International Center for AIDS Care and Treatment Programs

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2007 ICAP Annual Meeting
Title Rolling out ART to Primary Health Care
Centers in Tanzania The Chalinze Fast Track
Experience Name Dr. Stella Kasindi MD, MPH
Country Program Tanzania Date 3rd October 2007
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Background

• Tanzania Pop of 37 million, in 26 regions,
  majority of the population is rural
• ART roll out to approx. 200 centers
• Regional and District Hospitals
• 80,000 on ART, 400,000 est. to need ART
• Pwani region located on the East Coast of
  Tanzania, is among the regions being supported
  by ICAP
• It has 6 districts, a population of 1,024,402
  HIV prevalence of 7.3

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ICAP/CU Tanzania

• Pwani
• Mwanza
• Kagera
• Kigoma
• Zanzibar
• Dar-es-salaam
• Prevalence1-15

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The Challenge

• Ministry of Health declares goal for at least 500
  primary health centers to offer ART in 2007/8
• Goal of four health centers per district
• Care and Treatment centers
• Refill Centers
• Outreach

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Chalinze HC - responding to the challenge!

• Chalinze HC is GoT clinic located in Bagamoyo
  District, on the junction of 2 up-country busy
  highways, 109 km from DSM,- truck drivers, mobile
  groups, guest houses
• Providing primary health care (OPD IPD
  services)
• Catchment population is about 30,000 in 7
  villages

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Rationale

• High prevalence
• 15 HIV prevalence among Pregnant Women, 30 VCT
  clients, 18 TB clients
• Location - nearest CTC is either Bagamoyo or
  Tumbi (70 and 65K)
• Good Basic Structures - Good TB/HIV integration,
  PMTCT, HCT, STI and TB services already provided
• The WILL TO START!

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But.the Assessment Showed

• Assessment was done in March 2007
• Lack of adequate working space no rooms for CTC
  and lacked furniture e.g. patient seats, chairs
  and desks
• Inadequate HIV/AIDS care and treatment knowledge
  and skills
• Inadequate laboratory services supplies of
  medical equipment
• Lacked renovation and repair of the centers
  building over time
• Lack of ARVs and OIs drugs

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How did Chalinze Start

• Chalinze had been identified by the District and
  ICAP as a site needing CTC initially thought as
  a refill site
• April 2007 Stakeholders meeting
• RMO, RNO, DMO/Bagamoyo, District Pharmacist, ICAP
• Discussed the steps for initiating ART out
  including clearance from NACP, logistics and
  supply system, blood sample transport,
  supervision, ME

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Plans

• Agreements
• District Pharmacist and HC In-Charge would
  initiate access to drug supply
• MSD to provide ARVs and OI drugs and stored at
  Bagamoyo DH pharmacy
• The in-charge of Chalinze Health Center to
  request ARV/OI through BDH Pharmacy
• Blood sample for CD4 analysis to be transported
  to Tumbi Regional Laboratory for analysis two
  times every week
• Technical Support from ICAP- CU

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Training

• NACP course and On the Job training
• 2 clinical staff trained on provision of ART
  services (10 days)
• Others trained in PMTCT, Infant diagnosis, and
  Monitoring and Evaluation
• ICAP Tanzania Clinical Officer and Nurse spent 10
  days at Chalinze to assist in set up and provide
  mentorship
• ICAP staff visited for ensuring quality data
  systems in place

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What was then Done

• Repairs and Minor Renovations
• Painting in and out ceiling and roof repair
• Fans, electric repairs
• New entry way and waiting area concrete
• Equipment
• Locally made files for registers, patient waiting
  benches, tables and office chairs
• ITNs, beds, dustbins, weighing scales, mattresses

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BEFORE
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AFTER
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AFTER
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Expenditure

• Total Cost
• The overall cost for the whole project was 15
  million Tanzanian shillings, equivalent to 12500
  USD.
• This amount included central expenditures for
  transport, and per-diem for technical support
  staff

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Achievement Less than 2 months

• CTC services were initiated on 7th May 2007 (with
  10 clients on Day One) EID on 2nd July07
• By 12th July 2007
• Total patient enrolled 117
• Patient on ARV 41
• Transfer in 21
• TB/HIV 6
• Pregnant women 2
• Pediatric 2
• HIV Exposed Infants 9

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C T program by 21st Sept
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Plans for Future

• Strengthen sample transport systems for CD4 and
  DBS
• Increased management and support supervision by
  CHMT
• Strengthened lab, data and pharmaceutical systems
  in place
• More training of available staff on ART, Paed.,
  PMTCT, PITC and Adherence support

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Lessons Learnt

• ART CAN be provided at Primary health facility
• Lower cadre medical staff with additional
  training on ART, can provide satisfactory care to
  HIV/AIDS patients including ARVs
• Improved access to ART-patients who defaulted due
  to transport constrains - resume treatment.
• ART services integrated with other routine clinic
  services reduces stigma but increases patient
  waiting time

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Lessons Learnt, contd

• Expansion requires greater engagement with
  district management
• Facilitate, improved networks of services
• Minor infrastructure repairs boosts health
  facility morale and community confidence
• Involving local village leadership encourages
  uptake of services
• Important to think through sample transport
  systems

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RCHC
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By the end of the day!
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ASANTE SANA