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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:
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