ACCESS TO TREATMENT BY ACCESS TO TREATMENT BY PEOPLE LIVING WITH HIV IN PEOPLE LIVING WITH HIV IN

ZAMBIAZAMBIA

Presented by: Kunyima Lifumbela Banda

Network of Zambian people living with HIV/AIDS (NZP+)

Introduction

Government with support from Co-operating partners has been providing free ART in public health institutions in 2006.

The number of public and private facilities providing related services such as CD4 counts has also grown

There has also been an increase in the supply of HIV-related services in both rural and urban areas

Cont…

Increase in access to medication for prevention and treatment of opportunistic infections such as TB

Overview of ART Situation

1 million people living with HIV in Zambia

368,821 PLHIV accessing treatment

57% are women 31% are Men 27,419 children 0 – 14 years

Cont…

96% on 1st Line treatment 4% on 2nd line treatment Under 1% on 3rd Line treatment 69% urban 31% rural 54% receive care at health centre

level

Facilities Providing HIV related services

About 1,800 health facilities in Zambia (Government, private, NGOs)

1,468 provide VCT 1,253 provide PMTCT 484 provide ART 297 provide pediatric ART

Conti…

150 facilities provide CD4 3 sites provide PCR testing – UTH,

Kalingalinga and Arthur Davies Hospital 2 sites provide viral Load – UTH and

Kalingalinga

Facilities soon to provide Viral Load and PCR

Chipata General Hospital Ndola Central Hospital Mansa General Hospital

NZP+ Survey on Access to Medical services

NZP+ conducted a survey access to medical services by people living with HIV in 12 districts.

Survey was conducted among people living with HIV

Objective was to get experiences from PLHIV on access to treatment

General Information

59% of people interviewed were women

98% were above the age of 30 60% single (unmarried or

widowed)

Information on ART

98% where on ART 40% did not know the name of drugs they

were taking Less than 1% were on second line treatment 66% did not frequently get a CD4 test done 60% did not know their CD4 count 19% get information from the support groups 24% from medical staff

Cont..

Reason for testing 62% tested after a long illness 11% referred after TB treatmentDistance to ART centres 12% within 10km 75% above 20km

Access at health facilities

70% indicated 3 hours as minimum time before seeing medical personnel

48% saw a clinical officer on appointment days and 25% say a nurse

60% felt that time spent with the medical personnel was not enough but generally expressed satisfaction with the ability to express themselves.

Cont…

In the PLHIV Stigma Index study:

8.4% of respondents reported being denied health services (including dental services)

9.7% of the respondents reported having been denied family planning services as a result of their HIV status

11.8% indicated that they had been denied sexual and reproductive health services.

Challenges

Departure – Demand

Travel – Linkages Arrival – Supply side

•Stigma•Traditional and culture beliefs•Religious beliefs•Inadequate knowledge and information on treatment and other services•Poverty•Gender based violence Stigmatisation of young PLHIV

•Geographical features such as islands, plains, floods in the rainy season, sand, mountains•Long distances of 45Km – 100•Cost of travel – resources shared between travel and those remaining at home, accommodation

•Few centres providing ART services•Long queues, long waiting hours•Missing files, missing results•Inadequate information given to patient•Inadequate staff to attend to patients•Stand alone services

Challenges

Departure – Demand

Travel – Linkages Arrival – Supply side

•Physical challenges – tiredness, stress, fatigue•Vulnerability of women when travelling

•Limited referral within facilities for different services•Stigmatisation of young PLHIV by health personnel•Long waiting time to access results especially for children

Our Role in increasing uptake of services

Advocacy for increased ART Community Mobilisation Community preparedness

• Information provision• Treatment literacy

Community Referral Contribution at health facilities

• Pre and post test counselling• Adherence support• Referral• Record keeping

Linking PLHIV to business development services

Scale up access to treatment as close to people as possible

Need for integration of services - HIV, TB, MCH, SRH services

Scale up testing and treatment for children and adolescents

Scale up availability of pediatric formulae Scale up support to community initiatives Promote treatment as prevention

Our Recommendation