1 / 12

Plugging the Leaky Cascade: Programmatic adjustments for specific target populations

Plugging the Leaky Cascade: Programmatic adjustments for specific target populations . Dr Eric Goemaere Regional TB/HIV Advisor MSF South Africa. The low hanging fruits . Increased coverage/Higher Cd4 threshold . Patient friendly regimen. Testing. Patient self management. Staging/

lois
Download Presentation

Plugging the Leaky Cascade: Programmatic adjustments for specific target populations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Plugging the Leaky Cascade:Programmatic adjustments forspecific target populations Dr Eric Goemaere Regional TB/HIV Advisor MSF South Africa

  2. The low hanging fruits Increased coverage/Higher Cd4 threshold Patient friendly regimen Testing Patient self management Staging/ Eligibility Long Term survival Post –initiation ART Triage and fast track PHC decentralised care, nurse based CHW supported

  3. Specific targets, specific strategiesAdult males 43 % of male testingat site C are lessthan 25 yrs

  4. Recruiting eligible males: have a look at TB clinic Source : Fuchia bulletin (OCB) N= 54.679 Source: Town II TB clinic, Khayelitsha= 188

  5. Factors Influencing Retention in Care after Starting Antiretroviral Therapy in a Rural South African Programme. Boyles TH, Wilkinson LS, and all, 2011 PLoS Median CD4 count = 218 Baseline retention on pre-ART in SA ( CD4 monitoring within 12 months ): 31-45%

  6. Comprehensive care for pre-ART Weekly peer educator led HIV Care Group (Pre-ART+ART) • Effective referral system btw HIV care group and clinic • Accessible CD4/VL results to peer educator • Provision of ART/Cotri/IPT refills to HIV care group • M&E system at community level – simple mobile options? referrals • group support and education • CD4 count monitoring • weight + symptom screening • pregnancy referrals • ART prep/ counselling • Bactrim dispense CD4 <500 • IPT refills • pap smear monitoring • nutrition • defaulter tracing

  7. Specific targets, specific strategiesAdolescents Denial Stigma /parental judgment Peer pressure Outreach testing Reduce time/number prep sessions Mixing positive and negative ones Not Peer supporter <> counselor 1:1 guidance across all initial step Intensive emotional support

  8. ART for youth and adolescents in Khayelitsha, IAS poster THPE 0170 Van Cutsem G 1, 2 , Knight L 1, Abrahams M 1, Kerschberger B 1, Malavazzi C 1, Ford N 1, Boulle A 2 Kaplan-Meier: Virological failure by age group 0.40 0.30 0.20 0.10 0.00 0 6 12 18 24 30 36 42 48 Months on ART 10-24 >=25 • Virological suppres.@24mths • children 80.4 % • Adolescents:87.0 % • Youth : 74.5 % • Adults : 88.2 % ( p <0.001) • Remaining in care at 24 mths: • Children 95.4 % <> Adolescents 81.6 % ( p=0.007) • Youth 78.7 % <> Adults : 83.3% ( p=0.008)

  9. Multivariate analysis -> AHR for LTFU in migrants at one year 6.69 ( 3.18-14.09) Helen Bygrave1*, Katharina Kranzer2, Katherine Hilderbrand3,4, Jonathan Whittal3, Guillaume Jouquet1,Eric Goemaere3, Nathalie Vlahakis1, Laura Trivin˜o1, Lipontso Makakole5, Nathan Ford3,4, Plos One , October 2010 | Volume 5 | Issue 10 | e13198

  10. Mobile clinic one stop shop for the HIV/TB co-infected patient • HCT, POC CD4 at mobile points • Each visit, patient asked about travel plan and documented • Health passports + alternative treatment points • Temporary Transfer Out (TTFO): = plans to return (circular migration) • 3 months ARV supply + tail protection • If not intention to return, self addressed stamped envelope signed by receiving sites

  11. Acknowledgments • MSF teams in South Africa, Lesotho and Zimbabwe • South African Medical Unit & CAME • Gilles Van Cutsem , GuiseppeDemola, Daniela Garone, Katherine Hilderbrand, Nathan Ford • Staff and patients who are driving these new ideas Dedicated to Babalwa

More Related