Continuum of Comprehensive Response to HIV/AIDS

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Howard Strickland
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1 CONTINUUM OF RESPONSE DR FRED M ASIIMWE DATE: 09/12/2014 Continuum of Comprehensive Response to HIV/AIDS Definition of Continuum of Response (CoR): An approach that helps stakeholders plan for, and provide, a full range of services to address the various prevention, care/support, and treatment needs of people, families, and communities infected or affected by HIV/AIDS 1

2 CoR goal: Maximize health outcomes through Decreasing HIV transmission Slowing down disease progression Improving sense of well being Why is the CoR relevant to Lesotho HIV Response? CoR supports the Lesotho HIV/AIDS response evolution from an Emergency response to a Sustainable response. The CoR approach is in line with Lesotho NSP, PEPFAR Country Ownership paradigm CoR leverages the existing infrastructure CoR supports the evolution of the delivery of patient services from an urgent care model to a chronic care model Global HIV/AIDS response has successfully developed quality prevention, care/support, and treatment programs and needs now to better integrate, link, and coordinate these programs to maximize their impact 2

3 CoR Process Continuum of Prevention, Care and Treatment over the lifespan of the client Commun ity level surveilla nce and Site mapping Review epidemi ology for identific ation of target populati ons Commun ity Planning Community sites Linkage and Integration Service delivery sites Strength en the commun ity response Improve current service delivery sites Ongoing M&E QA/QI Process is much more complex 3

4 CoR is a Multi-sectoral approach Who are the participating service providers? Gov organizations, FBOs, NGOs, CBOs, private sector CoR builds on the existing infrastructure Where are the CoR services provided? Within healthcare facilities, communities, and homes Strive for co-location How are these services accessed and coordinated? They are organized in a formal network They are supported by a functional referral system The CoR uses a multidisciplinary team of providers The Need to Improve Health Efficiencies 20 40% of total health spending is consumed in ways that do little to improve people s health Inefficient mix/inappropriate level of strategies/activities Not right mix of health workers/task shifting Use effective medicines inappropriately Sub optimal quality of care, poor safety Fragmentation 4

5 Retention in HIV care the leaky cascade Testing HIV+ population Tested From testing to treatment initiation Lifelong retention on treatment Not tested Assessed Not assesse d ART eligible Not yet ART eligible Pre-ART care until ART eligible Lost before ART eligible Initiate ART Lost before ART initiation Retained through first year Lost in first year Retained through 5 years Lost by 5 years Baggaley, IAS 2013 Retained years Lost after 5 years Keep kids in the Treatment Cascade: Lesotho situation HIV infected HIV Approx. 15% Diagnosed Enrolled in Care Approx. 25% ART Eligible PLUGGINNG THE LEAKAGES ART Initiated HSS Retention on ART UNKNOWN! 5

6 Diagnostic Access, Treatment and monitoring gaps Diagnostics + Access Impact of Treatment Cascade = EID CD4 Viral Load Uptake Coverage Quality of Treatment Prevention Cascade PEPFAR Lesotho Strategy for Integrated HTC, Care and Treatment Services to support CoR OVC and Communit y Based Care Inputs and Processes Clinical Care and ART (including TB) PITC Clinical Services emtct Communit y Counseling & Testing VMMC Behavior al and OP Outcome and Impact Treatment Scale Up and HIV Incidence Reduction Quality Improvement Approaches 6

7 PEPFAR is Aligning Support to Core and Near-Core Prevention Treatment Care Health System Strengthening PEPFAR s Goals Partnership Opportunity Partner s Business Interest??? Impact of an efficient COR For every 1000 patient-years of treatment: 226 patient death are averted 432 children are not orphaned 60 sexual transmission of HIV averted 39 mother to child transmissions are averted 9 TB cases averted among the HIV infected 2419 life-years gained 7

8 Lesotho Treatment cascade status PLHIV 2013 PMTCT CHILDREN (0-14)HIV+ UNAIDS 2013 data RESULTS 2013 APR 2014/?GOL Q3 With an efficient CoR we can reverse the situation below 8

9 As achieved by the countries below. Lesson learned Recognizing the power of partnerships Building bonds between communities Using standardized tools for data driven response Monitoring not just quantity but quality as well BCC that moves beyond raising awareness On going support Let the community take the lead 9

10 Lastly>>>> A man in a hot air balloon looked down and saw a man walking in a field. He shouted: hey, you, where am I? He looked up and answered: You are in a hot air balloon suspended vertically about 200 feet above the ground with no visible means of descent. Oh, you must be a researcher. Yes, how did you know? You are full of technically correct information that is totally irrelevant to my current situation. Oh, and you must be a policy maker. Yes, how did you know? You do not know where you are; you do not know what to ask to find out what you need; and you are blaming other people for your current situation KEA LEBOHA 10

Global Update on HIV Treatment 2013: Results, Impact and Opportunities

June 2013 Global Update on HIV Treatment 2013: Results, Impact and Opportunities WHO/UNAIDS/UNICEF v2 Outline Results: Progress towards Global Targets - Antiretroviral treatment - Prevention of mother-to-child