20th International AIDS Conference - Melbourne, Australia


MOAE03 Health Systems for HIV: How Can We Make Them Work Better?
  Oral Abstract Session : Track E
Venue: Melbourne Room 1
Time: 21.07.2014, 16:30 - 18:00
Co-Chairs: Fonny Silvanus, Indonesia
Kate Gilmore, UNFPA

16:30
MOAE0301
Abstract
Powerpoint
Webcast
Strengthening Mozambique's district level health system to deliver quality HIV clinical services
D. Lee1, C. Cuellar2, D. Jacobson2, M. Castrillo1, A. Hulme2
1Abt Associates, Inc., International Health, Maputo, Mozambique, 2Abt Associates, Inc., International Health, Bethesda, United States

16:45
MOAE0302
Abstract
Powerpoint
Webcast
Creating stigma-free health facilities: lack of HIV care policies, protocols, materials, exacerbate health worker fear of HIV transmission and stigmatizing avoidance behaviors, evidence from 6 countries
L. Nyblade1, A. Jain2, M. Benkirane3, L. Li4, A.-L. Lohiniva3, R. Mclean5, J.M. Turan6, N. Varas-Díaz7
1Health Policy Project and RTI, International, Global Health, Washington, United States, 2Health Policy Project and Futures Group, Washington, United States, 3Global Disease Detection and Response Program at the U.S Naval Medical Research Unit no 3., Cairo, Egypt, 4University of California, Psychiatry and Biobehavioral Sciences and Epidemiology, School of Public Health, Semel Institute - Center for Community Health, Los Angeles, United States, 5University of the West Indies St. Augustine Campus, Centre for Health Economics, Faculty of Social Sciences, Port-of-Spain, Trinidad and Tobago, 6University of Alabama at Birmingham, Department of Health Organization and Policy, School of Public Health, Birmingham, United States, 7University of Puerto Rico, Center for Social Research, Social Sciences Faculty, San Juan, Puerto Rico

17:00
MOAE0303
Abstract
Powerpoint
Webcast
Getting products to people: commercial sector segmentation analysis helps build integrated public health supply chains
N. Olson, C. Keddem, J. McCord, N. Printz, E. Wilson
John Snow, Inc., Arlington, United States

17:15
MOAE0304
Abstract
Powerpoint
Webcast
Stepping up the pace in key population prevention programming in Kenya by establishing a technical support unit within ministry of health government of Kenya: experience from Kenya
J. Anthony1, G. Githuka2, B. Ogwang1, S. Kaosa1, M. Sirengo2, P. Bhattacharjee3
1University of Manitoba, Technical Support Unit, Nairobi, Kenya, 2National STD AIDS Control Program, Ministry of Health, Nairobi, Kenya, 3University of Manitoba, Nairobi, Kenya

17:30
MOAE0305
Abstract
Powerpoint
Webcast
Training and mentorship in HIV medicine by the Baylor College of Medicine International Pediatric AIDS Initiative in Africa
R.S. Wanless1, M. Mizwa2, M.W. Kline2, G.E. Schutze2, N.R. Calles2
1Baylor College of Medicine International Pediatric AIDS Initiative, Pediatrics, Glasgow, United Kingdom, 2Baylor College of Medicine at Texas Children's Hospital, Pediatrics, Houston, United States

17:45
MOAE0306
Webcast
Moderated discussion

Powerpoints presentations
Strengthening Mozambique's district level health system to deliver quality HIV clinical services - Daniel Lee

Creating stigma-free health facilities: lack of HIV care policies, protocols, materials, exacerbate health worker fear of HIV transmission and stigmatizing avoidance behaviors, evidence from 6 countries - Laura Nyblade

Getting products to people: commercial sector segmentation analysis helps build integrated public health supply chains - Edward Wilson

Stepping up the pace in key population prevention programming in Kenya by establishing a technical support unit within ministry of health government of Kenya: experience from Kenya - John Anthony

Training and mentorship in HIV medicine by the Baylor College of Medicine International Pediatric AIDS Initiative in Africa - Gabriel Anabwani



Rapporteur report

Track E report by Jennifer Butler


Stepping up the pace is going to require stronger and more integrated health systems with significant emphasis on the capacity to provide services at the local level.  This session explored various components of strengthening health systems for HIV.   As the HIV response decentralises and reaches the local district and community level the health system will need to become more flexible.  

Daniel Lee described a process of strengthening the capacity of the district level health directorates, to support the Government of Mozambique’s Acceleration Plan with targets to increase coverage by at least 80% by 2015, including through decentralising ART services.  The Graduation Path Strategy focuses on improving managerial capacity to ensure district health directors are supported to do their job and maximise health outcomes, with a continuous quality improvement cycle.

Health professionals have a core role in the HIV response.  Commonly, though, stigma from health care workers acts as a barrier to service access and uptake.  Laura Nyblade found that health care staff are often not aware of their stigmatizing behavior towards people living with HIV and experienced secondary stigma themselves as people working on HIV. Their work field-tested a stigma tool in six sites ranging in size, location, with a mix of staff. The conclusion was that stigma is an integral part of QALY and that stigma reduction needs to be incorporated into training and performance assessment.

This interesting paper looked at supply chain and supply chain management and innovate approaches to improve efficiency, essential to any and all efforts to step up the pace. 

Investment in products is a large proportion of health budget for services, so it is important those resources be used wisely. Public health supply chains manage a multitude of products essential to achieving an AIDS free generation. 

Edward Wilson described an innovative approach of supply chain segmentation adapted to local circumstances.  The focus is to minimise the cost to the buyer/customers (health facilities) and improve stock management. 

Supply chain and supply chain management is highly dynamic.  The segment approach uses data to make rational decisions about how to manage and distribute multiple products in the supply chain –whether to manage different programs’ products in the same way/jointly or differently/separately. Introducing segmentation into the “integration” and health system strengthening discussion can help stakeholders make rational decisions about system design and preserve product availability.  

Many governments in sub-Saharan Africa are struggling to address the escalating HIV epidemics among key populations as their national responses have been directed towards heterosexual epidemics.  Kenya has quite diverse HIV epidemics and HIV rates among key populations are high: 29% among female sex workers, 23% among female sex workers, 18% and 11% among MSM and MSW, and 18.7% among people who inject drugs. Just two national government staff were responsible for managing programmes to reach key populations.  John Anthony described the establishment of the technical support facility (following closely the programmatic approach established by the University of Manitoba/AVAHAN).  This has resulted in a dramatic scaling up of technical support to all parts of Kenya and a reported significant increase in Key Populations accessing services. 

The final presentation, by Dr Gabriel Anabwani (replacing Michael Mizwa) provided an interesting review of BIPAE , first established in Botswana, and its work in training health service personnel with a focus on paediatrics.  The BIPAI outreach training and mentorship model is effective in empowering health care providers in the provision of paediatric HIV care, leading to significant and rapid increases in knowledge and enrolment into care 73,967 local healthcare professionals trained; approximately 500 receive mentorship or COE clinical attachments per quarter; 620 primary health centres serviced by BIPAI personnel; 125 primary health centres graduated.  Mentorship is key to sustainability of capacity building.

It will be interesting to learn, two years from now the impact these innovations have made.  

 

 

 




   

    The organizers reserve the right to amend the programme.