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