# Presentation: 417358

## Scaling-up ARV Therapy For HIV/AIDS In Zambiaprogress report2002-2004

- V.C. Mtonga
- Director Clinical Care and Diagnostic Services-CBOH

## History of ARV Therapy in Zambia

- HAART became available in the private sector in Zambia as early as 1996 soon after it became available in the west.
- The number of patients on HAART in Zambia by 2002 was estimated at just over 1,000 patients.

## History of ARV Therapy in Zambia

- In 2002 the government took a policy decision to introduce HAART in the public hospitals.
- 12 billion kwacha was made available to purchase ART for up to 10,000 PLWHA.
- This programme involved the phased implementation of the programme starting with Lusaka and Ndola(2002) and spreading to all provincial capitals(2003).

## What Is the Current Status of the GRZ Programme?

- To date 52 centers are operational.
- National treatment guidelines and training manuals have been developed.
- HR capacity building undertaken – teams trained(Dr,Nurses,Lab,Pharm,counsellor, nutritionist) –ART,

## What Is the Current Status of the GRZ Programme?

- HR cap. Building contd
- OI training –use Diflucan in severe fungal infection
- Logistic Management – DILSAT
- Local Study tours undertaken
- ART national trainers has been trained and will soon be conducting trainings across the country

## What Is the Current Status of the GRZ Programme?

- Laboratory Support
- Medical supplies & reagents – centers using hosp. Allocation & supplement using cost sharing funds
-  The programme has with the help of JICA began introducing dynabeads technology for CD4 monitoring of patients on HAART at all the provincial centers

## What Is the Current Status of the GRZ Programme?

- Documentation & Accountability
- Various record forms & registers developed
- Draft M & E tool developed
- Operational Research
- -Resistance tracking
- -ART Work force & costing studies done

## What Is the Current Status of the GRZ Programme?

- An estimated 8,000 patients are already accessing HAART through this programme.

## Emerging Issues

-    Logistic management of drugs needs to be strengthened:
- -	Drug order form not authenticated on time, therefore cause delay for one hospital for additional supply.
**-****	****National ART Drug Stock Levels:  See annex 11 –** Some combinations expiring by August 2004. (See appendix II1 for action taken).

- -	ART drugs packaging too large e.g. Eferverenz and Indinavir – 3 boxes and 12 boxes per month respectively.

## Cost sharing

-   Cost-sharing: - Difficulties experienced in effecting exemptions therefore some patients not accessing care due to lack of funds.
- -	Review of cost sharing guidelines required to possibly reduce the contribution from the patient.
- -    Orientation to cost sharing guide for institutions
- -    Public debate on social criteria for accessing ART

## Monitoring & Evaluation

- --- Data management – Data collecting tools and reporting formats need to be harmonized
-   - Patient Tracking
-    Computerization of patient records necessary Requires robust system that ensures patient confidentiality, with password access and  accessible from any part of Zambia.

## Community mobilisation

- Needs strengthening-
-    some IEC materials available
-    Active community radio programmes
**Requires communication for social change   **

## WAY FORWARD

-  1. Increase access to ART
- Increasing ART centres
-     - training under way:started 11.04.04
-      targeting 30 districts nationally, 33                    new centres opened
-  distribution ART to hospices, Defence          forces, Mines, Private sector, mission hosp

## Way forward contd

- Distribution & sales of ART to designated private clinics and pharmacies thro’ MOUs
- Follow-up request to NZPplus & ZNAN to access ART

## Way forward contd

- 2. Develop & implement communication strategy
- Development of strategies from recommendations of partners meeting on CSC held on 31st March –2nd April 04
- Develop & Disseminate ART IEC materials including treatment literacy

## Way forward contd

-  3. Dev. MTCT plus guidelines, pocket size HIV guidelines
-    4.Finalize M& E tool (M&E TWG NAC) and operationalise computerised patient records

## Way forward contd

-  5 conduct operation research
- Contd Resistance tracking(UTH-Virology)
- Adherence studies
-    -community based DOTs & HAART                                     -community education & referral;supporting adherence to ART & prevention for PLWHA

## Way forward contd

- 6 Disseminate cost sharing guide
- 7 Approval of finalized implementation plan and Policy operational guidelines

- ART SCALE UP IMPLEMENTATION PLAN

## Scaling up ARV Therapy From 10,000 to 100,000 PLWHA

- Of the estimated 900,000 PLWHA in Zambia, between 150,000 to 250,000 required to be on HAART.
- Thus the current programme will only provide HAART to approx 10% of patients requiring HAART.

## Scaling up ARV Therapy From 10,000 to 100,000 PLWHA

- Zambia has embraced the global 3 by 5 target, that aims to have 3 million people worldwide on antiretroviral treatment by the end of the year 2005.

## Strategic Objectives and Activities Under the Implementation Plan

- The **goal** of scaling-up ART is to provide **universal access** to treatment for all people in Zambia who need it.
- The immediate target is to put **100,000** people in Zambia on antiretroviral treatment by the end of **2005**.

## Strategic Objectives an Activities Under the Implementation Plan

- Objective # 1 Develop a conducive supportive environment to rapid ART scale-up
**Activities**
-  Enabling policy/legal environment
- Dev public-private partnership

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 2 Expand provision of ART services in all sectors in Zambia.
**Activities **
- Expand identification of people advanced HIV infection**.**
- Identification and assessment of new ART sites.
- Build capacity of health facilities to deliver ART.

## Strategic Objectives and Activities Under the Implementation Plan

- Develop/update ART guidelines & protocols
- Certify ART delivery centres.
- Provision ART by all certified ART centres.

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 3 Dev national HR capacity to deliver ART
** ****Activities**
- Put in place national HR plan
- Produce new health professional graduates competent in ART delivery

## Strategic Objectives and Activities Under the Implementation Plan

- Provide practising health professionals with competencies ART delivery.
*    **Training of trainers*.
*Training for ART Teams*.
*Training for specific areas*.
*Training for communities*
- Train non health agents to support ART delivery
- Recruit, motivate &retain health care providers.

## Strategic Objectives and Activities Under the Implementation Plan

- motivate &retain non health agents
- Promote public-private partnership

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 4 Strenghen infrastructure & laboratory capacity for ART scale-up.
** ****Activities**
- Draft national minimum standards for infrastructure, lab pharmacy& imaging facilities
- Refurbishment/upgrading to meet national min standards

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 5 Strengthen the role of communities in provision of ART.
** ****Activities **
- Develop national ART communication strategy
- Conduct Treatment Awareness Education
- Provide input ART into anti-stgma activities.

## Strategic Objectives and Activities Under the Implementation Plan

- Support media to adequately address ART issues.
- Provide tools for districts to suport ART capacity for community support groups

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 6 Strengthen ART procurement, storage & distribution
** ****Activities.**
- Strengthen ART drugs & medical supplies logistic management ststems.
- Ensure availability of food for indigent patients starting ART

## Strategic Objectives and Activities Under the Implementation Plan

-  Ensure a continuous availability & Quality of ARV drugs and other supplies.
- Ensure rational use of AIDS drugs & medicines

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 7 Strengthen ART program  monitoring, evaluation & research
**Activities**
- Institute national M&E for ART
- Put in place national ARV drug resistance surveillance system

## Strategic Objectives and Activities Under the Implementation Plan

- Carry out operational research to guide ART scale-up
- Adherence
- Tracking emergence HIV drug resistance strains & minimising emergency
- Role of DOT for ART
- Health outcome & quality of life

## Strategic Objectives and Activities Under the Implementation Plan

- Objective # 8 Strengthen programme management, coordination & resource mobilisation.
** ****Activities **
- Strengthen coordination & supervision of national ART program .

## Strategic Objectives and Activities Under the Implementation Plan

- Utilise TA of CPs for information  collection on areas of comparative needs & advantage, database of partner mandates & technical specialisation
- Mobilize adequate resources for ART scale-up

## Implementation Plan 2004 to 2005

- Implementation of the plan will begin in early 2004 with the official launching of the programme.
- The **first quarter** of 2004 will be devoted to finalizing guidelines and developing the various systems required for the programme.

## Implementation Plan 2004 to 2005

- The **second quarter** will be for initiating training activities, equipping facilities, mobilizing communities and opening new ART centres.
- The **third and fourth quarters** will focus on strengthening recruitments to ensure that centres are operating at full capacity.
- In **2005**, the focus will be on increasing the number of ART sites and the numbers of people using them.

- THANK YOU FOR LISTENING