FHI Experience in scaling up HIV care and treatment

Dr. Hendra Widjaja

Mortality rate due to AIDS

2.0 Developing countries

1.5 1.0 0.5

Anti Retroviral Treatment

Developed countries

a s a s h aed y r aeY t l 5991

0.0

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2003

HIV in Indonesia
Life Threatening Illness (before 2004)

Chronic Manageable Illness (after 2004)

ARV drugs are not enough !!!

ART is for life Side effects monitoring High level of adherence (> 95%) Resistance to drugs unforgiving We need Good Chronic Care strategy

HIV - Chronic disease

HIV Opportunistic Infection: TB Mental Disturbance: Addiction Co-infection: Hepatitis B/C Side effects: Hyperlipidemia

Components of comprehensive

HIV/AIDS Care, Support and Treatment

Respond to chronic care challenge

Team work training Integrated training modules Counseling and Support Patient Monitoring Tools Collaboration with other diseases Networking - CoPC

Briefing package: Integrated Public Health Approach

GOOD CHRONIC CARE

Develop a partnership with the patient Use the 5 As (Assess, Advice, Agree, Assist and Arrange) Proactively arrange follow-up visit Use written information: R/R Working as a clinical team Link the patient to community based resources and support

COPC Universal Access

Comprehensive Integrated Continuum, Acute Care Chronic Care incl. ART Center Palliative Care based) TB/HIV PMTCT MMT Hospital Primary Health Community (home

FHI strategy

Care Preventio n Care Preventio n Care Preventi on

Preventio n

Care

1995

2004

2011

FHI contribution to Universal Access

Decentralization of ART providers Training in cluster (piloted sites) Team work Involving Expert-patient trainer Clinical mentoring Program monitoring M&E Health System Strengthening

Piloted Sites for COPC Jakarta, Malang and Papua

TB Clinic (PPTI) - Sulianti Suroso Hospital Primary Health Center (Gambir) - Tarakan Hospital Prison (Salemba) - St. Carolus Hospital District Health Offices Provincial Health Offices District AIDS Commission (DKI) Family Heath International Other International Agencies: WHO, KNCV and GF ATM

Challenges
Lack of human resources: task shifting Collaboration with other teams: TB/HIV Mainstreaming: Prevention, Care & Treatment Stigma & discrimination: Confidentiality vs Secrecy Involvement of PLHIV: training (EPT), adherence support (Peer group) & advocacy M & E system: integration to existing Health Care System

Team work

Task shifting to volunteers as caregivers

Prison (home) based care

Primary Health Center - Gambir

Expert Patient Trainer

NCD in South East Asia

On the rise Managing Chronic Diseases at Primary Health Care Lesson learned from HIV chronic care

Lesson learned from HIV

Empowerment of patients : self care & peer support group Simple diagnostic and treatment protocols Simple monitoring devices Transition from acute care only to acute and chronic care

THANK YOU

Support Care

Treatment

Prevention