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Universal ART Scale up: Delivering the second Wave

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Peter Mugyenyi FRCPI, FRCP Edin, ScD. Joint Clinical Research Centre, Kampala, Uganda ... Greetings from Uganda. in. the heart of Africa ... – PowerPoint PPT presentation

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Title: Universal ART Scale up: Delivering the second Wave


1
Universal ART Scale up Delivering the second
Wave
  • The Situation in Uganda

Peter Mugyenyi FRCPI, FRCP Edin, ScD Joint
Clinical Research Centre, Kampala, Uganda XVII
international AIDS Conference, Mexico, Wednesday
6, August 2008
2
Greetings from Uganda in the heart of Africa
3
Uganda ART programme of Partnerships and
collaborations
  • Ministry of Health
  • JCRC
  • TASO
  • Elizabeth Glaser Pediatric AIDS Foundation
  • UWESO
  • Health Alert Gulu
  • World Vision
  • GTZ Fort Portal
  • AVSI Hoima
  • AFXB
  • Pentecostal, Anglican, and Catholic churches
  • Mildmay
  • Academic Alliance
  • MU-JHU
  • Walter Reed
  • Mbarara University of Science and Technology
  • etc

4
Joint Clinical Research Centre (JCRC)Founded 1991
  • Strategic Joint venture
  • Ministry of Health
  • Makerere University
  • Health Dept Ministry of Defense
  • Planned to maximize scanty resources

Goal To address the national AIDS crisis in
partnerships especially with MOH
5
JCRC successful PEPFAR funded ART roll out TREAT
programme
JCRC
6
JCRCs approach to ART scale up.
  • Initial emergency response
  • Maximize available infrastructure
  • Low cost Renovations
  • Improvisation where necessary
  • Addressing Sustainability
  • Infrastructure stepwise approach
  • human resource development to go side with
    expansion of services
  • Integrating ART services into improved continuum
    of care services
  • Need for longer term commitment of donors as AIDS
    treatment transforms from emergency to Chronic
    illness management.

7
  • Community mobilization information and
    communication

8
Best practices for introducing ART to the
community, aimed at breaking stigma, promoting
community ownership and IEC
Drama Children act AIDS death
Community participation
Parade by students
Spectacular community Concerts
9
  • JCRC -TREAT provides ART in over 75 places
    (Public and private) in diverse parts of Uganda
    regardless of the infrastructure state.
  • Addressing Infrastructure

10
Taking ART to Mubende where there we found no
infrastructure for a clinic..
JCRC
  • Mubende

11
Tent in Mubende before use
Space was cleared and a tent was put up
12
Tent in use at Mubende
Functional Mubende clinic the following week .
13
Mubende ART clinic Now
Modern laboratory
Lab equipment
14
  • Addressing human resource deficiency

15
The Challenge of Human Resource
  • Critical nationwide shortage of skilled manpower
    in clinical, laboratory, and counseling/adherence
  • Recruitment and retention of staff
  • Placing critical personnel in RCEs and high
    volume areas
  • Improving working conditions and adequate
    compensation of staff

16
Training
  • The training offered in form of training
    workshops, placements in clinics and labs, hands
    on training, e-education and formal courses
  • Training in ART provision, HIV related palliative
    care, TB treatment/ prophylaxis, strategic
    information and laboratory management.
  • Training of support lay, staff and community
    volunteers and development of training syllabuses
    and manuals
  • Expertise from within and outside the country
    have been utilized.

17
  • The
  • achievements
  • of the
  • JCRC TREAT programme
  • to-date.

18
Cumulative patients on ART from JCRC supported
centers, 2004-2007
19
Over 50 satellites and 25 outreaches established
by TREAT
20
Geographical location of JCRC Regional Centre of
Excellence (RCE)

SUDAN
Moyo
Yumbe
Kitgum
Adjumani
Arua
Kotido
Pader
Gulu
DEMOCRATIC REPUBLIC CONGO
Moroto
Nebbi
Lira
Apac
Katakwi
Nakapiripirit
Masindi
Kaberamaido
Soroti
Kumi
Kapchorwa
Hoima
Nakasongola
Sironko
Pallisa
Kamuli
Kiboga
Kibaale
Fort Portal
Kayunga
Luwero
Iganga
Mbale
Tororo
Kabarole
Bugiri
Mubende
Jinja
Kyenjojo
Busia
Mayuge
Mukono
Waikiso
Kampala
KENYA
Kasese
Kamwenge
Mpigi
Sembabule
Masaka
Mbarara
Bushenyi
Kalangala
Rukungiri
Rakai
Kanungu
Ntungamo
Kabale
Kisoro
TANZANIA
KEY
RWANDA
Mbarara region
JCRC Site
Centre of excellence
Kabale region
Kampala region
Fort Portal region
Mbale region
Gulu region
21
JCRC infrastructure - centers of excellence in
Uganda
Joint Clinical Research Centre Research ART scale
up Drug, and lab logistic management OVERALL
COORDINATION
Mbarara serving the south west
Fort Portal serving the West
MbaleEastern Uganda
Inside Fort Portal lab
Kabale Southern Uganda
22
A network of JCRC RCE provide nation wide
referral laboratory services
  • CD4 and Viral load available locally in at least
    one centre in each region
  • DNA PCR infant diagnosis done in all RCEs
  • HIV and TB Resistance testing done in main JCRC
    lab in Kampala

Photo from Botswana programme
23
Other TREAT establishments
  • Adherence programme
  • Communications strategy
  • A treatment campaign TREAT FOR LIFE has been
    rolled out countrywide
  • IEC materials have been produced
  • Logistics for drugs, laboratory supplies and
    equipment maintenance
  • Support supervision, Monitoring and Evaluation in
    place

24
Current state of epidemic in Uganda
  • Prevalence rate 6.4 (Adult population 15 49
    years)
  • About 1,100,000 living with HIV Adults 950,000,
    Children 150,000.
  • 1,000,000 Children orphaned by AIDS
  • 2007 132,500 new infections, 25,000 due to MTC,
    78,000 pregnant women with HIV
  • 2008 130,000 adults on ART out of estimated
    280,000, and 10,000 Children out of estimated
    52,000.

25
Challenges to address in second wave
  • Theme
  • From crisis management to quality,
    sustainability, and integration into an improved
    continuum of health delivery
  • Without improvement in general /public
    health care services HIV/AIDS specific programme
    are ultimately futile and unsustainable.

26
Challenges to address in second wave-1
  • Rehabilitation of public sector infrastructure,
    sharing of facilities and establishing new
    appropriate infrastructure at all levels of
    health care delivery.
  • Laboratory services providing CD4 and VL at all
    regional and high volume district hospitals
  • Establishing basic laboratory services at health
    centers To include HIV Testing, TB and Malaria
    diagnosis.

27
Challenges to address in second wave-2
  • Programme to support and develop critical mass of
    human resource
  • Improve working conditions of public sector
    workers to minimize both internal and external
    brain drain
  • Strengthen training and include community
    volunteers and lay providers to support adherence
    and to undertake other low tech but high demand
    services

28
Challenges to address in second wave-3
  • Scale up to include hard to reach and other
    underserved areas
  • Special incentives for staff to work and stay in
    rural areas
  • Establish national robust logistics for drugs and
    laboratory services access to all levels
  • Quality and sustainable services
  • Adherence and counseling to be strengthened and
    integrated for best treatment outcome
  • TB and HIV services to be at least linked for
    better management of HIV

29
Conclusion
  • Uganda must harness the available HIV/AIDS
    expertise, logistics and facilities for
    strengthening and eventual integration into an
    improved national general delivery of health care
    services.

30
With sufficient support Uganda is ready for
Quality Universal ART access
Thank you
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