AIDS Programme Management

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AIDS Programme Management

  1. 1. National STD/AIDS Control Programme Dr. Ajith Karawita MBBS, PGDV, MD National STD/AIDS Control Programme
  2. 2. Contributing to a healthier nation through sexual health promotion, emphasizing the prevention, control and provision of quality care for STIs including HIV and AIDS 2 Mission Vision Quality sexual health services for a healthier nation.
  3. 3. STI service delivery points Service delivery points No 1 Full time STD clinics 29 2 Branch clinics 21 3 IDH 1 ART centers 1 Central clinic, Colombo 2 STD clinic, Kalubovila 3 STD clinic, Ragama 4 STD clinic, Kandy 5 IDH PROGRAMME AREAS (includes clinical and preventive components) 1 Administration 2 Counselling and testing 3 Epidemiology 4 Financial management 5 HIV treatment, care and support 6 IEC and condom promotion 7 Multisectoral programme 8 Planning and coordination 9 Laboratory services & infection control 10 PMTCT 11 STD care 12 Strategic information management 13 Training and capacity building
  4. 4. HMP Health Master Plan (has 5 strategic areas) (10 year) 1. Health service delivery 2. Community empowerment 3. Human resource development 4. Financing , Resource allocation & Utilization 5. Stewardship & management of the health sector Programme areas of Health service delivery 1.1 Programme for organizational development 1.2 Medical supplies 1.3 National quality assurance 1.4 Disease control programmes 1.5 Programme for vulnerable populations 1.6 National Nutrition programme 1.7 Health promotion programme 1.4. Disease control programmes (has 28 areas) STD/AIDS CONTROL National STD/AIDS Control Programme
  5. 5. National STD/AIDS Control Programme, Sri Lanka National STD/AIDS Control Programme and the Central Clinic Strategic Information Management Unit of the National STD/AIDS Control Programme
  6. 6. Partners in the STD/AIDS Control • Government – National STD/AIDS Control Programme, NBTS, NDDCB, Epid unit, FHB, HEB • Private sector partners (Business coalition) • Civil society organizations (NGOs, CBOs, FBOs) – E.g. Sarvodaya, CSDF, COJ, Alliance Lanka, MMM – Family planning association • Development partners (UN agencies, Other INGOs)
  7. 7. STRENGTHS FOR ACTION: POLICY AND LEGAL FRAMEWORK
  8. 8. National Policy Framework for HIV Prevention Interventions • Constitution • National Health Policy • National AIDS Policy • National Policy on HIV/AIDS in the world of work • Draft MCH policy • Draft National Blood Policy • Health Promotion Policy
  9. 9. STRENGTHS FOR ACTION: INTERNATIONAL POLITICAL TOOLS AND COMMITMENTS
  10. 10. Resolution adopted by the General Assembly related to HIV/AIDS 1989: Convention on the Rights of the Child (CRC) 2000: UN security council resolution 1308 2000: United Nations Millennium Declaration 2000: Review of the problem of HIV/AIDS in all its aspects 2002: The rights of the child 2004: Follow-up - Declaration of Commitment on HIV/AIDS 2004: Access to medication in pandemics - HIV/AIDS, TB & M 2004: Rights of the child 2004: Regional call for capacity-building in public health 2004: Scaling up treatment and care
  11. 11. Resolution adopted by the General Assembly related to HIV/AIDS 2005: International cooperation against the world drug problem 2005: 2005 World Summit Outcome 2006: Political Declaration on HIV/AIDS 2007: Trafficking in women and girls 2007: Rights of the child 2008: Towards global partnerships 2009: The protection of human rights in the context of HIV/AIDS 2010: Policies and programmes involving youth 2010: Achieving universal access for DU, PLHIV/affected by HIV 2010: WHO HIV strategy 2011-2015 2010: UNAIDS HIV strategy 2011-2015
  12. 12. The Millennium Development Goals (MDGs) Eradicate Extreme Poverty and Hunger Improve Maternal Health Achieve Universal Primary Education Combat HIV/AIDS, Malaria and other Diseases Promote Gender Equality and Empower Women Ensure Environmental Sustainability Reduce Child Mortality Develop a Global Partnership for Development
  13. 13. National Guidance of the Programme/Commitments • Health Master Plan (10 year) – Supported by Mid-term plan (3 year) – Annual Health Plan • National Strategic Plan (NSP) based on external reviews • GFATM performance frameworks (R6, R9)
  14. 14. National STD/AIDS Control Programme, Sri Lanka National STD/AIDS Control Programme and the Central Clinic Strategic Information Management Unit of the National STD/AIDS Control Programme
  15. 15. ORGANOGRAM, National STD/AIDS Control Programmes 17
  16. 16. Committees • National AIDS Council • National AIDS committee with subcommittees for each programme components – Prevention sub committee – HIV clinical care and counseling sub committee – Laboratory and surveillance sub committee – Strategic Information Management (SIM) – IEC subcommittee – NGO sub committee – Legal and ethics sub committee • Provincial AIDS Committees • Programme director and the senior management team (SMT)
  17. 17. PROGRAMME AREAS (includes clinical and preventive components) 1 Planning and coordination unit 2 Capacity building and training unit 3 STD unit 4 PMTCT unit 5 HIV Care and treatment unit 6 Multisectoral coordination unit 7 Counselling and testing unit 8 IEC and condom promotion unit 9 Laboratory services unit 10 Strategic information management (SIM) unit (M&E, Surveillance, Research) 11 Financial management unit 12 Administration unit
  18. 18. National Strategic Plan (NSP) 2007-2011
  19. 19. Goals and Strategic Objectives in the National Strategic Plan The goals of the National STD/AIDS Control Programme  Maintain current low prevalence of HIV among most-at-risk- populations (MARP) and the general population  Improve the quality of life of people infected with, or affected by HIV The strategic objectives 1. Increase coverage and effectiveness of prevention interventions 2. Increase coverage and effectiveness of care, support and treatment interventions
  20. 20. Strategic Approach in the National STD/AIDS Control Programme Strategy 1: Prevention Strategy 2: Treatment, care, and support Strategy 3: Generating and using strategic information Strategy 4 Multisectoral involvement and decentralization Strategy 5 Policy development and legislation Strategy 6: Strengthening national coordination and management capacity
  21. 21. Strategy 1: Prevention
  22. 22. Increased scale and quality of comprehensive interventions for MARPs: FSW & clients, MSM, IDU/DU and prisoners. • Routine interventions for MARPs by the network of National STD/AIDS Control Programme clinics through staff of the 28 fulltime STD clinics and 21 branch clinics. • Mapping of MARPs as a pilot project and implementation of micro- planning • Under GFATM R9 – Provision of sexual health services for MARPs including beach boys. • Routine provision of services for prisoners through prison hospital network in Sri Lanka include management of SRH issues, referrals for STI care, HIV care and HIV counselling and testing services. • Under GFATM R9-Provision of sexual health services for prisoners • Under GFATM R9-Social mapping of these populations for TIs
  23. 23. Increased scale and coverage of HIV communication interventions for general population and lesser risk populations (youth, migrant workers, etc.) • Routine IEC programmes through network of service delivery points in the NSACP • Mainstreaming of SRH and STI and HIV issues to Education sector, inclusion of HIV/AIDS in to school curriculum through National Institute of Education (NIE) • Under GFATM R6-education of school children in sabaragamuwa province • Under GFATM R6-awarness programmes for plantation sector workers (60 estates in 5 districts) • Mass media campaigns • World AIDS Day campaigns (public, private and civil society organizations)
  24. 24. Increased quality and coverage of STI services. • Provision of STI services through delivery points of NSACP and private practitioners STI service delivery points Total number of STI clinics 29 Branch clinics, Yellow 21 STI clinics with ART facility, (Blue pins) 4 Non STI units with ART facility (IDH) 1
  25. 25. Increased quality and coverage of PPTCT services • Four prong approach is used – Prong 1: Primary prevention of HIV, especially among pregnant women and young people; – Prong 2: Prevention of unintended pregnancies among HIV-infected women; – Prong 3: Prevention of HIV transmission from HIV-infected women to their children; – Prong 4: Treatment, care and support to HIV-infected women and their families • Opt out HIV screening among urban antenatal mothers (Colombo district hospitals, DMH, CSHW, Gampaha, Kalutara) • Provision of prophylaxis through STD clinic delivery points (onsite and referred basis) • Training of HCWs on PPTCT, Breast feeding options etc.
  26. 26. Increased quality of blood transfusion services. • HIV screening commenced in 1987. (Now using 11 days window period ELISA for screening) • No Blood transfusion related HIV infection reported since year 2000 • So far 3 cases of transfusion related HIV infections reported (0.4% of all HIV cases)
  27. 27. Reduced transmission in the health services • Implementation of standard precautions for HCWs through infection control units • Provision of post exposure prophylaxis • Developed SOPs for STI care services • Prevention of biohazards – use of safety precautions e.g. Safety cabinets • Safe waste disposal systems • Training of STD clinic staff and infection control unit staffs for PEP
  28. 28. Strategy 2: Care, treatment and support
  29. 29. Increased quality and use of counselling and testing services. • Counselling and testing services are integrated to the service delivery points of the NSACP. • Under GFATM R6-Counselling and testing model introduced to plantation sector workers (26 centres) • Training on HIV counselling and testing for HCWs – International and national level.
  30. 30. Increased quality and coverage of HIV and AIDS treatment services • ART is provided through 28 STD clinics (4 centres are on site drug dispensing units, others are referral and follow up centres) • ART is also provided through one identified Base Hospital (former infectious disease hospital) in Angoda • Slandered treatment protocols are use for treatments and M&E. E.g. WHO guidelines, BASHH guidelines etc • All eligible patients are given ART.
  31. 31. Increased quality and coverage of home and community based care for PLHIV • Low prevalent country – Not a huge issue • Home and community-based care is provided through some NGOs • Training of family members for provision of care • Home visits are done form Gov. STI service providers if necessary
  32. 32. Strategy 3: Generating and using strategic information
  33. 33. • National integrated behavioural and biological surveillance (IBBS) implemented, documented and disseminated • Formative and operational research implemented, documented and disseminated • HIV/AIDS related services monitored, documented and disseminated through national progress reports.
  34. 34. Strategy 4: Multisectoral involvement and decentralization
  35. 35. Increased engagement and capacity of NGOs in prevention, care and policy development. • Provision of training and capacity building for NGOs • NGOs represent in the National AIDS Committees, sub committees, provincial AIDS committees.
  36. 36. Increased engagement and capacity of key ministries/departments. • Mainstreaming of HIV/AIDS concerns in to the relevant wok plans of the ministries and other departments – Department of Education and National Institute of Education (NIE) – Foreign employment bureau – Department of fisheries and aquatic resources
  37. 37. Strategy 5: Policy development and legislation
  38. 38. Policy development and legislation • Supportive National HIV/AIDS policy passed • Sectoral HIV/AIDS policies developed in accordance with the NAP • Compassionate and supportive attitudes improved among lawmakers, advocates, law enforcers etc
  39. 39. Strategy 6: Strengthening national coordination and management capacity
  40. 40. ORGANOGRAM, National STD/AIDS Control Programmes 42
  41. 41. The “Three Ones” principles • The "Three Ones" are a set of principles for the coordination of national AIDS responses • These principles were endorsed at a high-level meeting held on 25 April 2004 and co-hosted by UNAIDS, the United Kingdom and the United States. The “Three Ones” principles are: • One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. • OneNational AIDS Coordinating Authority, with a broad-based multisectoral mandate. • Oneagreed country-level Monitoring and Evaluation System.
  42. 42. One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. National Strategic plan
  43. 43. One National AIDS Coordinating Authority, with a broad-based multisectoral mandate. National AIDS Council National AIDS Committee Sub committees
  44. 44. One agreed country-level Monitoring and Evaluation System. National AIDS Council National AIDS Committee Surveillance, M&E subcommittee
  45. 45. GFATM and other Project Frameworks
  46. 46. PROJECT OR PROGRAMME AREAS Progress of GFATM R6 activities in GFATM R9.con R6 proposal (HIV component) School sector project (GFATM R9.con R6), Sabaragamuwa Province Plantation sector project Treatment, care and support for people living with HIV/AIDS under GFATM R6 Other projects and programmes Police awareness programme under UNFPA funds in the Colombo and Gampaha Districts Development of National HIV/AIDS policy National World AIDS day programme Programme for the Elimination of congenital syphilis by 2015 (WHO funded project)
  47. 47. PROJECT OR PROGRAMME AREAS Major activity areas under GFATM R9 (HIV component) 1. Provision of Sexual health services for FSWs 2. Provision of Sexual health services for MSM 3. Training of STD clinic staff 4. Provision of Sexual health services for BB 5. Provision of harm reduction Sexual health services for BB 6. Provision Sexual health services for prisoners 7. Procurement of health products 8. Increase quality of VCT services 9. Increase quality and coverage of HIV/AIDS treatment services 10. Formative and operational research 11. Planning and administration on M&E 12. National size estimation of MARPs
  48. 48. What next and future?
  49. 49. 2011 Political Declaration: Targets and elimination commitments • Achieve universal access to HIV prevention, treatment, care and support by 2015 • Targets and commitments

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