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AIDS Medicines and Diagnostics
Service (AMDS)
Annual Stakeholders and
Partners Meeting
Geneva, Switzerland
May 7-8, 2013
Francis Aboagye-Nyame, Program Director David Mabirizi, Principal Technical Advisor, HIV and AIDS
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Systems for Improved Access to
Pharmaceuticals and Services (SIAPS) Program Improved Access. Improved Services. Better Health Outcomes.
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SIAPS Goal and Objective
• Goal
• To assure the availability of quality pharmaceutical
products and effective pharmaceutical services to
achieve desired health outcomes
• Objective
• To promote and use a systems-strengthening
approach consistent with the Global Health
Initiative that will result in positive and sustainable
health impact
Health Outcomes
Services
Products
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Intermediate Results
• Strengthen pharmaceutical sector governance
• Build individual, organizational, and institutional capacity for pharmaceutical supply management and services
• Address the information for decision-making challenges in the pharmaceutical sector
• Strengthen financing strategies and mechanisms to improve access to medicines
• Improve pharmaceutical services to achieve desired health outcomes
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Where SIAPS/SPS Works
• TA in 30 countries
• Offices in ~22 countries
• 340+ staff worldwide
• 80+% of staff from host country
SIAPS 2011-13
• Angola
• Bangladesh
• Brazil
• Burundi
• Cameroon
• Dominican Republic
• DRC
• Ethiopia
• Haiti
• Jordan
• Lesotho
• Liberia
• Rwanda
• Guinea
• Mali
• Mozambique
• Namibia
• Philippines
• South Africa
• South Sudan
• Swaziland
• Tajikistan
• Turkmenistan
• Ukraine
• Uzbekistan
• Vietnam
SPS AA
• Afghanistan
• Kenya
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SIAPS Funding By Health Element
Total Field/Regional Support
HIV & AIDS
50%
Malaria
20%
MNCH
16%
TB
14%
Cross Cutting
1%
HIV & AIDS
43%
Malaria
18%
MNCH
18%
Nutrition
0%
TB
20%
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SIAPS Systems Strengthening Approach
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Selected TA Activities (1)
• Strengthening quantification
• Dominican Republic, Democratic Republic of the Congo (DRC), and Cameroon
• Strengthening procurement management systems
• Cameroon and Lesotho
• Improving storage of medicines
• Cameroon and DRC
• Strengthening Information systems
• Cameroon, DRC, Lesotho, South Africa, Namibia, Uganda, Kenya, Ethiopia, and Dominican Republic
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Selected TA Activities (2)
• Prevention of substandard medicines and ensuring
patient safety
• Lesotho, Namibia, Swaziland, Kenya
• Develop and implement treatment guidelines
• Mitigate antimicrobial/drug resistance
• Build human resource capacity for Pharmaceutical
services
• Enhance coordination
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Implementation and
monitoring of
HIV Drug Resistance
Early Warning Indicators: The Case of Namibia
Dr. David Mabirizi
Principal Technical Advisor – HIV &AIDS
SIAPS
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Objectives
Share an experience
• The Early Warning Indicators (EWI) and the strategy
of the HIV Drug resistance monitoring
• The importance and implementation of EWI
monitoring
• The results and challenges
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Background: HIV-DR Early Warning
Indicators (EWIs)
• WHO HIV drug resistance (DR) prevention strategy
• Assesses antiretroviral therapy (ART) sites and program
factors associated with HIV-DR
• Uses routinely collected data (medical & pharmacy records)
• Collects data annually or quarterly at representative sites
• Provides evidence for making programmatic adjustments at
• ART site
• Country level
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Background: HIV and ART in Namibia
• Population of 2.1 million
• Nov. 2011, ~200,000 People Living with HIV and AIDS (PLWHA)
• Among 15-49-year-olds, ~18.2% HIV-infected
• High ART coverage ~90% by Dec. 2010
• ART available in private sector since 1997 and public sector since 2003
• ART at all 35 public hospitals and at >140 satellite sites
• ARVs are provided free of charge following a public health approach
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Background: Minimizing HIV-DR in
Namibia • With support from SIAPS, The Namibia Ministry of Health and Social Services
(MoHSS) undertook the WHO strategy and published first report in 2012 • HIV-DR indicators evaluated in the quarterly reports
• National program mandates the use of • standardized national ART prescribing practices,
• WHO prequalified drugs, and
• standardized medical and pharmacy record-keeping systems
• Uses three data sources— • Pharmacy-based tool—Electronic Dispensing Tool (EDT) for collection, reporting,
analysis, and use of routine pharmacy data
• Clinical data tools—Electronic Patient Management System (ePMS)
• Patient care booklet
• The USAID’s SPS and SIAPS programs have supported EDT
• USAID has also supported implementation of ePMS
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Background: Comparison of ART Data
Systems
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Intervention: Data Abstraction • MoHSS selected 5 of the 7 WHO EWIs for Namibia based on—
• Available data
• Anticipated impact of interventions related to these
indicators
• Data abstraction follows database queries created in the EDT
for calculating the EWI indicators
• Data abstracted centrally from National Database
• for 33 ART sites following WHO guidelines on sample size
and selection
• Abstracted data exported to an Ms Excel® tool provided by
WHO, which calculated results for each indicator
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Results (1) • Available data records allowed for monitoring of 3 of 5 EWIs
• Data from 3,875 patients abstracted and analyzed
• EWI 1: appropriate initial ART regimen prescriptions
• 22 of 33 (67%) sites met the target of 100% appropriate initial
ART regimen
• 9 of 11 sites not meeting the target had appropriate ART
regimen for 98%–99% of their patients
• The 1%–2% with “inappropriate first-line regimen” had a protease
inhibitor-based regimen
• Results are comparable to other African settings
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Results (2)
• EWI 2: Lost to follow-up (LTFU) 12 months after ART initiation
• 17 of 33 (52%) sites met the target of ≤ 20% LTFU at 12 months
• Similar to other African reports
• The LTFU rates ranged from 3% to 68%
• EWI 3: Patients on appropriate first-line regimen at 12 months
• 15 of 33 (45%) sites achieved 100% target
• In 55% of sites, only 1%-8% patients switched to a second-line regimen
before the 12-month date
• EWIs 4 and 6: (on-time pill pick-up ) and (ARV drug stock-outs*)
• Could not be calculated because of data-related inconsistencies
* It has been documented that Namibia has > 99% availability of ARVs but
existing data systems did not allow a thorough analysis for all sites
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Discussion • 2010 EWI data extraction exercise provides Namibia with a
evidence for national and site-specific programmatic monitoring of potential HIV-DR
• The initial evidence is further investigated to contextualise results and identify facilities with major shortcomings
• guides design and implementation of interventions
• Strengthening standardization of dispensing practices and addressing gaps in ART data quality at facility level
• MoHSS has initiated interventions to address gaps
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Challenges
• Data quality issues
• At ART sites with a high turnover of pharmacy staff
• Weak paper-based record-keeping practices in the regions
especially rapidly decentralizing ART services from district
to health centres and clinics
• Analysis and use of EWI data for decision making at facility
level
• Most health facilities grappling with shortage of health
workers (doctors, nurses, pharmacists) and high workload
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Conclusion
• Implementation of robust electronic data collection systems
facilitated quick and efficient central abstraction of EWI data
• EWI abstraction identifies areas that require MoHSS
intervention to improve quality of ART service delivery and
prevent HIV-DR
• On-going efforts required to improve
• ART data quality
• Availability and accuracy of ART data and reports for all the
EWIs
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Way Forward
• Continued support to MoHSS —
• data analysis capacity and implementation of targeted
interventions for “at risk” ART sites
• Improve data quality
• Promote discussion of EWI results at facility level
• Work to ensure that health information systems at facility
level are compatible and complementary in their data
systems to minimize duplication
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References and Acknowledgments
• Bibliography
• Alcorn. Keith. 2011. Is HIV drug resistance spreading? Early
warning signals say ‘yes.’ NAM AIDSMAP
http://www.aidsmap.com/Is-HIV-drug-resistance-spreading-
Early-warning-signals-say-yes/page/1684209/
• Ministry of Health and Social Services. 2012. Report on World
Health Organization Early Warning Indicators - Namibia for
2010. MoHSS Namibia
• WHO. 2012. WHO HIV drug resistance report 2012. Geneva:
WHO.
• Acknowledgments
• MoHSS Namibia; USAID Namibia; WHO Namibia Field Office;
Tufts University School of Medicine; SIAPS team