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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3244.0: Monday, December 12, 2005 - Board 9

Abstract #113287

Rapid ART scale-up in Zambia: Achievements, pitfalls and lessons learned

Joseph Nikisi, MD1, Richard S. Hughes, MA2, and Maureen Chilila, RM, MSc2. (1) Zambia Country Office, JHPIEGO, PO Box 36873, Lusaka, Zambia, (2) Zambia Country Office, JHPIEGO Corporation, 8 Ngumbo Road, Long Acres, PO Box 36873, Lusaka, Zambia, +260-1-254555, rhughes@jhpiego.net

Issues: The Zambian Government adopted an aggressive program to expand access to ART. Before the Global Fund, WHO 3x5 initiative, or US Emergency Plan, Parliament committed to putting 10,000 patients on ART and provided funds that enabled the initiation of public sector ART programs. In 2004, with less than 3,000 patients on ART, the government adopted a goal of 100,000 patients on ART by the end of 2005. The rapidity and limited focus of the effort has left significant gaps in the ensuing quality of services provided.

Description: The government was under pressure to distribute ARVs widely, without having prepared clinicians to deliver them. In response to this, MOH and a team of Zambian clinicians and external experts developed standardized, competency-based training packages for ART and OI management. This team was trained as trainers and carried out trainings in all nine provinces in the country. In a three month period, over 400 providers were trained and more than 40 new ART centers were opened.

Lessons Learned: Anecdotal evidence, site visits, observations, and provider interviews indicate some of the teething problems providers and facilities faced. This presentation shares specific successes, problems and issues, and some of the strategies that have been, or must be, put in place to address them.

Recommendations: The availability of funding is not the only necessity to scale-up ART services, given the weakness of health systems in resource limited settings. Countries and donors need to understand the constraints in developing the requisite systems to support these services.

Learning Objectives: Participants attending this session will be able to

Keywords: HIV Interventions, Antiretroviral Combination Therapy

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

HIV/AIDS: Care and Prevention across Diverse Settings

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA