Joint ENAHPA and CCFC HIV/AIDS inititative

ENAHPA, in collaboration with the Christian Children’s Fund of Canada (CCFC) and the Ethiopian Ministry of Health has begun an antiretroviral treatment (ART) program for AIDS victims living in one of the poorest communities in Addis Abeba, Ethiopia.

1. A RAPID SCALE-UP PROGRAM TO PROVIDE ART

The two organizations fully cognizant of the many challenges have embarked on a carefully planned treatment program that will provide not only ART but also a comprehensive HIV prevention and treatment program along the life span of the individual in conjunction with accepted and respected social support networks.

2A. Goals and Objectives

Goal I:

To provide ART to 600 HIV-infected persons within the first year and expand treatment o 10,000 over five years in Ethiopia, utilizing available international, and local resources in line with best clinical practices that are relevant within resource-constrained settings.

Goal II:

To create and/or augment the skill, and knowledge of the staff and the technological and data monitoring capacity of each of the selected sites to ensure sustainable AIDS care.

2B. Program Description

2B.1 Create Community Linkages for Recruitment and Care Activities:

Complex health interventions that are isolated from their communities and contexts have a low chance of succeeding. HIV/AIDS care, because of its new care paradigms, complex family dynamics, sexual behavior, behavior change, and stigma, is not an exception. The complexity of HIV care demands a multi-sectoral approach that links health care facilities to other organizations in the community and community resources. The demands of people infected and affected are not limited to medical care; they need psychosocial/spiritual, legal/human right, and socio-economic supports, which hospitals or other treatment facilities alone can never provide. Patient’s broad demand and need is compounded by the extreme shortage of trained manpower and poorly equipped infrastructure. New programs like this, unless they come with innovative new vision to solve this impasse, are likely to fail.

For this reason, linkage to local community resources—NGOs, FBOs, other civil society organizations and associations of people living with HIV/AIDS (PLHA)- will be a critical component of our program. This treatment, care and support to PLHA should always be holistic and sustainable. Moreover, treatment programs in the health facilities will be integrated with preventive and support activities within the community, and the community will be included and mobilized to have adequate awareness about the treatment program and understand their roles and responsibilities.

2B.2 Create Community Advisory boards (CABs) at each facility to assist in recruitment and ART.

The ENAHPA project office in collaboration with the treatment sites will assist in creating community advisory boards at each site. These community representatives jointly working with representatives of the health facilities play critical role in interfacing the health facility with the community activities and resources, as well as technically assisting the community initiatives. Jointly working with health facilities in organized way, the community organizations will contribute in such activities as patient selection for treatment, community mobilization, drug literacy, involving lay service providers and counselors in the treatment sites to support the health professionals, linking prevention and care activities within the communities with treatment and care services in the hospital, and reducing stigma and discrimination which is among the major barriers to utilize services in the facilities.

2B.3 Create referral linkages

1. Hospital and health center based services such as MCH, and STI will be linked to VCT services. Individuals who test positive for HIV will be referred for care. The same is true to patients attending TB or STI clinics, or general outpatient services.

2. Other area health centers and health posts will be asked to refer patients for VCT and AIDS care.

2C. Selection of ART Delivery Site

ENAHPA’s project office has assessed select health facilities to determine preparedness for the implementation of ART program. Selection was based on various factors including geographical location (urban and rural mix), proximity to a referral center, and the availability of AIDS prevention and control program. ART program will begin at one site and will gradually include other hospitals and health centers in the country as deemed feasible and appropriate. With appropriate budget allocations in place for year 1, and projected through year 3, it is the strong belief of the project office that patient scale-up projections will be ethically and appropriately realized.

2D. Profile of the First Treatment Site

The All African Leprosy Research and Training (ALERT) Hospital: It is a public hospital, which is under the Ministry of Health of Ethiopia. In its early days, it was jointly run by Ethiopian MOH and international donors (Scandinavian countries and German Leprosy organization). It is a hospital, which was originally built with a mission to control leprosy. Right now, it is a multidisciplinary hospital, which is also involved in caring for patients with HIV/AIDS. It has an inpatient and outpatient services with a capacity of 230 inpatient beds. It is a multi disciplinary medical facility, which has Internal medicine, surgery, dermatology, ophthalmology, childhood care, physiotherapy and occupational therapy departments. It serves around 300,000 Addis Ababa residents, and some patients referred from regions for leprosy and dermatological problems.

The training and qualification of medical personnel to be involved in HIV/AIDS care, laboratory services and pharmacy of the hospital fulfils the accreditation criteria set forth by ENAHPA. The hospital is among hospitals authorize to prescribe ARV drugs by MOH for those who can afford out-of-pocket funding. Last year, the hospital has seen 461 HIV/AIDS patients of whom 80% were symptomatic requiring treatment. However, no patient has so far been prescribed since the hospital is located in the periphery of the city and residents around the hospital are among the extremely poor sectors of the city dwellers, including substantial number of leprosy patients and family, who try to get their daily bread by begging in the Inner City. The occupation around the hospital is also characterized by settlement of temporary migrants predominately from rural Gojam.

There is very strong leprosy association working on support of its members and engaging in HIV/AIDS activities. This will be a potential partner of CAB of the hospital that will interface the treatment initiative with community support. It has registered 200 AIDS patients and close to 1000 HIV patients through its home care initiative. The beneficiaries of the hospital come from allover the country and treatment is free as long as patients produce poverty certificate from Kebele, otherwise the price of the service is very modest for those without the certificate. According to Dr Ruth Lekasa, who is the medical director of the hospital, they are exceedingly happy to initiate free ARV therapy in their hospitals and contribute as much as they can in what is needed from them. The community package of the treatment program is also very attractive to the hospital. The hospital has a well-facilitated training center for Leprosy experts coming from sub-Saharan Africa. This center can be used for training of health care workers on ARV therapy.

How you can help: Technical expertise, training of health care workers, nutrition and family support, child care for families affected by HIV/AIDS, fund raising.

Please contact:

• Dr. Getachew Asresahegn - getachew@enahpa.org

• Dr. Asqual Getaneh - mailto:asqualg@aol.com