Ethiopia Unlocking the confines of Illness pMTCT Project Fekadu Chala Dabi, Christine Groff Nadia...
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Ethiopia
Unlocking the confines of Illness
pMTCT Project Fekadu Chala Dabi, Christine Groff Nadia Nijim, Rebecca Noe, Cynthia Pearson
Ethiopia
A Regional Glance: Population
0
20,000
40,000
60,000
80,000
100,000
120,000
Nigeria
Ethiopia
Dem
ocratic Republic of the Congo
South Africa
United Republic of Tanzania
Kenya
Algeria
Uganda
Ghana
Mozam
biqueM
adagascarC
ôte d'IvoireC
ameroon
Angola
Zim
babwe
Burkina FasoM
aliM
alawi
Niger
Zam
biaSenegalG
uineaC
hadRw
andaBurundiBeninTogoSierra LeoneE
ritreaC
entral African Republic
Congo
LiberiaM
auritaniaLesothoN
amibia
Botswana
Gam
biaG
abonG
uinea-BissauM
auritius
A Regional Glance: GDP per Capita
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
Mauritius
South A
frica
Botsw
ana
Gabon
Nam
ibia
Algeria
Zim
babwe
Guinea
Côte d'Ivoire
Lesotho
Angola
Dem
ocratic Republic of the C
ongo
Kenya
Togo
Cam
eroon
Central A
frican Republic
Ghana
Mauritania
Senegal
Congo
Gam
bia
Madagascar
Uganda
Nigeria
Zam
bia
Burkina F
aso
Benin
Rw
anda
Guinea-B
issau
Mozam
bique
Liberia
Sierra L
eone
Mali
Chad
Eritrea
Niger
Burundi
Malaw
i
United R
epublic of Tanzania
Ethiopia
Health System Structure
Budget $150 million US ~ 1.7% of GDP
3 medical schools train 200 doctors a year, but highest rate of brain drain in Africa
Physician to population ratio: 1 : 38,619
Health care facility to population is 1:172,000 – Health stations 1 : 27,456 persons – Hospitals 1 : 658,305 persons
Basic Health Determinants
Indicator Status
Life expectancy 43.8 years
Child Mortality < 5 years 170
Infant Death <1years 1 in 10
Child Stunting and Malnutrition 64%
Preventive Health Coverage <50%Access to Antenatal Services 34%
Adult literacy 29% females
41% males Access to Safe Water 35%
Ethiopia and HIV/AIDS
2,100,000 Ethiopian living with HIV/AIDS– 52% women; 38% men; 10% children
6.4% HIV/AIDS prevalence – Urban 13.7% rural 3.7%
87 % of all HIV/AIDS infections result from hetero-sexual transmission.
990,000 estimated orphans
Sources:UNAIDS,U.S.Census Bureau 7/2002
Ethiopia
The City: Nazret
Capital city of the largest region - Oromia– Population: 130,000
Worst health conditions in Ethiopia
75% of the endemic disease are communicable– Respiratory, Diarrhoeal– Malaria/TB– STI/HIV/AIDS
Health Structure of Nazret
LegendChurch School
Mosque
Pharmacy
FGAE
Hospital/MOH
Factory
Clinic
Highway
Railroad
Unpaved roads
Major pMTCT Interventions
Improved Maternal Child Health (MCH) Services
Voluntary Counseling & Testing (VCT)Safe infant-feeding choicesSafe Motherhood practicesAntiretroviral drugs (ARV): Nevirapine
http://www.coregroup.org/working_groups/hiv_resource_materials.pdf
Project Objectives
1. Offer voluntary counseling and STI testing (VCT) to all (100%) women who are receiving antenatal care (ANC).
2. Increase the acceptance of VCT from 50% to 80% of ANC participant.
3. Increase acceptance/delivery of nevirapine from 20% to 80% of HIV infected mothers who received ANC and who have
accepted VCT.
Provision of VCT and pMTCT– MOH hospital, 3 private clinics, 1 RH clinic
Training and program implementation – Family Guidance Association
Community groups for follow-up support:– 3 religious groups (2 Christian, 1 Muslim)– 4 NGOs– 1 PLWA group– 1 women/mother’s support group, and– 1 youth group
Community Partners
Input: Time - 3-year program
Training: VCT counselors – 2 weeks Clinics: ARV – 3 days
1-day refresher training every 6-months
Training for replacement VCT counselors and clinic staff
Bi-weekly visits by VCT and pMTCT trainers and supervisors (later monthly)
Every 3 months overall project meeting
Input: Staff
Trainer of trainers - 1
Trainers: 2 VCT; 2 clinic pMTCT
Project coordinator: 1
Supervisors: 1 VCT; 1 pMTCT
VCT staff: 6 (2-hospital, 1-RH clinic, 3-private clinic)
pMTCT clinic staff (~14) doctors, nurses, midwifes
p M TC T P rog ram C h art
V C T T rainer
V C T T rainer
M T C T T rainer
M T C T T rainer
T ra ining S uperv iso r
H o spita l V C TC o unselo r
H o spita l V C TC o unselo r
P rivate C linicV C T C o unselo r
P rivate C linicV C T C o unselo r
P rivate C linicV C T C o unselo r
R epro ductiveH ealth C linic
V C T C o unselo r
V C TS uperv iso r
5 P harm acis ts1 f ro m each
Lo cal P harm acy
H o spita l H eadP hysic ian
3 P hys ic ians1 f ro m each
P rivate C linic
3 N urses1fro m each
P rivate C linic
P hysic ianR epro ductiveH ealth C linic
N urseR epro ductiveH ealth C linic
M T C TC linica l T eam
S uperv iso r
P ro gram S taf f
G rants & FundingO f f icer
P ro gram A cco untant
M edica l S upplyM anager
M edica l S upplyW o rker
A dm inis trative D iv is io n
C o m m unityL iaso n
C o m m unityL iaso n
C o m m unity P artnerships
O ro m ia B ureau o f H ealthpM T C T P ro ject C o o rd inato r
Input: Other Resources
Funding
Training materials (rooms, lunch, supplies, kits)
VCT and pMTCT guideline manuals for all participants
Space to ensure VCT can be provided and will be confidential
Supply of HIV rapid test kits, Nevirapine– 6 months inventory maintained on hand at local
hospital warehouse
Present Model of VCT Service Delivery
Pre-test counseling
Testing (as desired by the client and after informed consent is provided
Post-test counseling (more than one visit if needed)
Individual risk assessment & risk reduction planning
Model for Nevirapine Delivery
Sustainable HIV kits/drug supply
Strengthen delivery infrastructure
Nevirapine HIV+ pregnant women– To women at the onset of labor: 200mg– To baby within 72 hrs. of delivery:
2mg/kg body weight
p M TC T P rog ram C h art
V C T T rainer
V C T T rainer
M T C T T rainer
M T C T T rainer
T ra ining S uperv iso r
H o spita l V C TC o unselo r
H o spita l V C TC o unselo r
P rivate C linicV C T C o unselo r
P rivate C linicV C T C o unselo r
P rivate C linicV C T C o unselo r
R epro ductiveH ealth C linic
V C T C o unselo r
V C TS uperv iso r
5 P harm acis ts1 f ro m each
Lo cal P harm acy
H o spita l H eadP hysic ian
3 P hys ic ians1 f ro m each
P rivate C linic
3 N urses1fro m each
P rivate C linic
P hysic ianR epro ductiveH ealth C linic
N urseR epro ductiveH ealth C linic
M T C TC linica l T eam
S uperv iso r
P ro gram S taf f
G rants & FundingO f f icer
P ro gram A cco untant
M edica l S upplyM anager
M edica l S upplyW o rker
A dm inis trative D iv is io n
C o m m unityL iaso n
C o m m unityL iaso n
C o m m unity P artnerships
O ro m ia B ureau o f H ealthpM T C T P ro ject C o o rd inato r
Process (1)
Develop plan: initial training manuals
Train VCT counselors and pMTCT clinic staff
Monitor quality of training and quality of teaching
Teach trainees to use the manual as a resource
Initial follow-up: bi-weekly trainee meeting to discuss barriers/problems
Process (2)
After 6 month in field – secondary training
Ongoing support and feedback
Monthly site visits by supervisors
Monthly reports from project supervisors to coordinator
Consumer satisfaction feedback
Outputs and Outcomes:
Trained 6 VCT counselors; 14 clinic staff in pMTCT
Track quality – Pre-post-test
• % Increase in knowledge• Areas to improve curriculum
– Focus groups at 6-month training
Availability of HIV test/Nevirapine – % Of time in 3 years with no shortage of
HIV test kits or Nevirapine
Outputs and Outcomes: (2)
Use of pre-test counseling: – % of women who received counseling
[initial use]
Use of HIV testing/post-counseling:– % of women who received HIV testing
during pregnancy [Measures initial use &continuity]
Use of Nevirapine:– % of women who HIV+ and request
treatment and receive course [measures continuity of service]
VCT/ARV Impact
100% ANC participants offered VCT
80% acceptance of VCT services
100% of HIV + women identified through VCT will have access to Nevirapine
80% of these (HIV + mothers & newborn) will complete Nevirapine regimen.
Amesegnalehu (Thank you for your attention)