Integrated Programming for HIV and NonCommunicable Diseases Medication Adherence C lubs in Kibera and other stories Tom Ellman Southern Africa Medical Unit MSF TomEllmanjoburgmsforg Conflict of Interest ID: 765079
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Integrated Programming for HIV and Non-Communicable Diseases Medication Adherence Clubs in Kibera and other stories Tom Ellman, Southern Africa Medical Unit, MSF Tom.Ellman@joburg.msf.org
Conflict of Interest No conflicts of interest to declare
What are we talking about? There are many NCDsFocus on hypertension, CVD, DM…..and fertilityCo-morbidityHIV patients with NCDsTB and DMOpportunity cost of treatment is relatively low Service delivery models Lifelong treatment ‘Wellness’ Differentiated approaches Integration or introduction?
NCDs came before HIV care
Zimbabwe Chipinge OCB South Sudan Agok OCG Aweil OCP Kenya : Kibera closing OCB/ Embu starting Daghaley OCG Afghanistan OCB/OCA Ukraine OCG /OCB Myanmar OCA Swaziland Manzini OCA DRC Mweso OCA ( Diabetes only) Ethiopia OCA MSF Projects with NCD Focus May 2017 Africa : 8 projects 6 countries Middle East : 3 countries Eastern Europe / Russia: 2 countries Central asia /Asia: 2 countries Lebanon OCB / OCB Jordan OCBA /OCA Iraq/Syria OCG/OCA Chechyna OCA ( DRTB) 13 countries 26,056 patients
HIV and NCD care in an informal setting in Kibera, Kenya Apply lessons from ART rollout to NCD cohorts 4,227 NCD patients enrolled by Nov 2014 70% (2,950) females Overall median age: 46 years (IQR: 38-54) 87 % (3,691) hypertensive , diabetes or both1Van de Vijver et al,2013; Ayah et al 2013
Success of treatment in Kibera Retention higher in HIV positive: 22% v 36% at 6 months Success after 6 months: 40 % of PLWHIV SBP < 140 50 % of HIV negative SBP < 140 37% PLHIV HBA1C<7%20% HIV negative HBA1C of < 7 %.
Task-shifting within NCD care
When? Every 3 months in the afternoons after work or Saturday morning Where? Most Meet At facility Who : faciliated lay worker Medication Adherence Clubs- Stable Adults (20-30 clients; facility based; lay worker led)
1432 enrolled into 47 clubs Offloaded 2,208 consultations from routine outpatient care Loss to follow up 3.5% 71% HIV positive 29% have Diabetes or Hypertension Medication Adherence Clubs- 2
All are lifelong diseases of mostly healthy people requiring daily treatment but… HIVYounger and deadlier Low NNT Activism and advocacy Simple treatments Standardised guidelines Simple affordable tools and formulations Assured quality drug supply Decentralised care Task-shifted careAnnual consultations and multi-month refillsDifferentiated service deliveryA Global Fund and free careCVD, hypertension, and DM
Access to NCD medications Survey 40 countries ( 2011)Cameron et al Medication class Public Sector ( median medicine availability %) Private sector ( median medicine availability %) Antidiabetics ( n=2)* 49.5 65.0 Antihypertensives (n=5) 34.7 57.1 Antiasthmatics ( n=2)30.143.1Antiepileptics ( n=2)29.440.3WHO just repeated surveys with new adapted tool in Mozambique , Ethiopia and DRC
Where next? Patient-centred demedicalised careSelf-managementCritical enablersNothing possible without……. free quality-assured accessible drugs Appropriate normative guidance and advocacy for simplification Pilots at scale
THANKS Acknowledge MSF Field teams and MoH colleaguesColleagues in SAMU, Access Campaign, MSF HQs