Post on 12-Mar-2015
description
FHI Experiencein scaling up
HIV care and treatment
Dr. Hendra Widjaja
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Anti Retroviral Treatment
Developing countries
Developed
countries
19921991 19991993 19951994 1996 1997 20011998 2000
Mortality rate due to AIDSMortality rate due to AIDS
2003
HIV in Indonesia
Life Threatening Illness (before 2004)
Chronic Manageable Illness (after 2004)
ARV drugs are not enough !!!
• ART is for life• Side effects monitoring • High level of adherence (> 95%)• Resistance to drugs – unforgiving• We need “Good Chronic Care”
strategy
HIV - Chronic disease
• HIV• Opportunistic Infection: TB• Mental Disturbance: Addiction• Co-infection: Hepatitis B/C• Side effects: Hyperlipidemia
Components of comprehensive HIV/AIDSCare, Support and Treatment
Respond to ‘chronic care’ challenge
• Team work training • Integrated training modules• Counseling and Support • Patient Monitoring Tools• Collaboration with other diseases• Networking - CoPC
Briefing package: Integrated Public Health Approach
GOOD CHRONIC CARE
• Develop a partnership with the patient• Use the 5 A’s
(Assess, Advice, Agree, Assist and Arrange)• Proactively arrange follow-up visit• Use written information: R/R• Working as a clinical team• Link the patient to community based
resources and support
COPC – Universal Access
• Comprehensive TB/HIV
• Integrated PMTCT
• Continuum, MMT
• Acute Care Hospital
• Chronic Care incl. ART Primary Health Center
• Palliative Care Community (home based)
1995
Prevention
Care
Care
Prevention
Care
Prevention
2004 2011
Prevention
Care
FHI strategy
FHI contribution to Universal Access
• Decentralization of ART providers • Training in cluster (piloted sites)• Team work• Involving Expert-patient trainer• Clinical mentoring• Program monitoring• M & E• Health System Strengthening
Piloted Sites for COPC – Jakarta, Malang and Papua
• TB Clinic (PPTI) - Sulianti Suroso Hospital
• Primary Health Center (Gambir) - Tarakan Hospital
• Prison (Salemba) - St. Carolus Hospital
• District Health Offices
• Provincial Health Offices
• District AIDS Commission (DKI)
• Family Heath International
• Other International Agencies: WHO, KNCV and GF ATM
Challenges
• Lack of human resources: task shifting• Collaboration with other teams: TB/HIV• Mainstreaming: Prevention, Care & Treatment • Stigma & discrimination: Confidentiality vs
Secrecy• Involvement of PLHIV: training (EPT),
adherence support (Peer group) & advocacy• M & E system: integration to existing Health
Care System
Team work
Task shifting to volunteers as caregivers
Prison (home) based care
Primary Health Center - Gambir
Expert Patient Trainer
NCD in South East Asia
• On the rise• Managing Chronic Diseases
at Primary Health Care• Lesson learned from HIV chronic care
Lesson learned from HIV
• Empowerment of patients :
self care & peer support group• Simple diagnostic and treatment
protocols• Simple monitoring devices• Transition from acute care only to acute
and chronic care
Support
Prevention Treatment
Care
THANK YOU