1. Office of Overseas Programming & Training Support (OPATS) Overview of Care, Support, and Treatment HIV Care, Support, and Treatment

2. Definition of Care and Support A comprehensive, wide range of services for PLHIV and caregivers (other than anti-retroviral therapy) that meet holistic needs PEPFAR. December 2009. The U.S. President’s Emergency Plan for AIDS Relief: Five-Year Strategy. Annex: PEPFAR and Prevention, Care and Treatment. Washington, DC: PEPFAR and UNAIDS. 2010. UNAIDS 2011- 2015 Strategy: Getting to Zero. Geneva: UNAIDS

3. Definition of Treatment  Anti-retroviral therapy (ART) is the treatment of people infected with HIV using a combination of at least three anti-retroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease http://www.who.int/hiv/topics/treatment/art/en/index.html

4. Purpose of Care, Support, and Treatment  Improves the survival, well-being, and quality of life of PLHIV over all stages of the disease and their caregivers  Helps PLHIV to stay healthy and productive for as long as possible PEPFAR. Dec 2009. The U.S. President's Emergency Plan for AIDSRelief: Five-Year Strategy. Annex: PEPFAR and Prevention, Care and Treatment. Washington, DC: PEPFAR

5. Care, Support, Treatment, and Prevention: 3 Pillars Figure from UK Consortium on AIDS and International Development/HIV Care & Support Working Group. 2008. What do we really mean by "HIV Care and Support"? Progress towards a comprehensive definition. London: UK Consortium on AIDS and International Development

6. Care, Support, and Treatment: The ART Era  Rapid, dramatic expansion of HIV care and treatment in the developing world is one of the largest public health successes in history  ART transformed HIV from survival (measured in weeks or months) to a chronic, lifelong disease

7. Care, Support, and Treatment: The ART Era  Keep in mind, care and support is vital with or without ART – Psychosocial support to PLHIV taking ART is directly associated with improved ART adherence and better health outcomes – Clinical care prolongs and improves the quality of life Cotrimoxazole (to prevent opportunistic infections) has great impact on health and survival of PLHIV

8. Know Your Epidemic, Know Your Response  Some CST services are needed across all epidemics: generalized, concentrated, low-level – Peer support – Management of TB  Some CST services are specific to a type of epidemic, key population, and local context. For example, – People Who Inject Drugs (PWID) – drug dependence treatment, promotion of viral hepatitis vaccination – In sub-Saharan Africa – food security, malaria prevention

9. Know Your Epidemic, Know Your Response in (Country) Post Adaptation  Insert post-specific information on type of epidemic and a few examples of major care and support services. Give only a few, key examples. Do not include too many details. As appropriate, link to the Global Health Sector Training Package session Introduction to Epidemiology.

10. Challenges in CST  Knowing your status and accessing care  Retention in care and support  Access and adherence to ART  Stigma and discrimination  TB  Gender  Integration, coordination, and linkages  Quality of services

11. CST Basics: Group Task  All groups: Read the Handout “Care, Support, and Treatment Basics”  Groups 1-3: Discuss, then select two points (based on your observations in country so far) that you consider most important about Care and Support in (insert post name) and explain why.  Groups 4-6: Discuss, then select two points (based on your observations in country so far) that you consider most important about Treatment in (insert post name)and explain why.

12. Wrap Up  Compare this discussion to our experiences “What Helped Us Get Better” – What strikes you as similar? Why? – What strikes you as different? Why?

13. The Continuum of Care

14. Continuum of Care: Definition  A network that links, coordinates, and consolidates care, support, and treatment services (provided in homes, communities, and health facilities) and is also the group of services themselves

15. Continuum of Care: Explanation  Counseling and Testing: Knowing one’s status is a gateway for care, support and treatment (as well as prevention) – Services/levels in the Continuum of Care are represented by the “circles” – Linkages in the Continuum of Care are represented by the “arrows”

16. Continuum of Care: Practice  Watch this short film clip http://www.viewchange.org/videos/kiberatv-life- beyond-hiv  As you watch – Listen for the services that Agneta and Benta describe. Write these on (color) sticky notes, one idea per note. – Listen for the linkages that Agneta and Benta describe. Write these on (color) sticky notes, one idea per note.