Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

the international community. 4. Despite ongoing coordination, dialogue may
become fragile if objectives fail to coincide.
Recommendations: This initiative is still young and will require nurturing
from both members and sponsor technical and financial partners. The foreseen
results will make it worth the effort.
MOK C 0 1
Decentralization, scaling-out antiretroviral
treatment to health centres in a rural district in
Malawi process, progress and lessons learnt after
two years
M. Massaquoi', M. Fitzgerald2, F. Samura', R. Nalikunkgwi', R. Teck',
R. [email protected], A. Harries4. Medecins Sans Frontieres, Thyolo
District, Malawi, Medical Department, Brussels, Blantyre, Malawi, 2Medecins
Sans Frontieres District, Malawi, Medical Department, Brussels, Blantyre,
Malawi, 3Medecins Sans Frontieres - Operational Centre Brussels (OCB),
Medical Department, Brussels, Brussels, Belgium, 4Ministry of Health and
Population, Malawi, HIV Unit, MoH, Malawi, Lilongwe, Malawi
Issues: Since April 2003, people living with HIV/AIDS in Thyolo, in rural Malawi
were offered antiretroviral treatment (ART) through "centralized" clinics located
in hospitals. High patient load and "congestion" became a reality with potential
detrimental implications on the quality of care. Besides, hospital-based care
implies high transport costs and "time lost" from livelihood activities for both
patients and their families. Decentralizing ART initiation, and follow-up to health
centres is thus desired.
Description: In July 2004, seven of eleven public health centres were selected
on the basis of set criteria. Lower cadres of health staff (medical assistants/
nurses) were trained on follow-up of patients on first-line ART. Health surveillance
assistants, (the Malawian brand of community health workers) were included
to manage patient registration, adherence counselling and patient flows. A
referral-system was established between hospital clinics and health centres. A
mobile team moves around health centres on a scheduled basis to provide "on
the job" support to health centre staff.
Lessons learned: After a period of two years, 650 ART patients are managed
at health centres comprising 25% of all people currently on ART in the district.
Health centre staff developed confidence in ART management.
In the first year, patients expressed concerns over the quality of care they
might receive at health centres and decentralisation was achieved in only 10%
of all placed on ART. Greater emphasis on patient counselling, on establishing
good links between hospital and health centre teams, and continued supervision
of health centres reassured patients who then gladly accepted being seen at
health centres.
Recommendations: Progressive ART decentralization to health centres in rural
settings is an inevitable reality to promote access, ensure long term adherence
and the quality of care. Embarking on decentralisation strategies is pivotal in
the efforts towards trying to achieve "Universal ART Access".
Providing continuum of care for patients with dual
TB/HIV infections
A. Kulsharova', D. Hausner', L. Khodakevich', A. Deryabina',
V. Seledtsov'. 'The CAPACITY Project, JSI/Central Asia, Almaty, Kazakhstan,
'Almaty Institute of Advanced Medical Training, Almaty, Kazakhstan
Issues: Cooperation of Tuberculosis (TB) and AIDS services to provide a
continuum of care for dual-infected patients.
Description: Health care systems in the countries of Central Asia have weak
linkages between vertical service providers. Integrating AIDS and TB services
is a challenge. In Central Asia, there are more than 50,000 new TB cases
annually. HIV is spreading quickly in the region, especially among injection drug
users. TB is the leading cause of death among people with AIDS. The USAID
funded CAPACITY Project facilitated form Technical Working Groups (TWG)
in Uzbekistan, Tajikistan, and Kyrgyzstan. For the first time, the Ministries of
Health and Justice, National AIDS and TB Centers, UN agencies, and NGOs
discussed methods of linking TB and AIDS services. TWGs developed national
protocols for diagnosis, registration, treatment, and reporting dual infections,
and joint work plans including patient flow and budgets. CAPACITY assisted
in developing training curricula and trained more than 70 national trainers in
the three countries. The later in turn trained about 500 specialists on dual
infection management. TWGs selected model sites in each country for testing
and refining the integration approaches.
Lessons learned: Recognition by the officials of the urgency for integration of
TB and AIDS services was raised. Joint planning through multi-sectoral TWGs
played a key role in the development of one training program, one team of
trainers, and one monitoring team for integrating the two services. Models of
service delivery are currently being tested in countries where integration of
these services was previously not possible.
Recommendations: CAPACITY continues involvement in the implementation,

monitoring, and supervision of the models of TB and HIV service integration in
Central Asian countries. Following rigorous model evaluation, successful models
will be promoted for national scale-up.

MOKCS03
Implementation of PMTCT policies and programs in
east, central & southern Africa
S. Onyango1, T. Mwikali2, K. Chebet3. 'Ministry of Health, STD/AIDS Control
Program, Kampala, Uganda, 2Ministry of Health, NASCOP, Nairobi, Kenya,
3ECSA Health Community Secreteriat, HIV/AIDS, Arusha, Tanzania, United
Republic of
Issues: MTCT is a growing problem in sub-Saharan Africa due to high HIV
prevalence among women of reproductive age, high fertility rates and ineffective
nationwide interventions to prevent transmission. Effective interventions
can virtually eliminate HIV among children as evidenced by experience from
developed countries. The East, Central and Southern Africa Health Community
Secretariat commissioned a review to assess the implementation of PMTCT
within 6 member countries namely: Lesotho, Zimbabwe, Zambia, Tanzania,
Kenya and Uganda.
Description: Literature review was conducted followed by visits to selected
countries and interviews with representatives from relevant Government
Departments e.g. National AIDS Commissions, Reproductive and Child Health
Departments; National AIDS Control Programmes and Nutrition Departments.
Information was also obtained from Development Partners supporting HIV/
AIDS interventions and PMTCT; civil society organisations; organisations for
people living with HIV/AIDS; faith-based organisations and medical professional
organisations.
Lessons learned: The PMTCT issues had been included in related HIV/AIDS
or Reproductive Health policy documents except in one country that had a
specific PMTCT policy document. The guidelines had been finalized and
disseminated in two countries while the rest had draft copies guidelines. There
was variation in content and scope of the PMTCT guidelines among the member
countries, including failure to address the first and fourth strategic prongs of
comprehensive PMTCT. In addition, the guidelines had not taken into account
recommendations for use of more efficacious regimens that include HAART for
the eligible mothers. Training curricula and manuals for in-service use varied
among the member states in terms of content and duration of training while
there was a clear gap in the pre-service training.
Recommendations: PMTCT is a priority intervention as evidenced by the
policies and guidelines being in place. However, they need to reviewed to
address the four strategic prongs of comprehensive PMTCT and operationalised
in order to have a greater impact on the programs.
Diagnostic HIV counseling and testing of TB patients
in Kinshasa, Democratic Republic of Congo: from
pilot project to evidence-based policy development
and roll-out
A. Van Rie', M. Sabue2, K. Vanden Driessche2, F. Behets', J. Kokolomani3,
E. Bahati4. 'The University of North Carolina at Chapel Hill, Epidemiology,
Chapel Hill, United States, 2UNC-DRC, Kinshasa, Congo, the Democratic
Republic of the, 3Programme National de Lutte contre le SIDA, Kinshasa,
Congo, the Democratic Republic of the, 'Programme National de Lutte contre
la Tuberculose, Kinshasa, Congo, the Democratic Republic of the
Issues: In July 2004, WHO published the Interim Policy for Collaborative
TB/HIV activities. Key to reducing the burden of HIV among TB patients is
implementing HIV counseling and testing (CT) for all TB patients. Few TB
patients are currently tested, in part because little evidence is available on
how, where and when HIV CT should be offered to TB patients.
Description: Evaluation of a pilot study (2004-2005) including 1289 TB
patients demonstrated that provider (TB nurse) initiated diagnostic HIV
CT was acceptable, feasible and the preferred method by both patients and
nurses. The preferred time for CT was at commencement of TB treatment.
Confidentiality was identified as an important issue. Discussion of results with
stakeholders resulted in: a policy of diagnostic HIV CT; clearly-defined roles of
health care workers and National TB and HIV Programs, and identification of
potential barriers to large scale implementation of activities. A training manual
for collaborative TB/HIV activities was developed and field tested by health care
workers, National HIV and TB Control Program officers, educational specialists,
and international TB experts. The 4-day training targets all health care workers
involved, i.e. primary health care nurses, clinic directors, laboratory technicians
and physicians.
Lessons learned: Pilot projects provide evidence for translation of international
guidelines into local policy. Involving key decision makers in operational research
accelerates the process of translating research into practice. Integrating new
collaborative TB/HIV activities into clinical practice demands the development
of training materials to equip health care workers with the knowledge and skills
required to provide quality HIV CT and care for HIV co-infected patients.
Recommendations: Assa next step, monitoring, and evaluation of the program
in Kinshasa, aimed at counseling and testing 5000 TB patients in 2006, will
identify barriers to diagnostic CT as a routine program activity at primary
healthcare level and further refine the training manual.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1