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The Infectious Diseases Institute Care and Research Initiatives. Dr Alex G Coutinho Executive Director IDI-MUCHS. IDI’s Contribution to the National HIV/AIDS Care and Treatment Response. The Care and Treatment Services at Mulago 9,000 active clients in care
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The Infectious Diseases Institute Care and Research Initiatives Dr Alex G Coutinho Executive Director IDI-MUCHS
IDI’s Contribution to the National HIV/AIDS Care and Treatment Response • The Care and Treatment Services at Mulago • 9,000 active clients in care • 6,500 active clients on antiretroviral therapy (ART) • 600 active clients on second-line ART • The KCC-IDI Project • HIV/AIDS care capacity established at 6 KCC Health centres • 5,000 active clients in care • 2,500 active clients on antiretroviral therapy
PCT Programme Innovations • Internally-focused Innovations (task-shifting) • Nurse visit programme • Pharmacy- refill visit programme • Use of HIV+ friends to support clinic flow • Computerization of medical records (ICEA) • Externally-focused Innovations • Development of care capacity in the Kampala city council facilities • Development of care and treatment capacity in 7 districts in North- West Uganda
Summary of the Task-shifting Approach: ART REFILLS -Protocol • Criteria: Assessed by MO • Adherence to ART 100% • Disclosure • Regular appointments for 6/12 • Not pregnant • No ART toxicity grade 3/4 • Agrees to refill • CD4 rising • Cohort: undetectable viral load WHO stage 3 or 4 CD4 count less than 200cells/ul On ART Stable At least 4 nurse visits Counseling Reinforce adherence message for refill Prescription by the doctor for Two refills 6 MONTH CYCLE Mo 1 Refill 1 Mo 2 Refill 2 Mo 3 3 monthly routine nurse visits: History and assessment Prescription by Nurse/ Doctor I/c Nurse visit Lab-request for lab-file Mo 5 Refill 2 Blood taking Mo 4 Refill 1 6 monthly doctors visit with CD4 results and assessment Good adherence & good response to therapy¹
Using ICTs to improve Programme Quality • ICEA.net (Clinic Database) • On-line prescriptions and lab requisitions fully functional • Clinical dashboards for user friendly access to clinical information • Automatic downloads of lab results The ICEA Client Interface for Clinicians
IDI Research Programme Summary • Programme goal is to cultivate African-led research • 97 publications in peer-reviewed journals by June 2010 • Over 40 research projects currently active
Late Presentation increases mortality in HIV-infected subjects on ART
Early Mortality in ART Cohorts is Dependant on Baseline CD4 Count Cumulative probability of death over 36 months on ART according to CD4 cell count stratum with the highest mortality rates realized in those with CD4 T cell counts<25 cells/μL. Probability of death
Planned Research Studies to investigate how to reduce early mortality in HIV treatment • Prevention of Early Mortality Study in a district setting (Kiboga District Hospital) • The PROMPT Study on prevention of early mortality among TB co-infected HIV patients
Makerere University The Ministry of Health-Uganda College of Health Sciences Prof Moses Kamya Prof Harriet Mayanja Prof Elly Katabira IDI Management / Staff CDC/PEPFAR IDI Clients Acknowledgements