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Scaling up ART in Sénégal: specifics needs for strategic information. Mame Awa Toure MD, MSc AIDS/STI Division, MOH Senegal. Introduction. Senegal: a west African country Area: 196.722 km² Population estimated to 10 millions 11 regions and 30 departments/ provinces.

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Scaling up art in s n gal specifics needs for strategic information

Scaling up ART in Sénégal: specifics needs for strategic information

Mame Awa Toure MD, MSc

AIDS/STI Division, MOH Senegal


Introduction
Introduction

  • Senegal: a west African country

  • Area: 196.722 km²

  • Population estimated to 10 millions

  • 11 regions and 30 departments/ provinces.

  • Resources constrained settings: GDP of 500$ US.

  • Concentrated HIV epidemic

    • Low HIV prevalence in general population less than 2%

    • 5-20% in high risk group


The senegalese initiative for access to arvs isaarv
The Senegalese Initiative for Access to ARVs : ISAARV

  • A Governmental initiativelate 1997

    • Political commitment : increasing annual subsidy

    • Collaboration of ANRS: technical support, project design

    • First step : Pilot study

      • Building up a model according limited resources

      • Evaluation before extension (collaboration with ANRS)

    • Second step : scale up for nationwide access


2000 2006 accelerating phase of isaarv
2000- 2006Accelerating phase of ISAARV

  • Political comittement

    • Government subsidy increased

    • Subsidy included to the national budget line

    • Credit IDA : MAP

  • Expanding Fund and Partnership for ARV program

    • government,

    • WB, GF, USAID/FHI, UE, GTZ, UN agencies…

  • Decrease of the of financialparticipation

    • Increasing demand



Financial participation
Financial participation

  • Government subsidycon’t

  • October 2000: ACCESS Program

  • Levels of financial participation

    • SES assessed by a social workers team

    • A package including drugs, CD4 count and viral load

      • Low income: $30- $7 per month

      • Government officers $60- $15

    • About 80% of patients treated free of charge


Isaarv managerial structures
ISAARV managerial structures

  • Health facilities level: hospital/treatment centers

    • Medical committees

      • Enrollment and medical follow up

      • PEP documentation and management

    • Psycho-social support committees

      • Adherence support, accompaniment counseling…

      • PLWHA clubs

  • Coordination level: HIV/AIDS Division, MOH

    • Drugs and reagents management committee

    • PMTCT management committee

    • VCT piloting committee


Services delivery package
Services delivery package

  • District level : operational level

    • Counseling, certain OI management,

    • * PMTCTservices,

    • Referral functional system,

    • Monitoring ARV (next step)

  • Hospital level : district + ARV

    • ARV entry point

      • Rapid functionality of structures


Needs coverage
Needs, coverage

  • ISAARV components

    • prior Conditions:

      • HIV testing available/ VCT

      • ARV Treatment Centers

      • Counseling, treatment of OI, use of Cotrimo…

      • Laboratories capacity : CD4, routine exams

      • Training of health personals

      • ARV monitoring committees


Needs coverage 2
Needs, coverage (2)

  • Monitoring ART

    • Adults,Children,

  • PMTCT

  • Post Exposure Prophylaxis

  • Psycho-social and adherence support

  • Supportive research:

    • Monitoring drugs resistance

    • Promoting clinical trials


Chain of distribution

  • National procurement pharmacy

  • Treatment centersRegional procurementpharmacy

    Fann Pharmacy Regional hospital/ Districts

    HPD, IHS


Isaarv up to date
ISAARV up to date

  • 1350 patients included Period Aout 98 - may 2003

  • 5 out of 11 regions involved

    • Active local sponsorship in process

    • Extension to the remaining regions by end of 2003


How does the data collection work
How does the data collection work?

  • Patient monitoring

    • Detailed patient data base for the first 100 naives patients enrolled to the pilot phase,

    • Database on 80 patients enrolled in the two clinical trials ANRS1204/ ANRS1206

    • Few initiatives on the remaining

      • Data not being collected regularly

    • Lack of systematized data collection


Strategic objectives
Strategic objectives

  • Nationwide access to ARV drugs planned

    • Strenghten capacities in the 11 regions

  • Increasing number of PLWHA treated

    • 7000 patients by 2006

  •  M&E system urgently needed!!!

    • Weak part of the program to be improved


M e approach
M&E approach

  • M&E system already in place

    • For other priority diseases

    • except HIV/AIDS new strategies (PMTCT, ART..)

  • Building up process for HIV/AIDS:

    • Capacity building**

      • M&E Unit: NACA, MOH, and other ministries

      • Strengthening technical resources: training


  • M e approach 2
    M&E approach (2)

    • M&E plan developed

      • Workshop in June 2003: set of indicators for each components ** (UNGASS/MAP)

      • M&E tools and Operational guidelines to be developed

      • training

      • Data collection plan



    M e approach 4 next steps by end of 2003
    M&E approach(4)next steps by end of 2003

    • Workshop series

      • Update and reinforce competencies in M&E within targeted sectors (health, education, youth…)

        • Priority for the Health sector

        • TOT, training series

      • M&E tools development

        • Data collection plan

        • Data collection forms

        • Defining evaluation system and calendar

    • M&E sub- units to be set up at the regional level,

    • Contracting services ???


    Specifics needs
    Specifics needs

    • Lack of technical resources :

      • Urgent need to

        • Strenghten HR capacities in M&E

        • Recruit human resources for M&E units at each level

    • More use of available data

      • Systematisation of information,

      • Regular data collection

        • For patient monitoring and program monitoring


    Specifics needs1
    Specifics needs

    • ARV delivery system to be improved

      • Logistical issues

    • Better planning of Evaluations for all ISAARV components

      • Evaluation of the pilot phase (ANRS 02)

      • More in-dept Cost-effectiveness analysis

        • External expertise needed


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