Transcript Slides - View the full AIDS 2016 programme

Every day. In times of crisis. For our future.
Integrated Community Case
Management One Opportunity for Integrating
HIV/TB: The Malawi Experience
Dr. Kechi Achebe, Senior Director HIV/AIDS & TB
Outline
• CCM Elements, Main Sub
Strategies, Program
Requirements and Benefits
• Adaptation considerations
• Lessons learned from pilot
of iCCM for TB/HIV in
Malawi
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CCM – What is it?
3
CCM: Elements
• Priority Elements: Treatment of childhood malaria,
pneumonia, and diarrhea by CHW at community
level
• Other Elements:
– Malnutrition
– Neonatal sepsis
– Preventive/promotive: newborn care, PMTCT, etc.
according to local need/epidemiology
4
CCM: Main sub strategies
• Equip and train Ministry of Health staff at clinics to:
– Provide standard case management
– Support, supply and supervise community health workers.
• Equip and train community health workers to:
– Treat and sometimes refer common, serious, infections.
– Manage small drug boxes or “kits”.
• Train families to:
– Recognize and promptly seek treatment for danger signs.
– Complete the treatment or accept referral.
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Benefits of iCCM
• Increases geographic access for parents and caregivers seeking
treatment for sick children
• Encourages timely care seeking for the diagnosis, treatment
and care for three common childhood illnesses (pneumonia,
diarrhea and malaria)
• Reduces inappropriate use of artemisinin combination
therapies and antibiotics which maximizes resources and
lowers potential for drug resistance
• Promotes resilient and sustainable community health systems
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Adaptation of iCCM for TB/HIV
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Adaptation of iCCM
• September 2013 - Geneva consultation to review draft WHO/UNICEF
materials to use by CHWs for newborns and children and the HIV/TB
adapted materials became available in 2014
• CHWs are a vital channel for
increasing the access of mothers,
children, and women who are
pregnant or lactating to HIV- and
TB-related interventions
• Contacts with mothers, pregnant
and lactating women, and
caregivers of sick children provide
the opportunity to provide
information and advice on HIV and
TB prevention, testing and care
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Adaptation Considerations
• Capacity of CHWs
• Maintaining quality
• Asking one very clear question: eg. Yes or No:
Q. Lives in a household with someone who is on TB treatment?
• Thus the adaptions does not include:
–
–
–
–
–
Community-based counselling or testing
Dispensing HIV care such as cotrimoxazole prophylaxis
Personal counselling on ARV uptake and adherence
Clinical assessments for ARV-related side effects
Dispensing TB prophylaxis
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The Mwayi wa Moyo Project, Blantyre,
Malawi: Background
• Save the Children went into partnership with MOH
• National consultation workshop with key MOH,
DHO, other partners held in February 2015
• CCM-HIV/TB integration pilot endorsed
• Adaptation of Malawi CCM manual conducted based
on WHO-UNICEF package Caring for the newborn and
child in the community/Sick child
• Save the Children started implementing pilot in
Blantyre District in partnership with DHO in April
2015
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WHO/UNICEF manual: Caring for the Sick Child in
the Community
Caring for the sick child in the community (2 to 59 months):
“The CHW identifies and refers children with danger signs to a health facility; treats
pneumonia, diarrhea and fever; identifies and refers children with severe
malnutrition, HIV and TB or at risk of HIV & TB; refers children with other problems;
advises on home care and prevention of illness.”
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Steps taken …..
1. Oriented trainers to the adapted manual – March 2015
2. Conducted a pre-test of the manual – March 2015
3. Identification of district facilities to implement this
intervention – March 2015
4. Randomized selected facilities into intervention and
control arms. (9 control and intervention) – April 2015
5. Trained 51 HSAs in the 2 arms – May 2015
6. Distributed of registers and drugs - June 2015
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Other activities…
1.
2.
3.
4.
5.
6.
Trained Senior HSAs in CCM
Trained Mentors
Trained HSAs and SHSAs in C-Stock
Trained AEHOs in supervision
Trained Senior HSAs in supervision
Conducted Endline assessment to evaluate differences
in uptake of HIV/TB services between intervention and
control arms after one year
7. MOH evaluated pilot experience for uptake and scale
up
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Lessons Learned from Malawi
• Substantial number of Children at risk for HIV
identified
• Lack of privacy in village clinics prevent disclosure of
HIV/TB status
• Referral between the community and health facilities
still remains a challenge (less than 10% identified
were referred to the health facilities)
• HIV/TB indicators are not included in the children’s
health passport, so difficult to capture, identify and
support children exposed and visa versa
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