Date post: | 16-Dec-2015 |
Category: |
Documents |
Upload: | duncan-noon |
View: | 218 times |
Download: | 2 times |
Community Systems Strengthening for Improved HIV Care: The Uganda Experience
Dr. Ario Alex Riolexus, STD/ACP – Ministry of Health, Uganda 24th July 2014TASO Satellite Meeting, 20th International AIDS Conference, Melbourne – Australia
Uganda HIV Context After over a quarter century, HIV
epidemic in Uganda is still severe and generalized.
Current estimates of HIV prevalence is at 7.3% in adults but with marked geographical, socio-demographic and socio-economic heterogeneity.
Burden: About 1.5 million adults and children in a population of 35 million.
New infections:124,000 in 2009, 130,000 in 2010, 145,000 in 2011, 130,000 in 2013
60,000 annual mortality
Uganda HIV Context Cont:
Scale up of ART using a public health approach in 2004
Number in need of ART at 500 CD4 – 1,405,000 (1,207,000 adults and 193,000 children)
Current No. on treatment – 600,000Retention after 12 months of ART
initiation – 86%Adherence to ART at 95% and above -
91%, LTFU – 18.5%96.8% are on 1st line ARV regimen; 3%
are on 2nd line; a small percentage is on 3rd line
The National HIV Response
Appropriate policies Multi-sectoral response with broad based
stakeholder involvement NSP Decentralisation policy MoH Sectoral Policies and Guidelines
National Health policy HSSIP The Client Charter Public Private Partnership Policy ART , eMTCT, HCT, HBC Policies, Adherence Strategy etc
National Prevention Policy
The National HIV Response Cont:
National Development Policy Financing ARV procurement Decentralisation of ART to lower level HF Political commitment
eMTCT campaign – 1st Lady is Champion The President and 1st Lady openly
undergoing HIV Testing HIV Trust Fund
What is Community Systems Strengthening?
An approach that promotes the development and sustainability of communities and community organizations and actors, and enables them to contribute to the long term sustainability of health and other interventions at community level.
Background to Community Strengthening - 1 Experience from community based
organisations and lessons learnt The rapid scale up of ART using a public
health approach posed health systems challenges
The medical paradigm for control of the HIV epidemic was stretched to the limit in Uganda, where institutional and human resources were inadequate for the large numbers seeking care.
This called for task sharing and skills transfer
Background to Community Strengthening - 2
NHP and HSSIP recognises the role community plays in health delivery but notes its current weaknesses
Understanding the cause of weakness in a system is the first step towards recognising the solution
HSR of the HIV national response revealed serious gaps in all health systems building blocks
Background to Community Strengthening - 3
Recognition of the role of community systems in the whole HIV treatment cascade
Strengthening the community system and using PLHIV as part of the solution to the workforce needs to bridge the gap for a better national response
Grant proposal funding requirements
Institutions with improved Community – Facility Linkage Infectious Diseases Institute (IDI) The AIDS Support Organization (TASO) Joint Clinical Research Centre (JCRC) Mildmay Uganda Reach Out Mbuya Northern Uganda Health Integration to
Enhance Services (NUHITES) and STARs EGPAF SUSTAIN Uganda Cares, Mama’s Club, M2M etc VHTs in Public and PNFP Facilities
Program approaches to Strengthening Communities
A- Family-Centered Care: offering care and support to meet the needs of the entire family Using the Chronic Care Model Using Mother Baby Care Point Using the Male Involvement Strategy
Proposed Uganda Chronic Care Model
Community•Raise awareness and reducestigma
•Encourage better outcomes through leadership and support•Mobilize and coordinateresources•Provide complementaryservices
Health CareOrganization•Promote continuity and coordination•Encourage quality throughleadership and incentives•Organize and equip health careteams•Use information systems•Support self-management and
preventionPatient
Family
Positive Policy Environment•Integrate policies•Provide leadership and advocacy
Better Outcomes for Chronic Conditions
Pre
pare
d
Links
•Strengthen partnerships•Support legislative andregulatory frameworks•Reduce disparities in care
•Promote consistent financing•Assure workforce capacityand capability
The Chronic Care Model
The Chronic Care Model, depicted above emphasizes a patient-centred approach to handling chronic conditions, with the Community, Family, Health System and favourable policies all contributing to a patent’s wellbeing and health.
The core triad of Patients and Families, Community Partners, and the Health Care Team is the cornerstone of chronic care.
The Chronic Care Model
The three-tiered Uganda Chronic Care Model encompasses Patients and Family, Community Partners and Health Care Teams and focuses on a patient-centred approach helps programs control costs by enabling appropriate use of self-care and low-cost services based in the family and community.
The model also emphasizes a proactive approach to anticipated care needs.
Mother Baby Care Point
The mother baby care point is an improved service delivery model to optimize retention and adherence, EID uptake, and appropriate transitions for mothers and exposed infants
Keeps mother-infant pairs together at one "care point" through 18 months post-partum and beyond
Minimizes the number of transfers for the pair
Negative infant
discharged
Positive infant and mother referred to treatment
clinic
Mother referred to treatment
clinic
Antenatal Care for Mother
Mother - Baby Care point (post natal)
MCH Service Point
• Routine ANC care
• HTC, risk reduction counseling, condoms, & couples HTC
• ART initiation & management for HIV+ pregnant women
HIV Treatment Clinic
• ART for already enrolled HIV+ Postnatal mothers
• ART for newly diagnosed HIV+ postnatal mothers
• Family planning
• Routine PNC including Immunization, well child services, EID & care for HEI up to 18 months
• ART for all HIV+ infants through 18 months
Pregnancy Postpartum / Breastfeeding
Period
Ongoing care & support
18 months postpartu
m
HIV
N
egati
ve
Infa
nts
at
18
month
s
HIV
Infe
cted
infa
nts
at
18
month
s
Community Systems: FSG, Peer Mothers, Community Follow up
MBC Service Delivery Model
Program approaches to Strengthening Communities
B- Comprehensive Care: providing holistic care for people living with HIV/AIDS, TB, sexually transmitted infections, and other opportunistic infections. National Adherence Strategy Treatment Supporters Expert Clients
Program approaches to Strengthening Communities
C- Service Linkages: leveraging locally available existing resources, training health workers and improved reporting. Linkage Facilitators Peer Mothers/Fathers PLHIV Networks Village Health Teams (VHT) Family Support Groups (FSG) Home Visiting by Health workers Effective referral system mTRAC, DHIS2 MARPs strategy
Program approaches to Strengthening Communities
D- Sustainable Approaches: strengthening existing CSOs and increasing their capacity to mobilize and manage resources. Civil Society Fund Enhanced planning capacity of CSOs Local generation of revenue by CSOs Increased support to CSOs by government Encouragement of formation of indigenous
NGOs – TASO, Baylor Uganda, IDI, Mildmay, Mama’s Club etc
Program approaches to Strengthening Communities
E- Fostering Partnerships: promoting partnerships at all levels—local, regional, national, and international. Representation of CSO and ADP in TWGs, PC, HPAC Partnership Committee East African Community Partnership Frameworks with International Agencies JRM, JAR, NHA GIPA MoU with Implementing Partners
Other approaches to Strengthening Communities
1- Demand Creation and Advocacy: promoting uptake of services and improved lobbying for service provision and allocation of resources and accountability. Consumer advocates – CHAIN, PLHIV Networks CSOs – ICWEA, UGANET, NAFOPHANU, UDN
etc Parliamentary Committee on HIV/AIDS Tailored campaigns – eMTCT, HTC, WAD etc
eMTCT Campaign
Other approaches to Strengthening Communities
2- Improved Communication: promoting uptake of services, linkage and referral. Mobile phone text messaging as a reminder
tool for promoting adherence to ART Availability of many telecommunication
companies – MTN, Airtel, Orange, etc Booklets on HIV for political and cultural
leaders Use of local FM radios
Other approaches to Strengthening Communities
3- Capacity Building: improving the capacity of the community to respond and participate meaningfully in HIV care. Mentorship programs for service providers at
all levels Leadership and technical training of CSOs
and service providers Fellowship Program at MUSPH CSS Activity funding – GF, PEPFAR, Irish AID
etc
Other approaches to Strengthening Communities
4- Quality Improvement: improving the quality of HIV care using simple proven quality improvement models. National Quality Improvement
Framework Formation of Quality Improvement
Teams in all health facilities Inclusion of Expert Clients and CSO
representatives at Health Facility Quality Improvement Teams
I THANK YOU