Marseille 2007
| Abstract #165 - Integration of AIDS care into TB control programs : an efficient solution for expanding ART coverage ? First results of the International Union Against Tuberculosis and Lung Disease (The Union) Integrated HIV Care (IHC) program | ||||
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Session: 43.4: Access and models of care (Parallel) on Tuesday @ 16.30-18.30 in CP Chaired by Joseph Okone, Martha Nthenge Authors: Presenting Author: Dr Francois BOILLOT - Alter - Sant Internationale & Dveloppement, France |
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| Additional Authors: Dr Riitta Dlodlo, Dr Diane Capo Chichi, Prof Martin Gninafon, Dr Jean Pierre Kabuayi, Dr Andr Ndongosieme, | ||||
| Aim: Issues Whether delivered through national health services or non-governmental organizations (NGOs), AIDS care is often accessible only under vertical approaches, and adequate management of TB-HIV co-infection remains difficult to establish. As resources are not limitless, this may pose challenges in extending AIDS care to rural areas with lower HIV prevalence and limited NGO presence. Programs with tools for management of other chronic diseases with stigma, such as leprosy and tuberculosis (TB), are available and may contribute to scaling up of AIDS care. | ||||
| Method / Issue: Project The IHC approach is action-research to assess the feasibility and cost-effectiveness of delivering AIDS care using the TB services as an entry point to HIV diagnosis and care. A package of HIV/AIDS care has been developed based on the DOTS strategy, with the intention to complement existing approaches and improve integration within existing services. Besides the treatment of tuberculosis, the package includes: ? provider-initiated HIV counselling and testing verified by external quality assurance ? standardized protocols for cotrimoxazole prophylaxis and first- and second-line antiretroviral treatment (ART) based on CD4 counts and viral load measurement using appropriate technologies, with supervision of health staff and patient support ? a monitoring and evaluation system based on leprosy or tuberculosis program tools, allowing cohort uptake and treatment results analysis ? a quality-controlled drug and supply management system using existing programme channels. To compare different health system environments, IHC has been implemented since the second quarter of 2006 in 22 centres in two provinces of DR Congo and 18 centers in Benin. The first analyses show that the IHC approach is feasible, and the most recent results of cohort uptake and treatment results (end of 1stQ 2007) will be presented. | ||||
| Discussion: Lessons learned Current AIDS care financing mechanisms induce competition rather than collaboration between programmes, and in both countries weaken the regulatory capacity of health ministries. Project approaches hinder programme development as healthcare staff expect project related work conditions. Scale-up through prescribing physicians is constrained in both countries by staff turnover, limited continuous training capacity of programs, and the fast evolution of AIDS techniques. Delegation of responsibility to paramedics to deliver care should be possible, if standardized guidelines, supportive medical supervision, and higher level care for referred cases are available. Developing systems and skills common to HIV/AIDS, TB and leprosy care can form the basis for the management of chronic diseases in primary health care. A shift in approaches to developing and maintaining staff proficiency is required for AIDS care, involving baseline training, ongoing supportive supervision, and adequate remuneration. | ||||
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