Pascal Niamba, Cecil Beloume

Experience under the TAP: ART scale up and health systems

related bottlenecks in Burkina Faso

Treatment Acceleration ProgramLearning from the experiences gained and the

challenges ahead November 30, 2006, Washington DC

Introduction1.Situation analysis: Country Data

2 Interventions

3 Results

4. Key issues & challengesConclusion

Outline

Background & Background & ContextContext

Burkina Faso274 200 km² 12 802 282 inhabitants: 2005< 15 years: 55%52% WomenPNB 268 USD

12802282

-46 % of the population is below the poverty line

-IDH=0,303 ( 2000)

Situation Analysis

Epidemilogical Data:Sentinel site surveillance (2004):

Prevalence rate 2.4%.

Urban sites: 3.4%

Rural areas: 1.5%

Estimates for 2005 (UNAIDS)Adults living with HIV/AIDS: 135 120

HIV/AIDS prevalence rates in adults (15- 49): 2%

CARE SYSTEMIN BURKINA FASO

C.H.R

C.S.P.S

C.H.U

C.M.A

3rd Level

2nd Level

1st Level

Front line health facility level:

55 Districts

Mid-level health care system: 13 Regions

Central Level

Package of interventions: ART context

Package of interventions: ART context

1. VCT and regular support to PLWHI

2. Treatment ART and OI

3. Parent To Child Transmission P.T.C.T

4. Nutritional support

5. Psycho-social and economic support

6. Capacity building for different actors

ResultsResults

VCT and regular support to PLWHIV

2005 Achievements in VCT in networks settings

4863

32587

37689

0

5000

10000

15000

20000

25000

30000

35000

40000

NGO AIDSITI and CICDoc)

2004 2005 2006

1.RECAP OF ACHIEVED RESULTS IN VCT CENTER

15001666

1500

3203

1500

3733

15001642

1500

3110

1500

771

0

500

1000

1500

2000

2500

3000

3500

4000

AFAFSI AJPO BERGERIE SOS SIDA URBLS CICDép2

Tests prévus Tests réalisés

TESTED POSITIVE IN VCT CENTER

20

5047

107

15

60

28

66

26

159 9

0

20

40

60

80

100

120

AFAFSI AJPO BERGERIE SOS SIDA URBLS CICDép2

Hommes Femmes

Treatment ART and OI

COVERAGE IN TREATMENT (ART)

49629

1116

27000

3867

133

27000

8136

1124

27000

9536

5515

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2003 2004 2005 2006

Goal ART

Patients on ART

ART /ONG

COVERAGE on ART

2,5

10,13

24,56

0

5

10

15

20

25

2003 2004 2005

ART coverage

Status of patients under ART(TAP)

5901

3019

775 562

2693

1463

3532

43653 35

0

1000

2000

3000

4000

5000

6000

DS/Hôp St Cam AIDSETI CICDOC Priv(Suka)

File Active ARV-T1-2006

News patients under ART (in 2006)

34

29

53

40126

12

95

80

17

34

0

20

40

60

80

100

120

140

160

180

AFAFSI AJPO BERGERIE SOS SIDA URBLS

Patients ARV 05 Patients ARV 06 nouveaux

873 patients under ART now S2

Proportion of news patients under ART S1 2006

53,42%

43,10%

8,60%

45,70%

66,60%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00%

AFAFSI

AJPO

BERGERIE

SOS SIDA

URBLS

Nouveaux patients S1- 2006

Is an increase of 38,67 % of the patients under ART

Active file and patients under ART (TAP)

5901

3019

7828

2966

0

1000

2000

3000

4000

5000

6000

7000

8000

G structure (hospital ) NGO(AIDSITI,CICDoc,St Camille Suka)

File Active ARV-T1-2006

PTCT

General recap of key results in PTCTIndicator S1-2005 S2-2005 T1-2006

women seen at ANC 28772 13595 21.813

women seen at ANC and tested 11495 13528 15.831

pregnant women tested positive and have actually given birth

463 523 472

Number of newborns from positive mothers who have taken NVP

348 508 398

newborns tested positive at 18 month

11/102 6/91 8/48

Psycho-social and economic support

Participation for auto-support meetings

53

635

656

501

200

0 100 200 300 400 500 600 700

AFAFSI

AJPO

BERGERIE

SOS SIDA

URBLS

Participants

A total of 2045

Visites à domicile au bénéfice des patients

65308

361158 1033

1815

265

77

62192

0 500 1000 1500 2000

AFAFSI

AJPO

BERGERIE

SOS SIDA

URBLS

Bénéficiaires VAD réalisées

2550 VAD ont donc permis d’apporter un soutien à 1786 PVVIH

Psychosocial and nutritional support 2005

(CICDOC)

0

2281

0 12

5542

2062

0

1000

2000

3000

4000

5000

6000

1er Semestre 2ème semestre

Education nutrition Soutien Psycho-social Soutien alimentaire

Psychosocial and nutritional support 2005

AIDSETI

33546

2932210

15297

5531

0

5000

10000

15000

20000

1er Semestre 2ème Semestre

Séances Educat Nutri Soutien Psycho-social Soutien alimentaire

General overview of VCT, PTCT and PECM facilities from 2003 to T1-06

0

20

40

60

80

100

120

140

160

180

200

Fin 2003 Fin 2004 Fin 2005 T1-2006

Nombre de centre de PECM/ARV Nombre de centres de CDV Nombre de centre PTME

324

46 5112

29

63

152

176

56

93 95

Positive aspect of ART(1) Success1 NGOs involment has contributed to the improving the access to ARVs for PLWHI.

2. Collaboration between care and support NGOs network members and public health facilities is feasible;

3. The integration of care achieved from health centers and community centers to the referral hospitals.

2. Positive aspect of ART(1) Success

4. Capacity building of the different stakeholders has contributed to the improvement of the care and support of PLWHIV

5. With ART a strong demand for care has been established .

Key issues and challenges for scaling up

At NGO level

Make available human resources

data base harmonized and reliable for Patients

Social and economic impact

Documentation of lessons learned and operational research on

adherence

resistance

social and economic impact

Key issues and challenges for scalling up

At management structure level

-Make available resources in time VCT

Treatment OI

Infrastructures

Equity in service offers satellite (in the rural area )

To harmonize cost

General questions related to treatment

What will become of the 7000 patients under ARV after 2007?

Capacity building for ART stakeholders?

Reinforcing access to community for PLWHIV?

Supporting the involvement of NGOs?

Reinforcing the integration of voluntary testing in public health facilities!!!

Promotion of operational research!!!

Follow up on compliance surveillance

CONCLUSION

TAP has contributed at the national level to the greater involvement of PLWHI elegible for ARV treatment.

TAP has increase an honest collaboration between public health facilities and NGOs.

There is a need to be cautious while implementing resistance sentinel sites of HIV/AIDS and ART.

ART is a essential in Burkina Faso and needs to be continued.

AcknowledgementsAcknowledgements