

0

20000

40000

60000

80000

100000

120000

140000

160000

Oct 05 - Mar 06(12 Countries)

Apr 06 - Sep 06(13 Countries)

Oct 06 - Mar 07(13 Countries)

Arp 07 - Sep 07(12 Countries)

Oct 07 - Mar 08(13 Countries)

# of individuals who EVER received ART by the end of the reporting period (includes PMTCT+) -cumulative clients, AGES 15 +# of individuals who EVER received ART by the end of the reporting period (includes PMTCT+) -cumulative clients, AGES 0-14

Expansion to PHC

• Decentralization of care from the district hospital (initiation of 1st line ART and ART care follow up at PHC, referral to district hospital for complex care, CD4 support at the district hospital lab)

• Mobile ART care team (ART care team from the district hospital delegated weekly to PHC)

• “HAST model” (integrated prevention and care programs for HIV/AIDS, STI, and TB at the PHC and community levels)

Task shifting

• Nurse ART providers pilot project (Rwanda)

- Trained and supervised nurses authorized to stage

HIV, start 1st line ART, and monitor uncomplicated care.

• Trained community volunteers as lay counselors, Adherence Support Workers and PMTCT motivators (Zambia)- Many of these community volunteers are PLWHA

Chronic Care Model Primary Health Care

HIV is a chronic disease that requires: – Patient health literacy– Patient active involvement in their care– Regular monitoring (retention) and strict adherence to

ARV treatment– Long-term management of complications of the HIV

disease and its treatment– On-going prevention with positive services– On-going assessment of FP, nutritional, and psycho-

social needsThis will require strengthening of Primary Health

Care Services

FHI Children’s Initiative• Comprehensive 5 year global commitment to reclaim a generation

of children- Rapidly expending treatment & prevention- Addressing social needs of children and families

• Areas of initial focus:- Working closely with communities and local, regional, and national authorities to develop leadership and ownership- Investing in HR (training, mentoring)- Mobilizing strategic partners- Increasing identification of HIV-infected children- Leveraging existing prevention, care, and treatment sites- Laying the groundwork to develop the empowered communities concept- Establishing targets / performance indicators-Identifying knowledge gaps

MARPS in SSA

Expending activities targeting MARPs

• MSM

• FSW and MSW

• IDU

• Mobile populations

• Displaced populations

• Incarcerated populations