1. 9th EACS ADVANCED HIV/AIDS COURSE AIX-EN-PROVINCE 7-9th September Dr KANHON SERGE Conseiller technique Soin et traitement PNPEC/MSLS CAP-VERT du 14 au 16 Mars 2011 Dr KANHON SERGE, MD Care and Treatment Senior Technical Advisor NACP/MoH

2. OUTLINE BACKGROUND EPIDEMIOLOGY RESULTS STRATEGIES CHALLENGES WAY FORWARD CONCLUSION

3. BACKGROUND Location: West Africa Size: 322 462 sq km UNDP 2006: 164/ 177 with HDI 41,5% (low) GDP: 1 136 USD per capita Population: 20 581 777 inhabitants in 2007 – Death rate: 14/1000 – Child death : 125/1000 – Maternal death: 543/ 100 000 – Birth rate - 45/1000; – Life expectancy : 51,3 yrs – Population growth 2,8% 3 major diseases: Malaria, HIV/Aids, TB

4. EPIDEMIOLOGY CI most affected: prevalence 3,2% UNAIDS 2010 ( ANC: 5,6% vs 2,9%) 1986: 1st case notification HIV 1 and HIV 2 but dual infection PlwHIV: 480 000 (180 000 in need of treatment) 30 000 new infections all age 35 000 number of death 40% ART coverage and 50% PMTCT coverage 39% of HIV-TB coinfection 102 lab (4 VL) ARV and lab testing are free of charge

5. RESULTS INDICATORSRESULTS (2010 PREVENTION Nb of sites for CT 738 Nb of clients tested and received their results498 721 Nb of sites for PMTCT633 Nb of pregnant women tested 342 698 Nb of pregnant women receiving ART prophylaxis for themselves 9320 Nb of pregnant women receiving ART prophylaxis for their child 6698 TARV Nb of sites for ARV428 Nb of clients who ever been on ART117 460 Nb of clients still on ART 72 011

6. STRATEGIES PLANIFICATION – NSP: 2011-2015: To reduce from 30% new infections and STD on 2015 To enrolle 80% of adults and adolecents eligible for treatment on 2015 – EXP for health sector TRAINNING – Health workers (265 trainnings session to train 5723) – National pool of trainners – Regional pool of trainners – Mentorship – Refreshing sessions COORDINATION: – TB program, VHB program, MoD – National political documents for CT, PMTCT, PED treatment, TARV, laboratory management

7. STRATEGIES (2) INNOVATIVES APPROCHES: – PICT: – Task shiffting: NIMART (Nurse Initiated and Managed ART) pilot project – Emtct: Elimination of MTCT – The Expanded Treatment Program (Decentralized access to treatment: facilities, other than ARV clinics to initiate treatment) – New Treatment guidelines : In line with WHO recommendations, Eligibility Criteria reviewed, TDF in 1 st line regimen, to reduce the use of Stavudine, PMTCT and children regimens reviewed. PARTNERSHIP – Keys Technical Partners: WHO, UNAIDS – Financial Partners: GoCI, PEPFAR, WB, GFATM, UNICEF, UNFPA, WAHO, GIP- ESTHER, – Implementing Partners: EGPAF, FHI, ICAP, ACONDA, PSI, Alliance CI, JHPIEGO, JHU-CCP, URC, HAI, Abt Associates, … – Local partners: Network, NGO, Private Sector…

8. CHALLENGES COUNSELLING AND TESTING – available at all health facilities (public, private, community based) PMTCT AND PEDIATRIC CARE – eMTCT – EID CARE AND TREATMENT FOR ADULT – To reduce LTFU – Low coverage of ART despite increased sites LOGISTIC – Commodity stock-outs – Donor driven procurement of commodities FUNDING – Sustainbility HIS – Weak health information management systems, – Identifying trends & Using Data Sets for secondary analysis – Need to develop M&E systems that meet multiple needs

9. WAY FORWARD Primary Prevention Advocacy and sensitization Continue to build systems for improved access and capacity strengthening Competing for additionnal funding Maintain the highest level of good business practice and high quality care and treatment Continue to receive technical assistance from donor agencies Involvement of other stakeholders including FBOs and private health care providers Effective monitoring and evaluation Health system strengthening (logistics and supplies) Political commitment: Governance and leadership, value for money

10. CONCLUSION – Significant results were obtained for ART treatment in PLWHIV – However, to maintain this positive dynamic, it remains critical to overcome some keys challenges Funding sustainability Avoid stock out (ARV) Minimize LTFU Implement WHO new recommendations