Kumasi Field Report

1
Kumasi Field Report

• January 15 16, 2007

2
Team Composition

• Mr. Israel Sembajwe, ECA
• Dr. Alfredo MacArthur, NACP Mozambique
• Dr. Bernard Dornoo, WHO-NACP Ghana
• Dr. Richard Amenyah, FHI Ghana
• Cassandra de Souza, World Bank

3
Sites Visited

• Komfo Anokye Teaching Hospital, Kumasi
• St. Michaels Hospital, Pramso
• Obuasi Government Hospital
• AngloGold Ashanti Hospital, Obuasi

4
Health Social Demographics

• Ashanti Region, 21 districts
• Population is 4.2 million
• HIV prevalence 3.0 vs. 2.7 national
• 7 ART sites, 34 PMTCT and VCT sites
• Over 5,000 enrolled patients
• Almost 2,200 patients on ART

5
ART Situation Overview

• ART initiated in region in February 2004
• 6 additional sites added during 2006
• 98 of ART patients are at K.A.T.H
• Most patients are diagnostic referrals,
  presenting late
• Team approach to care (5 trained staff per site)
• Patient inflow follows national protocol
  guidelines
• Walk-in/referral, initial nurse assessment,
  doctor initiated treatment, 3 adherence
  counseling sessions

6
TAP Implementation

• Implementation begun in 2006
• Each site has less than 50 ART patients
• Public private partnership operational eg.
  Obuasi Govt. and Anglogold, St. Michaels, CRS and
  Kumasi South
• Regular monitoring and supervision provided
• Some HBC and community outreach evident eg.
  Anglogold and community engagement Pramso social
  mobilization

7
Laboratory Capacity

• CD4 machines not available in all sites samples
  taken to other sites, strengthen links
• Highly controlled utilization of machines
• Chemical analyzer not available in most sites
• At least 2 motivated and well-trained lab techs
  per site (heavily involved in care)
• HIV lab reagent stockouts in past 6 months
• Prohibitive lab costs for biochemistry tests

8
Pharmacy Capacity

• Pharmacists integrated in overall care provision
  often serve as adherence counselors
• Regular drug monitoring and reporting
• No stockouts in last 6 months for 1st line
  regimen
• Shortage of 2nd line drugs at K.A.T.H.

9
Integration/Linkages

• PMTCT and TB are integrated
• STIs referral linkage is weak
• VCT weak generally, mostly diagnostic CT which is
  well integrated

10
Supporting Activities

• Training for 5 staff per site prior to ART
  initiation
• Regular technical support provided (for TAP
  sites)
• Regular programmatic supervision by regional AIDS
  coordinator (quarterly)
• Strengthen the quality assurance system for
  scaling up to new sites to monitor adherence to
  standards (with checklist)

11
Monitoring Evaluation

• Sites provide monthly programmatic reports to
  Regional AIDS Coordinator (K.A.T.H. sends direct
  to NACP)
• TAP sites provide monthly reports to implementing
  partner (FHI,NCHS unclear)
• Data collected but not locally analyzed and
  utilized for programmatic decisions
• Utilization of national reporting format for
  figures, age and gender defined

12
Good Practices

• Public Private Partnership
• Good collaboration between Anglogold and Obuasi
  hospitals
• Where available, engagement of other partners
  (CRS and St. Michaels)
• Team approach and skills mix
• Self-motivated and committed lab technicians and
  pharmacists
• Free services to employees and dependants at
  Anglogold
• Staff mentoring by IPs

13
Constraints/Challenges

• Cost, cost, cost, cost!
• Chemical analyzers needed
• Space limitations in some sites
• Late entry into care
• Adherence monitors sometimes challenging
• Human resource limitations
• Low utilization of ART services
• Low community mobilization and interventions
• Stigma

14
Recommendations

• Regular and well-planned technical support and
  supervision should be strengthened
• Strengthen quality assurance system for new sites
  to monitor adherence to standards (with
  checklist)
• VCT promotion highlighted as a primary prevention
  mechanism and for early ART initiation
• Significant improvement in community outreach
  activities social marketing of VCT and ART
  marketing
• Need aggressive identification of paediatric
  cases
• Provision of basic lab equipment
• Strategic HR capacity building for all sites
  need-based
• Localized data analysis and utilization for
  ownership
• Review of 50,000 cedis package charge and policy
  guidance on use of these funds
• Inclusion of ARVs in health insurance scheme

15

• Obrigado
• Webale Nnyo
• Me da se
• Zikomo