1. Aurélie BONFILS ESTHERAID Project Manager ESTHERAID: a Sub regional PSM Program mobilizing hospital partnerships

2. 2 GOAL Initiated by ESTHER, funded by UNITAID, implemented in full cooperation with each country Ministry of Health Extend the number of patients accessing pediatric and 2nd line ARV in selected TC by strengthening the supply chain and building the health system capacity

3. gaps identified : Management of the ART supply-chains not yet proven efficient Weak lab and TCC capacity to diagnose (infants, failure), treat and monitor patients in need of pediatric or 2 nd line treatment Lack of reliable data to ensure accurate ARV quantifications and forecasts The reasons behind the project Low and irrational demand and consumption of pediatrics and 2 nd line ARV=> Stock out and expired drugs

4. % of patients on pediatric ARV Rational % of patients switched to 2L % of patients on pediatric ARV Rational % of patients switched to 2L Stock out Access to early diagnosis & monitoring of viral load and CD4 Rational use + compliance Accuracy of quantification & ART forecast Stock out Access to early diagnosis & monitoring of viral load and CD4 Rational use + compliance Accuracy of quantification & ART forecast OBJECTIVES / STRATEGY Reinforce the supply chain Optimize the quality of diagnosis, treatment and monitoring of patients Improve data collection and analysis

5. 2 TYPES OF EXPERTISE Hospital expertise multi-disciplinary teams of experts Capacity building at treatment center level ESTHER HQ/ coordinations Additional consultancy international, national consultants in collaboration with KOLs Technical workshop (SOPs, guidelines, norms) and recommendations at central level National key institutions, MoH & decision makers Steering Committee Complementary approach Synergy Sustainability

6. Hospital Partnership in ESTHERAID ● In the North: 14 Hospitals involved in the project. ● In the South: 57 health facilities as partners + each country National Reference Lab. 5 partner countries 57 treatment centers

7. Range of hospital partnership Capacity building : on site and workshop trainings, tutoring, seminars (HIV care, therapeutic failure, pediatric,..) Internships in hospital Technical training in laboratories Therapeutic committee National guidelines Supervision Treatment education, dispensing Objective: Improve healthcare provision by optimizing the quality of diagnosis, therapy and patients monitoring Activities

8. Hospital partners interventions since 2011 Hospital partners profile: Doctors - Infectiologists - Paediatricians - Gynecologists Biologists - Virologists – Laboratory technicians - Pharmacists - Nurses Hospital partners profile: Doctors - Infectiologists - Paediatricians - Gynecologists Biologists - Virologists – Laboratory technicians - Pharmacists - Nurses BENINCARBURKINA FASO Support to PMTCT HIV PCR development Paediatric Seminars Trainings on management of virological failures Laboratory strengthening Companionship for paediatric care Organization of collection and transport of VLT samples Training through tutoring Management of Treatment Committees

9. CONCLUSION Hospital expertise and additional technical assistance can be mobilized in a complementary way hospital to hospital & on overall health system capacity building at hospital level + strategy and recommendations at central level ITA provides a comparative and brings resourceful “south” public health expertise Hospital expertise brings legitimacy, trust and continuance with long lasting partnership Limitations: articulation between types of expertise, limited communication and availability of hospital partners between field missions

10. Acknowledgements to ESTHERAID teams Focal point Pharmacy: P. Doo-Kingué Focal point M&E: C. Barberousse, B. Bassirou Focal point PSS: M. Dieng, M. Touré, M. Dossou-Yvo Focal point trainings: A. Beugny Focal point UNITAID & Project coordinator: A. Bonfils BéninBurkina FasoMaliCameroon CAR A. Laurent S. Ogou L. Pourteau M. Nintoungbe C. Leger O. Terzolo G. Ouedraogo A. Traore I. Sonde A. Masali D. Fofana I. Maiga H.Ouedraogo L. Gressier C. Comiti J. Motto C. Mimbang C. Leger S. Perrot A. Naissem A.Backo X. Gillette