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  • 1. Scaling-Up HIV Treatment Experience from Cameroon in Operational Research: Main outcomes Sinata Koulla-Shiro MD Chief, Division Of Operations Research, Cameroon, Vice Chair, National AIDS Control Committee and Infectious Disease Service,Yaoundé Central Hospital XVII International AIDS Conference 3-8 August 2008, Mexico City
  • 2. OUTLINE
    • Background
    • The Public Health Approach to Scaling –Up
    • Cameroon Model of scaling-up ARV drug access
    • Operations Research and scaling-up programme
      • Characterisics
      • Main Outcomes
      • Key challenges
  • 3. Background (1/2)
    • 2001: 1 st UN General Assembly Special Session on HIV/AIDS(UNGASS):Targets and member states committment
    • 2004- 2005: Political Committment accompanied by flow of financial ressources(Domestic, multilateral, Bilateral and Private)
    • 2006: UNGASS: Countries agreed toward Universal Access to Comprehensive Prevention, Care and Support by 2010
  • 4. Background (2/2)
    • 2007: Better tools led to Readjustment of figures by UNAIDS and WHO
      • 33 million people live with HIV at global level
      • 2.7 million people newly infected in 2007
      • 9.7 million need treatment in low and middle income countries end 2007 (WHO,UNAIDS,UNICEFprogress report)
    • Unprecedented Momentum of Antiretroviral Treatment in Africa
      • 3 million received ART and >2 million in sub-saharan Africa
      • Access equal or higher among women
      • Adherence equal or greater than un Europe and North America
  • 5. Number of people receiving antiretroviral therapy in low- and middle-income countries, 2002–2007
  • 6. Antiretroviral therapy coverage in sub-Saharan Africa, 2003–2007
  • 7. Women as a percentage of all people receiving antiretroviral therapy versus women as a percentage of all people needing treatment, selected low- and middle-income countries, 2007a 10% 40% 50% 60%
  • 8. The public health approach to scaling up antiretroviral therapy
  • 9. Cameroon Approach to Scaling –Up HIV Drug Access
    • 2001-2002 ART Programme mainly at Central and Regional levels
    • 2003:Standardized guidelines for ART in place
    • 2004:Decentralization to District Hospitals catalysed by WHO « 3by5 » Initiative
      • Strenghthening Health sysytem (procurement, laboratory, task shifting, M/E tools)
      • Subsidies allocated to initial and follow up lab tests
    • 2005:Mentorship Strategy: Tertiary/2ndry hospitals mentor Primary District Hospitals
      • Training and supervision
      • Referral for laboratory tests
      • Referal for complex cases
      • Process accompanied by Operational Research(ANRS)
  • 10. Source: NACC Progress Report
  • 11. National Coverage of Antiretroviral Treatment Sites in Cameroon, 2005 Source: NACC
  • 12. Accredited Treatment centres (ATC) Mentors per province Management Units(MU) Number of MU mentored National Coverage of ART Management Units and Mentors, 2006 5 12 4 4 7 5 4 6 5 5
  • 13. Figure 6 : Evolution du nombre des malades sous ARV au Cameroun: juillet 2005 à décembre 2007 Source: NACC, 2008
  • 14.  
  • 15. Adult First Line ARV Regimens used in Cameroon, 2008 Source: NACC Progress Report, April 2008
  • 16. Source: NACC Progress Report, April 2008 First Line ARV Regimens used for Children in Cameroon, 2008
  • 17.  
  • 18.  
  • 19. Components of Scaling-Up Operations Research
    • 4 Complementary Projects
      • ANRS 12110 trial Stratall,Charles Kouanfack
      • ANRS 12120: Problematic of Access to Treatment: Advances, Limits and perspectives of decentralization, F. Eboko
      • ANRS 12108: Scaling –Up and Procurement of Drugs and Biological Tools, B. Coriat/M.J Essi (Presented yesteday)
      • ANRS 12116: Impact of Access to HIV Management and living conditions of Patients, J. P Moatti/SC Abega
  • 20. The Eval ANRS 12116 Study
    • Primary Objective: Evaluate the quality of care of patients on ART
    • About 3000 patients; 26 Health care Facilities;Urban and rural
    • Variables studied
    • Medical Effeciency:
    • Sociobehavioral Factors
      • Adherence to treatment
    • Health Related Quality of life
    • Sociodemograhic and economic factors
      • Cost effectiveness
      • Equity
      • Impact on risky behaviour:
      • Impact on Health System
      • KAP
  • 21. Outcome of decentralization
    • Early outcomes better at district level :
      • Early access to treatment
      • HIV service performance
      • HRQL especially mental
      • Adherence to therapy
      • Task shifting
      • Positive role of associations of PLWH
    • Patients perception in favour of decentralization
    • Financial accessibility of HIV services remains a major barrier
    • Other Challenges of ART scale-Up
      • ARV drug stocks out
      • unsafe sex common among PLWH on ART and erronous beliefs that ART efficacy prevents HIV transmission is a major determinant
      • Unfelt impact of Community relay workers: need revisiting
      • Health workers dissatisfied with working conditions
      • Sustained efforts on HIV Prevention
  • 22. Impact of 3 scenarios on HIV infection in sub-saharan Africa, 2003-2020