Download TB and antiretroviral treatment in Thyolo district, Malawi Southern

Antiretroviral treatment programme in
Thyolo district, Malawi Southern Region.
MSF Luxembourg &
Thyolo District Health Services
- Strategic information used for preparation
- Monitoring & Evaluation
- Challenges to overcome
Dr. Roger Teck – July 1st, 2003
HIV/AIDS in Thyolo District
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Mainly rural population: 475,000 people
Prevalence level of HIV infection among pregnant
mothers: around 21%
People living wih HIV/AIDS: about 50,000
People with AIDS: 5,000 – 10,000 ?
HIV Continuum of Care in Thyolo district
(June, 2003)
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7 VCT sites and one PMTCT site:
- 1,300 – 1,500 tested monthly
- 35 – 40 % test HIV +
Close to 2,300 a-symptomatic and symptomatic
HIV+ patients supported through HBC and health
centres.
Access for TB patients (1,200 per year) to VCT (>
90 % uptake, > 70 % HIV+) and CTX prophylaxis.
1,700 symptomatic HIV + patients registered at
district hospital based HIV/AIDS clinic
Strategic information (1)
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Institutional back-up
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Perspectives for sustainable financing
-
Through MSF
Global Fund
Other mechanisms
Strategic information (2)
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Policy environment allowing importation of
generic ARV medicines
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Elaboration of draft Malawi ART guidelines
- Organisational framework
- Objectives & targets (Global Fund proposal)
- Input and output indicators
- Eligibility criteria.
- First line treatment regimens
- Clinical guidance for drug toxicity & treatment failure
- Monitoring & evaluation framework
Strategic information (3)
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Estimates on the burden of HIV infection and
AIDS
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Assessment of health facilities
- District hospital and 9 health centres
- Missionary hospital and 8 health centres
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Community
- Perception of HIV/AIDS and HIV/AIDS/TB services
- Expectations on ART treatment.
Main target and strategies for “scaling up”
of the ART programme
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Over five years
period:
access to
HAART for
at least 50 % of
people with AIDS
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Simplified clinical protocol
Fixed drug combination
With national staff
Screening & preparation in
HBC and PMTCT population
Two HIV/ART clinics (two
hospitals)
Decentralisation through
health centres
Adherence follow-up
through guardians and HBC
Organisational plan for HIV/ART clinic
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Infrastructure and staffing for the HIV/AIDS clinic
to manage “in addition” a maximum of 700
patients during first 6 months of treatment:
- One receptionist
- Two “consultation units” (one clinical officer + nurse)
- Two “ART units” with each one nurse counsellor
- Patient archive and data base: data entry technician
(supported by one expatriate medical doctor)
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Patient flow: quick and slow circuit
Week programme
Patient follow-up
timing
Group
session
-7 days
X
CounselClinical Parallel
ling, weight consult. laboratory
monitoring
& ART
X
Day 1
X
X
X
14 days
X
X
X
14 days
X
X
X
Every 28
days
X
6 Months
X
X
X
Programme Monitoring & Evaluation (1)
according to Malawi treatment guidelines
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Outcome Indicators of Global Fund targets
Similar to NTP M&E system
Paper- based
- patient identity card/stamp (“health passport”)
- patient master card (file) for registration of monthly
treatment outcome, “functional” status, side
effects and adherence
- quarterly cohort analysis forms
- drug security form
Programme Monitoring & Evaluation (2)
“Fuchsia” Software Electronic Data base
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Epicentre and Mèdecins sans Fontieres
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Monthly & cumulative reporting on:
- HIV clinic
- ART programme
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Patient summaries
Antiretroviral treatment programme update
April 22nd - June 27th.
Total on ART
103
Stage III
55
Stage IV
43
Children
5
Deaths
2
Serious side
effects
2
Strategic information and monitoring &
evaluation: challenges
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WHO staging
Decentralisation to health centres:
- Continuation of follow-up of ART for children
- Drug security
- Staff capacity
- Monitoring & evaluation
Linking to other treatment centres
- Transfers
- ART “shopping”