fhi’s global art program: today's snapshot and tomorrow's vision 10 august 2010
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8 th Annual Track 1.0 ART Meeting. FHI’s Global ART Program: Today's snapshot and tomorrow's vision 10 August 2010. Kwasi Torpey, MD, PhD, MPH Regional Senior Technical Advisor, FHI. Part 1: Today’s Snapshot Overview of FHI’s Global ART Program. Provision of ART in 14 countries - PowerPoint PPT PresentationTRANSCRIPT
FHI’s Global ART Program:Today's snapshot and tomorrow's vision
10 August 2010
Kwasi Torpey, MD, PhD, MPHRegional Senior Technical Advisor, FHI
8th Annual Track 1.0 ART Meeting
Part 1: Today’s SnapshotOverview of FHI’s Global ART Program
• Provision of ART in 14 countries – across Asia, Africa and the Caribbean
• 322,586 patients currently on ART as of March 2010; of those:– 102,164 (31.7%) are in Zambia– 101,700 (31.5%) are in Nigeria– 23,245 (7.2%) are less than 15 yrs. old
• 30,091 patients were newly enrolled on ART from Jan 2010 – March 2010– 2,143 (7.1%) are less than 15 yrs. old
Early Infant Diagnosis (EID): Dried Blood Spot DNA-PCR
• Currently being implemented in 6 African countries: Zambia, Kenya, Nigeria, Mozambique, Tanzania & Rwanda
• Over 45,000 children tested through EID– 27,274 in Zambia alone
• Systems for early delivery of results and integration into under 5 clinics
– sms printers
– Web2sms for results pick up
Early Infant Diagnosis (EID): Dried Blood Spot DNA-PCR (2)
• Linking DBS results to determine effectiveness of PMTCT intervention
• Assessing the role of non drug factors eg. Disclosure, infant feeding, home vs facility to optimize effectiveness and efficiency in the light of limited resources
Part 2: Tomorrow’s VisionThe Future of ART programming
• Health Systems Strengthening platform• Integration of HIV services beyond Sexual,
Reproductive Health & TB. One target community, many diseases!
• Long-term tracking of ART patients• Sustainability
Overview of FHI’s TB/HIV Services
• Screening for TB and/or provision of TB treatment for HIV+ patients in 15 countries
• Integration of TB-HIV services
• As of March 2010:– 149,808 HIV+ patients were screened for TB in HIV
setting– 5,699 HIV+ patients in HIV care/treatment started TB
treatment
FHI Kenya’s CVD/HIV Integration Pilot
1. Assess CVD risk factors among:
– HIV Counseling & Testing (CT) clients
– HIV+ patients in care– HIV+ patients on ART
2. Provide behavioral and biomedical interventions (on site and/or through referral)
3. Document and disseminate lessons learned
Rationale for integration
• CVD complications in HIV patients• Burden of CVD and HIV among developing countries;
In Kenya:– HIV prevalence is 7.1%, with 1.5 Million PLWHA, and
390,000 on HAART– NCD contributes to 50% morbidity and 32% mortality
(Kenya MOH, 2007)
• Opportunity to combine lessons learned in CVD &HIV• Improve efficiency of health care delivery
Risk of high blood pressure according to HIV status (among CT clients)
81%
68% 70%
19%
32% 30%
0%
20%
40%
60%
80%
100%
HIV- (n=1,079) HIV+ (n=4,307) Total (N=5,386)
HIV Serostatus
Blo
od
Pre
ss
ure
(R
an
ge
)
Normal High P-value 0.003
Other findings
• Elevated blood sugar levels in 2nd line patients
• Increased lipids in second line patients
• High blood pressure related to duration of treatment
Strategies for tracking ART Patients
• Adherence support workers– Home visits and patient tracking
• SMS reminders– Web2sms for adherence and loss to follow up– Consent forms
• HMIS– Smartcare - Zambia
• 93,233 current ART patients (6,844 >15 yrs. – 7.3%)– Lafiya Management Information System (LAMIS) -
Nigeria
Lafiya Management Information System (LAMIS) - Nigeria
• 60,361 patients being tracked
• 14 facilities• Data included:
– Patient history– ART status and drug
regimen– TB and DOTS status– Clinical stage– Lab tests & results– Facility and lab setup– Specimen storage– Drug Inventory
Attaining operational sustainability
Technical Sustainability
Programmatic Sustainability
Social Sustainability
Financial Sustainability
Operational Sustainability
OVERALL SUSTAINABILITY
DistrictOverall score (%) by quarter
Months before graduationQ3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009
District 1 91.5 86 90 90 G 3yr 10mo
District 2 87 92.2 G G G 2yr 11mo
District 3 87 92.9 G G G 3yr
District 4 97 G G G G 3yr 1mo
District 5 84 92.4 G G G 3yr 10mo
District 6 78 85.4 92.6 G G 3yr 10mo
District 7 87 87.8 93.2 G G 3yr 3mo
District 8 89.6 84.2 94.2 G G 3yr 4mo
District 9 83 84.4 94 94 G 4yr
District 10 82.5 83.2 91.4 91.4 G 2yr 8mo
G = Graduated Average 3yr 4mo
Challenges for Sustainability
• Limited pre-service & in-service exposure to QI concepts
• Absence of strong QI system within MoH
• Use of financial incentives to drive QI & graduation activities
• High HCW turnover rate
• Financial sustainability