fhi experience in scaling up hiv care and treatment
DESCRIPTION
Presentation by Dr. Hendra Widjaja at the June 21, 2011 event "Meeting the chronic disease challenge: high-level regional workshop," co-hosted by the Partnership to Fight Chronic Disease and the Indonesian Ministry of Health in Jakarta.TRANSCRIPT
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FHI Experiencein scaling up
HIV care and treatment
Dr. Hendra Widjaja
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Yearl
y d
eath
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Anti Retroviral Treatment
Developing countries
Developed
countries
19921991 19991993 19951994 1996 1997 20011998 2000
Mortality rate due to AIDSMortality rate due to AIDS
2003
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HIV in Indonesia
Life Threatening Illness (before 2004)
Chronic Manageable Illness (after 2004)
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ARV drugs are not enough !!!
• ART is for life• Side effects monitoring • High level of adherence (> 95%)• Resistance to drugs – unforgiving• We need “Good Chronic Care”
strategy
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HIV - Chronic disease
• HIV• Opportunistic Infection: TB• Mental Disturbance: Addiction• Co-infection: Hepatitis B/C• Side effects: Hyperlipidemia
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Components of comprehensive HIV/AIDSCare, Support and Treatment
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Respond to ‘chronic care’ challenge
• Team work training • Integrated training modules• Counseling and Support • Patient Monitoring Tools• Collaboration with other diseases• Networking - CoPC
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Briefing package: Integrated Public Health Approach
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GOOD CHRONIC CARE
• Develop a partnership with the patient• Use the 5 A’s
(Assess, Advice, Agree, Assist and Arrange)• Proactively arrange follow-up visit• Use written information: R/R• Working as a clinical team• Link the patient to community based
resources and support
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COPC – Universal Access
• Comprehensive TB/HIV
• Integrated PMTCT
• Continuum, MMT
• Acute Care Hospital
• Chronic Care incl. ART Primary Health Center
• Palliative Care Community (home based)
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1995
Prevention
Care
Care
Prevention
Care
Prevention
2004 2011
Prevention
Care
FHI strategy
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FHI contribution to Universal Access
• Decentralization of ART providers • Training in cluster (piloted sites)• Team work• Involving Expert-patient trainer• Clinical mentoring• Program monitoring• M & E• Health System Strengthening
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Piloted Sites for COPC – Jakarta, Malang and Papua
• TB Clinic (PPTI) - Sulianti Suroso Hospital
• Primary Health Center (Gambir) - Tarakan Hospital
• Prison (Salemba) - St. Carolus Hospital
• District Health Offices
• Provincial Health Offices
• District AIDS Commission (DKI)
• Family Heath International
• Other International Agencies: WHO, KNCV and GF ATM
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Challenges
• Lack of human resources: task shifting• Collaboration with other teams: TB/HIV• Mainstreaming: Prevention, Care & Treatment • Stigma & discrimination: Confidentiality vs
Secrecy• Involvement of PLHIV: training (EPT),
adherence support (Peer group) & advocacy• M & E system: integration to existing Health
Care System
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Team work
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Task shifting to volunteers as caregivers
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Prison (home) based care
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Primary Health Center - Gambir
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Expert Patient Trainer
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NCD in South East Asia
• On the rise• Managing Chronic Diseases
at Primary Health Care• Lesson learned from HIV chronic care
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Lesson learned from HIV
• Empowerment of patients :
self care & peer support group• Simple diagnostic and treatment
protocols• Simple monitoring devices• Transition from acute care only to acute
and chronic care
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Support
Prevention Treatment
Care
THANK YOU