Adherence & Retention

Self-funded treatment programs

Started by Claire Cole on 26 May 2010

Dear all-- I am glad to post this new discussion on behalf of Dennis. Please see below for his post, and feel free to reference this discussion for further background http://www.ghdonline.org/adherence/discussion/at-front-lines-aids-war-is-fall...

Here in Cameroon, we are a large church based health care system delivering
largely rural health care for more than 60 years. So we have a large
infrastructure built up for general medical care. We have been involved in
HIV care for 10 years, beginning with pMTCT services and expanding to HIV
treatment five years ago. We were initially able to get funding through the
MTCT-plus program. Their support, along with some short term funding from
USAID and drugs from the national Global Fund funded program, enabled us to
rapidly scale up care and treatment to five treatment centers and more than
8000 patients on ART. The MTCT-Plus program ended more than a year ago and
Cameroon is not part of the PEPFAR program, so we were not able to identify
any external donors willing to pick up the cost of our program.

When we realized that we would not have external funding, we made the
following changes in the program:

We instituted a small monthly consultation fee for patients. Patients were
instructed that we had given them free care when we had resources but now
they would need to assist us if we were going to continue with our treatment
program. They accepted the explanation and continued to receive care in our
program. We also emphasized that patients should continue to come to the
clinic even if they did not have the money for the consultation fees.

We have developed a very cost efficient laboratory system which has enabled
us to generate some income to support the clinics. We use a low reagent
cost system for CD4 counts (Guava) which helped us keep down costs.

Drugs continue to be provided free through the national HIV Treatment
program although the supplies are irregular at times.

Within 5-6 months of making these changes, we were generating enough income
from the clinics to cover the basic operational costs. There was concern
that our lost-to-follow-up rates would increase with these changes but we
have not seen any problem with this.

So, we now feel more secure in our ability to continue to provide chronic
HIV care to our patients. Our program continues to grow but the income
matches this. We do not have extra funds from our patient fees to allow us
to purchase new equipment or buildings and staff complain that salaries are
not as high as they would like. Overall, I am happy with the transition. I
think the stability of the program is better and our focus is more on caring
for our patients. I don't know if this program is generalizable. Many
programs do not have the support of a large general medical system and this
has been important to us. We have also benefited from having a highly
motivated clinic staff who work hard in caring for these patients.

I doubt that external funds will continue to increase and begin to fall back
so beginning to focus on sustainability is appropriate. We can survive with
the locally generated funds, but are completely dependent on free drugs to
treat our patients. Perhaps a reasonable compromise in use of external
funds would be to use them to ensure adequate drug supplies and to direct
more support toward prevention programs.

Dennis