ESTHER initiative :

1
XVIth International AIDS Conference, Toronto,
Canada, 13-18 August 2006 Skill building Workshop

• ESTHER initiative
• networking for a collaborative response in
  procurement and supply management of AIDS
  commodities
• The experience of ESTHER Hospital Pharmacists
  Network

• Dr. Muriel DUBREUIL
• GIP ESTHER, Paris, France
• Dr. Nicolas TERRAIL
• Hôpital Lapeyronie, Pharmacy, Montpellier, France
• Representative of ESTHER network

2
ESTHER background (1)

• Initiative launched in 2001
• French Ministries of Health and Foreign Affairs
• Together for Network Hospital Therapeutic
  Solidarity 
• Hospital twinnings
• Main goal
• Improve access to care and treatment for PLWHIV
• with a global and operational approach
• 10 European countries involved

3
Main stakeholders to implement ESTHER Activities
ESTHER background (2)

• National and local health authorities
• Hospital teams
• NGOs
• Civil Society representatives
• Private sector

4
Activities Implemented by ESTHER

• Comprehensive care
• Medical Care
• Psychosocial Care and Support
• Training and capacity building for
• Medical (clinicians, biologists, pharmacists)
• Paramedical (nurses, auxiliaries)
• Social (psychosocial counsellors, social
  workers)
• Technical professionals ( programme designers,
  technicians,)

5
Pharmaceutical sectorESTHER positioning (1)

• Direct link with national health authorities,
  hospital administrations and clinical staffs
• Strengthening existing health facilities within
  health care systems
• Answering to the full range of pharmaceutical
  technical needs

6
Pharmaceutical sectorESTHER positioning (2)

• 2 main objectives
• ? Strengthening capacities
• Enhancing pharmaceutical competencies
• Improving supply and distribution systems
• French Hospital Pharmacists network
• ReMeD
• ? Answering to ARTs stockouts (stockpile)
• CHMP Nairobi

7
Pharmaceutical sector Key players

• ? ESTHER Hospitals Pharmacists network
• On site training sessions
• Mentoring activities
• Specific expertise
• ? Specific partnerships
• ReMeD
• CHMP

8
I. ESTHER/ReMeD/CHMP transversal project

• ? Capacity building (ReMeD CHMP)
• Ad hoc training modules organisational
  support to ARTs management and dispensation
• Selection and quantification
• Supply and management
• Dispensation and treatment follow up
• Partnership with WHO for french adaptation of
  IMAI pharmaceutical modules
• ? Specific expertise (ReMeD CHMP)
• ? ART stockpile (CHMP)
• A Nairobi based warehouse for storage of ARTs
  emergency stocks

9
II. ESTHER Hospitals Pharmacists network
Intervention fields

• ? Continuing education
• Training courses in local health settings
• University degrees (DIU Ouagadougou, Ouidah,
  IMEA,)
• Internships in French hospitals pharmacies
• Training objectives
• Drugs and pharmacy management
• ARV dispensation
• Compliance and therapeutic education
• Therapeutic drug monitoring
• ? Expertise and knowledge transfer
• Diagnostic and evaluation
• Supports to projects and mentoring
• Specific technical expertise

10
II. ESTHER Hospitals Pharmacists network
Involved hospitals
(n) number of involved Parisian hospitals for
the country
11
II. ESTHER Hospitals Pharmacists network
Geographical coverage
12
II. ESTHER Hospitals Pharmacists network
Examples of collaborative responses

• Software adaptations to identified local needs
• Co-development between ESTHER hospital partners
• Involving different type of partners according to
  each context
• Examples
• ADAGIO
• Calmette Hospital Phnom Penh, Cambodia /
  Kremlin-Bicêtre Hospital, AP-HP, Paris, France
• LOGONE
• NDjamena, Chad / Initiative et Développement
• Calculator of paediatrics protocols
• CDG Hospital, Ouagadougou, Burkina Faso / ESTHER
  projects

13
II. ESTHER Hospitals Pharmacists network
1. ADAGIO software adaptation (1)

• Main functionalities
• ARVs management
• Stock management
• Accountability
• Patient data files
• Treatment history
• Prescription analysis
• Previous prescription
• Drugs association
• Doses

14
II. ESTHER Hospitals Pharmacists network
1. ADAGIO software adaptation (2)
15
II. ESTHER Hospitals Pharmacists network
1. ADAGIO software adaptation (3)
16
II. ESTHER Hospitals Pharmacists network
1. ADAGIO software adaptation (4)
17
II. ESTHER Hospitals Pharmacists network
LOGONE software in Chad
18
II. ESTHER Hospitals Pharmacists network
2. LOGONE software (2)
19
II. ESTHER Hospitals Pharmacists network
2. LOGONE software (3)
20
II. ESTHER Hospitals Pharmacists network
2. LOGONE software (4)
21
II. ESTHER Hospitals Pharmacists network
2. LOGONE software (5)
22
II. ESTHER Hospitals Pharmacists network
Conclusions (1)

• Constraints
• Insufficient involvement of local pharmacists in
  HIV/AIDS networks, and in other southern
  countries
• Few knowledge transmission to fellow-members
  among trained pharmacists
• Lack of pharmaceutical resources
• Lack of qualified staff to manage pharmaceutical
  activities

23
II. ESTHER Hospitals Pharmacists network
Conclusions (2)

• Innovative cooperation methods allow
• Valorisation and peer recognition for pharmacists
  among other HIV/AIDS professionals
• Peer-to-peer transfer of knowledge
• Recognized University degrees (in France and in
  partner countries) with multidisciplinary
  teaching
• Mutual exchanges in the field of pedagogy and
  training
• Adaptative responses to each context
• Sharing of emerging difficulties
• Development of techniques and tools for knowledge
  sharing (website)
• Specific working groups to address key issues

24
The experience of ESTHER Hospitals Pharmacists
Network
We would like to address a special thank to all
ESTHER partners who contributed to this
presentation, specifically - Agnès Certain,
Hôpital Bichat, Paris - Initiative et
Développement, Chad and Kremlin Bicêtre hospital
team - and the whole Hospitals Pharmacists
network

• CONTACTS GIP ESTHER
• Muriel DUBREUIL, Drugs focal point
• muriel.dubreuil_at_esther.fr
• Nadine LEGRET, Communication Unit
• Nadine.legret_at_esther.fr

Poster THPE 0858 Thursday session