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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. A Regional Glance: GDP per Capita. Health System Structure. Budget $ 150 million US ~ 1.7\% of GDP

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ethiopia

Ethiopia

Unlocking the confines of Illness

pMTCT Project

Fekadu Chala Dabi, Christine Groff

Nadia Nijim, Rebecca Noe, Cynthia Pearson

health system structure
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
ethiopia and hiv aids
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

the city nazret
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
slide10
Legend

Church School

Mosque

Pharmacy

FGAE

Hospital/MOH

Factory

Clinic

Health Structure of Nazret

Unpaved roads

Railroad

Highway

major pmtct interventions
Major pMTCT Interventions
  • Improved Maternal Child Health (MCH) Services
  • Voluntary Counseling & Testing (VCT)
  • Safe infant-feeding choices
  • Safe Motherhood practices
  • Antiretroviral drugs (ARV): Nevirapine

http://www.coregroup.org/working_groups/hiv_resource_materials.pdf

project objectives
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.

slide13
Community Partners
  • 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
input time 3 year program
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
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
input other resources
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
Present Model of VCTService 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
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
process 1
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
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
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
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
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.
slide26
Amesegnalehu

(Thank you for your attention)

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