220489 An innovative approach to national scale up of comprehensive HIV/AIDS services in Ethiopia

Tuesday, November 9, 2010

A. Frederick Hartman, MD MPH , Communicable Diseases and Epidemic Preparedness, Managment Sciences for Health, Cambridge, MA
Bud Crandall, MSc , Ethiopia HIV/AIDS Care and Support Program, Managment Sciences for Health, Cambridge, MA
Melese Muluken, MD MPH , Ethiopia HIV/AIDS Care and Support Program, Managment Sciences for Health, Cambridge, MA
Background: The Ethiopia HIV/AIDS Care and Support Program (HCSP) provides comprehensive HIV/AIDS services targeting 64 million people in four regions plus Addis Ababa for prevention, curative and palliative services through 550 health centers (HC) and 6000 communities. Innovative technical approaches developed to achieve this massive scale-up including task shifting, new health care personnel, health systems strengthening, performance-based financing, case management approaches and standards-based management quality assurance.

Methodology: the HCSP directly employs case managers, data clerks and clinical mentors to HCs providing ART services; 6000 community volunteers; performance-based contracts with community organizations to extend services; and comprehensive prevention services.

Results: By the end of project year 3, 75,000 ART clients and 200,000 HIV-infected individuals were supported by the HCSP. Successes include a decrease in the lost-to-follow-up rate of ART clients to 7.3% compared with 23% nationally. In addition, 12 of 13 indicators, including counseling and testing, clients on ART, and number of people trained were achieved.

Conclusions: 1. Partnerships are essential to rapidly scale up and achieve results. Performance-based financing is essential to developing those community partnerships 2. It is possible to rapidly expand access to, and simultaneously improve the quality of, all HIV/AIDS services. 3. Strengthening the network of services from hospital to health center to community levels reduces the lost-to-follow up to acceptable levels and means many more lives saved. 4. Human resource improvements and task shifting are essential to rapid scale up. 5. Leadership development and health systems strengthening a key component of sustainable service delivery.

Learning Areas:
Chronic disease management and prevention
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe effective innovations needed for national scale up of comprehensive HIV/AIDS services to large populations

Keywords: HIV Interventions, Community-Based Partnership

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee the Ethiopia HIV/AIDS Care and Support Program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4326.0: Poster Session 4: HIV/AIDS