Title: Universal ART Scale up: Delivering the second Wave
1Universal ART Scale up Delivering the second
Wave
Peter Mugyenyi FRCPI, FRCP Edin, ScD Joint
Clinical Research Centre, Kampala, Uganda XVII
international AIDS Conference, Mexico, Wednesday
6, August 2008
2Greetings from Uganda in the heart of Africa
3Uganda 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
4Joint 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
5JCRC successful PEPFAR funded ART roll out TREAT
programme
JCRC
6JCRCs 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
8Best 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
10Taking ART to Mubende where there we found no
infrastructure for a clinic..
JCRC
11Tent in Mubende before use
Space was cleared and a tent was put up
12Tent in use at Mubende
Functional Mubende clinic the following week .
13Mubende ART clinic Now
Modern laboratory
Lab equipment
14- Addressing human resource deficiency
15The 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
16Training
- 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.
18Cumulative patients on ART from JCRC supported
centers, 2004-2007
19Over 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
21JCRC 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
22A 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
23Other 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
24Current 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.
25Challenges 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.
26Challenges 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.
27Challenges 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
28Challenges 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
29Conclusion
-
- 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.
30With sufficient support Uganda is ready for
Quality Universal ART access
Thank you