Adherence & Retention

Thank you mary,
This also a problem in Sierra Leones public health system. But what my
Organization is piloting in one district right now is using community health
workers to actually deliver the ARV to the homes of the Clients daily. Each
CHW is assigned a maximum of 10 households which he or she visits dairly and
observe them take the medication. The CHW's are HIV+ themselves. The
challenges of this program so is paying the CHWs, which requires continuous
funding as most governments can afford to take over this work force. But
what we also doing currently to be able to overcome this hudle is linking it
to a social enterpreneural
enterperprise in a Palm Kernel farm. The plan is to use the profit from
this agriculture project to continue funding the HIV PROJECT.
If you any further question i am willing to answer.
Thank you all.

Dr. M B Barrie

This is a common problem throughout Latin America. We have been working in several countries, together with the Ministry of Health and UNICEF, to identify the gaps in the provision of care and to translate those gaps into concrete actions. Each setting requires different interventions, depending on the specific gaps identified. The implementation is complex, because some actions require reorganizing certain areas of the health system, other passing a new law, revising clinical protocols, increasing accountability of health providers, and so forth. A link to the first country report of this work is at http://www.pih.org/inforesources/books/Integration_prenatal_care_in_HIV_testi.... We believe that if a group of countries is moving towards common goals and sharing information they can accomplish results faster than if they work in isolation.

Thanks you all for your responces
Yes there is a challeneg for the HIV positive pregnant women to keep appointments also after delivery, but we are trying to use thclinic appointments for the baby's vaccination visits to also see the mother, and also sreen the baby for DNA PCR. We have also initiated keeping the postnata women at the ANCs for up to six months after delivery unless her baby turns out to be HIV positive where we have to refer the child to a near by Care and Treatment clinic so that they can be initiated on Antiretroviral therapy. The challeneg here is that such follow ups we have initaied at few clinics, weh are working on how to scale this type of intergration as fast as possible since while the pregnant women are diagnosed at ANCs, they keep coming for thier visits and get ARV prophylaxis and after deliver they also come to the same clinic, they are seeing the same providers and are familier with. It is during the whole prenatal and postnatal period that the nurses are continuously couselling and encouraging the women that they will have to be enrolled at CTCs. Its the ones ...

Thanks you all for your responces
Yes there is a challeneg for the HIV positive pregnant women to keep appointments also after delivery, but we are trying to use thclinic appointments for the baby's vaccination visits to also see the mother, and also sreen the baby for DNA PCR. We have also initiated keeping the postnata women at the ANCs for up to six months after delivery unless her baby turns out to be HIV positive where we have to refer the child to a near by Care and Treatment clinic so that they can be initiated on Antiretroviral therapy. The challeneg here is that such follow ups we have initaied at few clinics, weh are working on how to scale this type of intergration as fast as possible since while the pregnant women are diagnosed at ANCs, they keep coming for thier visits and get ARV prophylaxis and after deliver they also come to the same clinic, they are seeing the same providers and are familier with. It is during the whole prenatal and postnatal period that the nurses are continuously couselling and encouraging the women that they will have to be enrolled at CTCs. Its the ones who are eligible for ARVs that have to visit both the Care and treatment and ANC clinics that we find so challenging to make sure they get to CTCs on time. For both cases, its is alot easier if the two clinics (CTCs & ANCs) are within the same health care facility where the ANC staff will do physical escorts, but for those that have to go to a CTC in the nearby next facility its is still a challnege for now. I like the idea of having a project that is able to generate income to fund for the community health care workers, in our Program we have intergarted services with comunity healt care workesr, but basically they follow up patients who have missed clinic appointments and bring them back to clinic. They do not take ARVs to thier homes.
As for my country, like in the Namibia, botswana etc, we also get ARVs for free for all who require to be put on treatment, be it in government or private facilities, however there are few differences in OI treatment. Government facilities offer free lab monitoring tests as well as Non ARVs for OI treatment, at private facilities even though the PLWHA get free ARVs from the Gov, they will pay some free for lab tests and OI treatment, but some have a weiver by support from HIV programs like ours, we support patients in private facilities for lab testing as well. people freely choose where they want to be attended be it a private or government facility.
The ARVs are bought as mentioned from other countries via Global fund, PEPFAR etc.

Here's a related article that may be of interest:
--HIV/AIDS--
Once-Daily vs Twice-Daily Darunavir/Ritonavir (DRV/r)
Medscape HIV/AIDS 2010
http://mp.medscape.com/cgi-bin1/DM/y/eCwMp0XBUuY0D2W0K41k0EJ&uac=146834DN

Hi Katie,

Thanks for sharing this resource. It looks like the article is closed-access, but you can listen to Dr. Paul Sax provide an excellent summary of the study ("The ODIN Trial") here: http://www.medscape.com/viewarticle/718412. If you're prompted to sign in on this page, try doing a Google search for "Once-Daily vs Twice-Daily Darunavir/Ritonavir". Dr. Sax's 4-minutes video should be among the top search results.

The abstract for this trial was presented at this year's 17th Conference on Retroviruses and Opportunistic Infections (CROI) (February 16-19, 2010), posted here: www.retroconference.org/2010/Abstracts/37635.htm

Hi all,

Thanks for the excellent discussion. I'm currently working at a health center in a remote area of Northern Uganda (Amuru District). We are working to strengthen the provision of community-based healthcare at a Health Center Level III (for those familiar with Uganda's structure of care).

One of the issues that we are facing in effective implementation of ANC surveillance and PMTCT provision is patient migration. With the cessation of war in Northern Uganda in 2006, many people have started moving back to their homeland after years of living in IDP camps. This has been a gradual process though and is still occurring. We've found it difficult to keep track of people who may show up for an initial ANC visit but then not return for HIV test results and further care, making it very difficult to trace them. I would anticipate that this won't be a long-term problem on such a large scale once the majority of people have settled back on their land.

I'm wondering if anyone has experience or suggestions for temporary measures to promote follow-up in such a situation.

Best,
Mike Westerhaus

Hi Michael,
The fact that the women and other people are moving back to their homeland poses a great challenge to follow ups as well as timely provision of interventions 4 pmtct as you have mentioned.

I would think that even though you anticipate things to go back to normal over time but I think you can still do something during this transition like designing simple referral forms which can be given to the women upon moving back home but have a plan for the best way of feedback or look into utilizing the existing referral system at your setting.

Alternatively is to provide HIV test results the same day that you offer the test to the pregnant woman. May I ask are you not giving the results same day at the moment?

Regards
Mary

Sent from my BlackBerry® smartphone from Zain Tanzania