1. The Debswana Anti Retroviral Therapy Programme
Presented at the 16th International HIV/AIDS Conference
Toronto - Canada
14th August 2006
Presented by:
Dr Onalethata Johnson, RPh, PharmD

2. Objective of the presentation
To provide background information on the Debswana Anti Retroviral Therapy Programme
To provide some essential statistics on the Programme
To highlight achievements and challenges encountered during implementation of the programme
To give an overview of the lessons learnt during the implementation of the programme

3. The Debswana Anti-Retroviral Therapy Programme
A Disease Management Programme (DMP) to assist beneficiaries to deal with long term illnesses associated with HIV
Implemented in May 2001
Administered by Aid for AIDS
Responsible for ensuring treatment at right stage of the disease & correct use of drug combinations
Run by mine doctors & a few nominated private doctors
18 Mine hospital & 17 private doctors
Responsible for patient registration & general patient medical management (pt f/u, review of tests results etc)

4. The Debswana Anti Retroviral Therapy Programme Continued…
Includes a Call Line (Toll Free) manned by a Nurse Adherence Consultant
Responsible for patient tracking, monitoring & follow up, claims processing, adherence counselling & provision of general information on the DMP
Fully funded by the Debswana Anti Retroviral Therapy Fund through 1.37% of the Company’s basic pay
Beneficiaries of the programme comprise all Debswana HIV +ve employees, their legally married spouses and children under 21
Its benefits – 100% subsidy of the cost of ART drugs, relevant monitoring blood tests, prophylactic, opportunistic infections & other AIDS related treatment

5. Patients Registration Status since Inception

6. Cumulative % HIV Positive Employees Registered on the Treatment Programme May 2005 – May 2006

7. Patients’ Age Profile

8. % Gender Distribution

9. Disease Stage on Registration

10. Patients Treatment Status on the Programme

11. Outcome of survey on disease progression

12. % Registered Patients Tracked Jan to May 2006

13. % Adherence to Treatment Jan to May 2006

14. Achievements
Tracked indicators have exhibited a negative growth since programme inception – an indication that the programme is bearing positive results
High levels of adherence to treatment by the patients
A strong patient follow up component as evidenced by high % of patients tracked
High utilisation of programme services – the Nurse’s office & toll free line

15. Percentage Productive Time Lost Due to Illness

16. Debswana Ill-Health Retirements 1996 - 2005

17. Summary of Deaths in Service at Debswana 1995 - 2005

18. Debswana Death Rates

19. Challenges Normalising HIV/AIDS and its treatment
Sustenance of prevention messages in the ARV environment
Keeping HIV -ve employees testing negative
Scaling up VCT/partner disclosure/registration on treatment
Ensuring adherence to treatment and monitoring as more people register on the programme
Late Registration into the Treatment Programme
Balancing time for HIV/AIDS interventions in the workplace and production demands

20. Lessons Learned
Early registration into the Treatment Programme is vital
Fear of Stigma & discrimination coupled with inadequate publicity of the programme results in sub-optimal utilisation. A robust IEC Programme is thus important
A treatment programme should not provide ART alone, it should have a strong follow up component to ensure high levels of adherence to treatment
Confidentiality can be a crippling concept it needs to be defined in context and managed properly across the entire organisation
Prevention should remain key - support structures and programmes to address needs of various interest groups are a requirement

21. Take Home Message…….
HIV/AIDS is a business issue and a shared responsibility that requires
Active involvement and visible support from top management (real commitment not compliance)
Adequate resources at appropriate levels for prevention and to manage impact (budget and staff)
Adequate systems to measure and monitor its impact
HIV/AIDS competent managers
Targeted effort to build capacity

22. RECOMMENDATION
ALL BUSINESSES SHOULD HAVE A WORKPLACE POLICY AND PROGRAMME THAT FACILITATES ACCESS TO HIV/AIDS TREATMENT, CARE AND SUPPORT AS A WAY OF MINIMISING THE IMPACT OF THE EPIDEMIC ON THE BUSINESS

23. Debswana Diamond Mining Plant

24. Well Employees = Full Productivity
Thank You