Care and Treatment Technical C onsiderations amp Priorities Dr Raymond Chimatira Dr Olarotimi S Oladoyinbo 1 Outline Care and Treatment priority a pproaches Treatment expansion strategy and activities ID: 533808
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PEPFAR South Africa Care and Treatment Technical Considerations & Priorities
Dr Raymond Chimatira
Dr
Olarotimi S. Oladoyinbo
1Slide2
Outline
Care and
Treatment priority
approachesTreatment expansion strategy and activitiesDifferentiated service delivery models
HIV/TB program
Advanced Clinical Care Program
Cryptococcal Antigen (
CrAg
) Screening Program
2Slide3
Care and Treatment
Priority Approaches
Continued support for District Implementation Plans
Scale-up of PITC & strategies for reaching men
Linkage to care
Test and Treat
Differentiated Service Delivery Package
Viral Load Scale-up
Strengthened community-program
3Slide4
4Slide5
5Slide6
Care and Treatment
Priority Approaches
Massive scale-up of facility-based PITC
Treatment expansion strategies
Implementation of National Adherence Guidelines
Rationalized/ focused/ targeted training
Intensified monitoring
Community-facility programme linkage, referral networks
Increase private sector engagement & services support
Patient data systems:
Tier.Net
, ETR, EDR
Community mobilization (HTS, Treatment Literacy)
Clinical services integration
Clinical systems (lab, pharmacy, supply chain)
Planning & monitoring of program implementation
Program & site level monitoring
6Slide7
Treatment Expansion
Strategy & Activities
DSP
7Slide8
Target Population
Service
Community
Facility
Newly Diagnosed
Test & Treat (S
eptember 2016)
X
Fast-track initiation
X
Adherence counselling and education
X
Disclosure support
X
New
on Treatment
support groups
X
X
Interactive reminders (SMS, social media apps, CHW call)
X
X
Stable
Decanting Patients
X
X
Adherence Clubs
X
2-3 month drug supply
X
X
Spaced / Fast Lane Appointments
X
Community-based dispensation of ARVS (clubs, PDUs)
X
Patient Services through GPs
X
Unstable patients
Regular appointment reminders until stable
X
X
Enhanced Adherence Counseling
X
X
Tracking and Tracing LTFU
X
Differentiated Service
Delivery Models
8Slide9
HIV/TB
Program
9
Percentage
of deaths by broad cause by district, 2008–2013: KwaZulu-Natal Province*
*
Source:
Massyn
, N., Peer, N.,
Padarath
, A., Barron, P., & Day, C. (Eds.). (2015). District Health Barometer 2014/2015. Durban, South Africa: Health Systems Trust.Slide10
HIV/TB
Program (2)
Drug-Resistant Tuberculosis (DR-TB): addresses clinical training and cross-infection in
facilities
Nurse Initiated Management of DR-TB (NIMDR)
EDRweb
Centre for Scientific & Industrial Research (CSIR
):
training
on infection control;
ensuring
appropriate design solutions for drug-resistant TB facilities in South Africa
10Slide11
ACC Program
11
Goal: To strengthen capacity for quality and sustainable clinical care for PLHIV with complicated HIV and TB/HIV co-infection, including 2nd, 3rd and alternate ART
To establish/strengthen systems and capacity to manage ART & TB treatment failure
To build capacity of
PHC
providers to better manage complex
medical problems
To establish/strengthen capacity for specialized clinical, laboratory and pharmaceutical services
To collect strategic information (SI) to track patient and program outcomes
Develop clear referral criteria
Referral pathways mapping for complicated HIV
Toll free
helplines
Referral Triage Lines
CHAT (virtual experts)
CPD accredited didactic ACC
training
M&M
meetings
Outreach support mentorship & case-based training by clinical specialists
Outreach support
On-site training and mentorship
Clinical chart & facility audits
Quality improvement
Viral suppression & triage of complicated patientsSlide12
CrAg
Screening Program
Reflex lab screening:
Sequentially implemented at approx. 200 facilities in Gauteng, Free State, Western Cape and KwaZulu-Natal
“Hub-&-Spoke” district model with central CD4 lab and referring facilities
Implementation steps:
Stakeholder engagement, lab set up, clinical training, procurement and distribution of fluconazole, START, routine program monitoring
12Slide13
Specimens with CD4 count <100 cells/µL, n=50,327
Specimens reflexively tested with CrAg lateral flow assay, n=50,324
Patients with CD4 count <100 cells/µL and CrAg test results, n=42,666
Patients eligible for CrAg screening, n=41,999 (98%)
Specimens not tested, N=3
Duplicate specimens tested, N=7,658 (15%)
Prior cryptococcal meningitis, N=667 (2%)
CrAg-positive (new diagnosis), n=1,271
(3%)
CrAg-negative, n=40,728 (97%)
13Slide14
14
Thank You