Overview Burkina--- ART Population: 11 millions Prevalence: 6.6% (surveillance data) Estimate of 650,000 PLWHA 300 peoples with red cross 2000 people to be on ART by end of 2003 Today 675 people under ART but estimate of 1,000 people if we add parallel systems not tracked by MOH CNLS under President Coordination interministeriel under MOH: coordination, prevention, care, support and treatment, surveillance –Fees for ARV = 15,000 CFA = $30.00 per month per patient –Some NGOs/associations provides ART free

Overview Burkina: Issues National guideline for ART developed based on WHO recommendations HIV/AIDS is not included in med school course To date: 100 providers trained on ART Need for equipment – CD4 count, Elisa VCT basically implemented by NGOs Care and support information collected: –Patient monitoring – paper based –National HIV/AIDS M&E being finalized –Software development on-going Brand and generic are used in Burkina Planned to increase number of trained but need to assess

Overview Rwanda--- ART Population: 7.4 millions Prevalence: 9% (UNAIDS 2001) and 13% (Surveillance) but prevalence has tendency to increase in rural area because of war and genocide 365 health centers 400 MDs and half of them do administrative functions M&E is based on classical HMIS from peripheral health centers to central level but no data focused on HIV/AIDS Private sector and religious associations are involved in ART provision 1,000 patients under ART Kigali where 900 patients Guideline available but not M&E tools to support the guideline Funds from WB, MAP, Global Funds Lack of trained staff– 18 MDs trained on Care and support, ART Generic and brand name are used in Rwanda No national M&E plan for HIV/AIDS

Issues and Steps for Burkina and Rwanda Situation analysis and assessment –Assessment tools exist but sound s very complicated and long: ex of FHI assessment tool adapted to Burkina –Need to develop and simplified tools for rapid situation and assessment –Implement situation analysis and assessment with involvement of site stakeholders, providers and community –Use results to design program Guidelines and protocols in draft forms and need to be finalized and disseminated Based on need assessment for training, train staff to adhere to guidelines and protocols

Issues and Steps for Burkina and Rwanda Develop national treatment framework for care and support and define tools for ARVs introduction Technologies –Select and adapt a kind of standardized software for data management Burundi is using Fuchiar and Burkina another from Esther Not all data has to be computerized Software has to be integrated taking into account those under ARVs and those who are not –Other technology: smart cards, finger print… could be used patient monitoring but should be adapted, evaluated and readapted

Issues and Steps for Burkina and Rwanda Quality of service assessment –Use existing tools such PI6 and PI7 assessment tools and adapt them to include HIV/AIDS components instead of “reinventing the wheel” Patient monitoring –Should be developed taking into account that the ART should be decentralized –Research on adherence: tested alternatives and documents and see which one works better –Design a patient monitoring that takes into account patient mobility and linkage between health centers –Community involvement: maybe “accompagnateur”

Issues and Steps for Burkina and Rwanda Reporting system –Format –Frequency –Should avoid overburden on service providers and should piggyback on existing reporting and existing HMIS –Feedback to service providers Evaluation –Need for self-assessment tools –Need for independent evaluation at least every 2 years –Burkina is planning to evaluate the process of introducing ARV including health providers burden, behavior change and socio- economic impact

Issues and Steps for Burkina and Rwanda Research OR and long term research –Process evaluation should be done at least every year Supplies Staffing Equipment Supervision system –What is the clinical efficacy of the treatment? –What is the impact of the ART on stigma reduction at the level of the households, community, patients and families? –Evaluation of resistance at least every two years –Evaluate non-medical such nutrition and psychology needs for the patients –What is the socio-economic benefits of ART on patients, households and health centers?