Post on 09-Aug-2020
AIDS Medicines and Diagnostics
Service (AMDS)
Annual Stakeholders and
Partners Meeting
Geneva, Switzerland
May 7-8, 2013
Francis Aboagye-Nyame, Program Director David Mabirizi, Principal Technical Advisor, HIV and AIDS
Systems for Improved Access to
Pharmaceuticals and Services (SIAPS) Program Improved Access. Improved Services. Better Health Outcomes.
SIAPS Goal and Objective
• Goal
• To assure the availability of quality pharmaceutical
products and effective pharmaceutical services to
achieve desired health outcomes
• Objective
• To promote and use a systems-strengthening
approach consistent with the Global Health
Initiative that will result in positive and sustainable
health impact
Health Outcomes
Services
Products
Intermediate Results
• Strengthen pharmaceutical sector governance
• Build individual, organizational, and institutional capacity for pharmaceutical supply management and services
• Address the information for decision-making challenges in the pharmaceutical sector
• Strengthen financing strategies and mechanisms to improve access to medicines
• Improve pharmaceutical services to achieve desired health outcomes
Where SIAPS/SPS Works
• TA in 30 countries
• Offices in ~22 countries
• 340+ staff worldwide
• 80+% of staff from host country
SIAPS 2011-13
• Angola
• Bangladesh
• Brazil
• Burundi
• Cameroon
• Dominican Republic
• DRC
• Ethiopia
• Haiti
• Jordan
• Lesotho
• Liberia
• Rwanda
• Guinea
• Mali
• Mozambique
• Namibia
• Philippines
• South Africa
• South Sudan
• Swaziland
• Tajikistan
• Turkmenistan
• Ukraine
• Uzbekistan
• Vietnam
SPS AA
• Afghanistan
• Kenya
SIAPS Funding By Health Element
Total Field/Regional Support
HIV & AIDS
50%
Malaria
20%
MNCH
16%
TB
14%
Cross Cutting
1%
HIV & AIDS
43%
Malaria
18%
MNCH
18%
Nutrition
0%
TB
20%
SIAPS Systems Strengthening Approach
Selected TA Activities (1)
• Strengthening quantification
• Dominican Republic, Democratic Republic of the Congo (DRC), and Cameroon
• Strengthening procurement management systems
• Cameroon and Lesotho
• Improving storage of medicines
• Cameroon and DRC
• Strengthening Information systems
• Cameroon, DRC, Lesotho, South Africa, Namibia, Uganda, Kenya, Ethiopia, and Dominican Republic
Selected TA Activities (2)
• Prevention of substandard medicines and ensuring
patient safety
• Lesotho, Namibia, Swaziland, Kenya
• Develop and implement treatment guidelines
• Mitigate antimicrobial/drug resistance
• Build human resource capacity for Pharmaceutical
services
• Enhance coordination
Implementation and
monitoring of
HIV Drug Resistance
Early Warning Indicators: The Case of Namibia
Dr. David Mabirizi
Principal Technical Advisor – HIV &AIDS
SIAPS
Objectives
Share an experience
• The Early Warning Indicators (EWI) and the strategy
of the HIV Drug resistance monitoring
• The importance and implementation of EWI
monitoring
• The results and challenges
Background: HIV-DR Early Warning
Indicators (EWIs)
• WHO HIV drug resistance (DR) prevention strategy
• Assesses antiretroviral therapy (ART) sites and program
factors associated with HIV-DR
• Uses routinely collected data (medical & pharmacy records)
• Collects data annually or quarterly at representative sites
• Provides evidence for making programmatic adjustments at
• ART site
• Country level
Background: HIV and ART in Namibia
• Population of 2.1 million
• Nov. 2011, ~200,000 People Living with HIV and AIDS (PLWHA)
• Among 15-49-year-olds, ~18.2% HIV-infected
• High ART coverage ~90% by Dec. 2010
• ART available in private sector since 1997 and public sector since 2003
• ART at all 35 public hospitals and at >140 satellite sites
• ARVs are provided free of charge following a public health approach
Background: Minimizing HIV-DR in
Namibia • With support from SIAPS, The Namibia Ministry of Health and Social Services
(MoHSS) undertook the WHO strategy and published first report in 2012 • HIV-DR indicators evaluated in the quarterly reports
• National program mandates the use of • standardized national ART prescribing practices,
• WHO prequalified drugs, and
• standardized medical and pharmacy record-keeping systems
• Uses three data sources— • Pharmacy-based tool—Electronic Dispensing Tool (EDT) for collection, reporting,
analysis, and use of routine pharmacy data
• Clinical data tools—Electronic Patient Management System (ePMS)
• Patient care booklet
• The USAID’s SPS and SIAPS programs have supported EDT
• USAID has also supported implementation of ePMS
Background: Comparison of ART Data
Systems
Intervention: Data Abstraction • MoHSS selected 5 of the 7 WHO EWIs for Namibia based on—
• Available data
• Anticipated impact of interventions related to these
indicators
• Data abstraction follows database queries created in the EDT
for calculating the EWI indicators
• Data abstracted centrally from National Database
• for 33 ART sites following WHO guidelines on sample size
and selection
• Abstracted data exported to an Ms Excel® tool provided by
WHO, which calculated results for each indicator
Results (1) • Available data records allowed for monitoring of 3 of 5 EWIs
• Data from 3,875 patients abstracted and analyzed
• EWI 1: appropriate initial ART regimen prescriptions
• 22 of 33 (67%) sites met the target of 100% appropriate initial
ART regimen
• 9 of 11 sites not meeting the target had appropriate ART
regimen for 98%–99% of their patients
• The 1%–2% with “inappropriate first-line regimen” had a protease
inhibitor-based regimen
• Results are comparable to other African settings
Results (2)
• EWI 2: Lost to follow-up (LTFU) 12 months after ART initiation
• 17 of 33 (52%) sites met the target of ≤ 20% LTFU at 12 months
• Similar to other African reports
• The LTFU rates ranged from 3% to 68%
• EWI 3: Patients on appropriate first-line regimen at 12 months
• 15 of 33 (45%) sites achieved 100% target
• In 55% of sites, only 1%-8% patients switched to a second-line regimen
before the 12-month date
• EWIs 4 and 6: (on-time pill pick-up ) and (ARV drug stock-outs*)
• Could not be calculated because of data-related inconsistencies
* It has been documented that Namibia has > 99% availability of ARVs but
existing data systems did not allow a thorough analysis for all sites
Discussion • 2010 EWI data extraction exercise provides Namibia with a
evidence for national and site-specific programmatic monitoring of potential HIV-DR
• The initial evidence is further investigated to contextualise results and identify facilities with major shortcomings
• guides design and implementation of interventions
• Strengthening standardization of dispensing practices and addressing gaps in ART data quality at facility level
• MoHSS has initiated interventions to address gaps
Challenges
• Data quality issues
• At ART sites with a high turnover of pharmacy staff
• Weak paper-based record-keeping practices in the regions
especially rapidly decentralizing ART services from district
to health centres and clinics
• Analysis and use of EWI data for decision making at facility
level
• Most health facilities grappling with shortage of health
workers (doctors, nurses, pharmacists) and high workload
Conclusion
• Implementation of robust electronic data collection systems
facilitated quick and efficient central abstraction of EWI data
• EWI abstraction identifies areas that require MoHSS
intervention to improve quality of ART service delivery and
prevent HIV-DR
• On-going efforts required to improve
• ART data quality
• Availability and accuracy of ART data and reports for all the
EWIs
Way Forward
• Continued support to MoHSS —
• data analysis capacity and implementation of targeted
interventions for “at risk” ART sites
• Improve data quality
• Promote discussion of EWI results at facility level
• Work to ensure that health information systems at facility
level are compatible and complementary in their data
systems to minimize duplication
References and Acknowledgments
• Bibliography
• Alcorn. Keith. 2011. Is HIV drug resistance spreading? Early
warning signals say ‘yes.’ NAM AIDSMAP
http://www.aidsmap.com/Is-HIV-drug-resistance-spreading-
Early-warning-signals-say-yes/page/1684209/
• Ministry of Health and Social Services. 2012. Report on World
Health Organization Early Warning Indicators - Namibia for
2010. MoHSS Namibia
• WHO. 2012. WHO HIV drug resistance report 2012. Geneva:
WHO.
• Acknowledgments
• MoHSS Namibia; USAID Namibia; WHO Namibia Field Office;
Tufts University School of Medicine; SIAPS team