Overview of the Implementation of the Linked Overview of the - - PowerPoint PPT Presentation

SLIDE 1

Presented by: Presented by:

• Dr. MEAN CHHI VUN
• Dr. MEAN CHHI VUN

Director of NCHADS Director of NCHADS

Overview of the Implementation of the Linked Overview of the Implementation of the Linked Response for Prevention, Care and Treatment of Response for Prevention, Care and Treatment of HIV/AIDS, Sexually Transmitted Disease, and HIV/AIDS, Sexually Transmitted Disease, and Reproductive Health Issues Reproductive Health Issues

SLIDE 2

Outline Outline

• Why Linked Response is needed?
• What is Linked Response?
• Objectives of Linked Response
• Service package of Linked Response
• Implementation and Results of Linked Response:

Phase 1

• Next step

SLIDE 3

WHY Linked Response is Needed? (1) WHY Linked Response is Needed? (1)

Missed Opportunities to Provide information and Refer patients t Missed Opportunities to Provide information and Refer patients to relevant

• relevant

Health Services to appropriate Testing or Treatment Health Services to appropriate Testing or Treatment Poor Communication between Health care providers and Community B Poor Communication between Health care providers and Community Base ase Support Team Support Team All Health Service Deliveries are not available at the same Heal All Health Service Deliveries are not available at the same Health Facility th Facility Limited Access to Health Facility due to Geographical and Resour Limited Access to Health Facility due to Geographical and Resource ce Constraints Constraints

SLIDE 4

WHY Linked response is Needed? (2) WHY Linked response is Needed? (2)

VCCT STI Clinic Maternity PAC OI and ART Service ANC Service TB Unit FP/BS CBS Team CBS Team NCHADS NCMCHC

SLIDE 5

WHAT is Linked Response ? WHAT is Linked Response ?

VCCT ANC Maternity PAC OI and ART Service STI Clinic TB Clinic FP/BS CBS Team CBS Team Refer Follow Up COMMUNITY Inform / Refer / Follow up NCHADS-NCMCH NPH

SLIDE 6

Linked Response: Institutional Linkages at National Level Linked Response: Institutional Linkages at National Level

NCHADS HIV/AIDS STI,OI/ART VCCT

• Dep. Of Medical

Service: RH, HC Laboratory, NCMCH RH,MNCH,BS Nutrition, EPI CENAT TB NAA NCWC Partners NGOs CBOs FBOs

• NPH

PAC

SLIDE 7

What is Linked Response: Strengthening R&F Linkages between and What is Linked Response: Strengthening R&F Linkages between and within HFC services and Community within HFC services and Community-

• Based Care

Based Care

Referral & Follow-up

CBS CBS CBS

Community level (HBC) HFC CBS R & F

RH HC

VCCT ANC BS Safe delivery STI OI & ART PAC EPI TB Nutrition Lab Data Management

R & F

Linked Response

Referral & Follow-up R e f e r r a l & F

• l

l

• w
• u

p

SLIDE 8

Linked Response: Objectives Linked Response: Objectives

Contribute to the strengthening of Cambodia Contribute to the strengthening of Cambodia’ ’s Health Care System s Health Care System Strengthen the existing Reproductive Health Services Strengthen the existing Reproductive Health Services Increase Access to HIV Prevention, Testing and Care and Treatmen Increase Access to HIV Prevention, Testing and Care and Treatment including t including PMTCT Services. PMTCT Services. Change Clinical Management to Public Health Approach Change Clinical Management to Public Health Approach Strengthen Ownership including Leadership and Management of OD M Strengthen Ownership including Leadership and Management of OD Management anagement Team and HC Management Committee Team and HC Management Committee

SLIDE 9

Linked Response: Service Package Linked Response: Service Package

• Hub

Hub One stop service: VCCT, PMTCT, OI/ART, One stop service: VCCT, PMTCT, OI/ART, STI, FP, logistics and data management, STI, FP, logistics and data management, referrals and links to referrals and links to HCs HCs, Hub, and Community , Hub, and Community

• Satellite

Satellite VCCT, ARV prophylaxis, safe delivery, VCCT, ARV prophylaxis, safe delivery, OI prophylaxis for newborns, DBS collection, OI prophylaxis for newborns, DBS collection, infant feeding education, Referrals and links to infant feeding education, Referrals and links to HCs HCs, Hub, and Community , Hub, and Community

• Linked Health Center

Linked Health Center Blood draw for HIV testing, Blood draw for HIV testing, referrals and links to referrals and links to HCs HCs, Hub, and community , Hub, and community

SLIDE 10

Linked Response Implementation: Demonstration Sites Linked Response Implementation: Demonstration Sites

Prey Prey Veng Veng Province: Province: LR Demonstration Project: 4 ODs; 47 HC (supported by Clinton Fo LR Demonstration Project: 4 ODs; 47 HC (supported by Clinton Foundation) undation) 1.

• 1. OD

OD Neak Neak Loeung Loeung: RH and 17 HC (LR Hub): Pop.: 175,860 (Female 15 : RH and 17 HC (LR Hub): Pop.: 175,860 (Female 15-

• 49:23,639, PW: 4,748)

49:23,639, PW: 4,748) 2.

• 2. OD Kg

OD Kg Trabek Trabek: RH and 11 HC : Pop. : 129,146 (F15 : RH and 11 HC : Pop. : 129,146 (F15-

• 49:17,360, PW: 3,616)

49:17,360, PW: 3,616) 3.

• 3. OD

OD Preah Preah Sdach Sdach: RH and 9 HC: Pop. : 112,941 (F 15 : RH and 9 HC: Pop. : 112,941 (F 15-

• 49:29,365, PW: 2674)

49:29,365, PW: 2674) 4.

• 4. OD

OD Mesang Mesang: RH and 10 HC: Pop: 121,735 (F 15 : RH and 10 HC: Pop: 121,735 (F 15-

• 49: 31,651, PW: 3287

49: 31,651, PW: 3287 Takeo Province: Takeo Province: Toatal Toatal pop.: 854,727 pop.: 854,727 AD:10.; Commune:100: Village:1117 AD:10.; Commune:100: Village:1117 OD: 5; RH: 5; HC: 70 OD: 5; RH: 5; HC: 70 LR Demonstration Project: 1 OD ; 20 HC (supported by ITM, UNAIDS LR Demonstration Project: 1 OD ; 20 HC (supported by ITM, UNAIDS/WHO) /WHO) 1.

• 1. OD

OD Kirivong Kirivong: 1RH; 20 HC : 1RH; 20 HC Total pop. : 223,091 (F 15 Total pop. : 223,091 (F 15-

• 49: 49,080, PW: 6,336)

49: 49,080, PW: 6,336) 6 satellites 6 satellites

SLIDE 11

When: LR Timeline (Prey When: LR Timeline (Prey Veng Veng) )

October 2007 Cluster Coordination Workshop December 2007 Cluster Coordination Meeting Training of HCW January 2008 March 2008 LR Orientations April 2008 Phase 1 Implementation February 2008 Ministry of Health Approval

SLIDE 12

When: LR Timeline (Prey When: LR Timeline (Prey Veng Veng) )

April 2008

• ngoing

Regular Coordination Meetings July 2008 Decentralization

• f Key Activities

August 2008 October 2008 Refresher Training February 2008 Contracting of HBC PMTCT Training for Technical Support Team Phase 2 Implementation ??? 2008 Assessment of community support mechanisms October 2008

SLIDE 13

Implementation of Linked Response Implementation of Linked Response

• Recruitment of Logistics Manager

Recruitment of Logistics Manager

• Recruitment of Data Manager

Recruitment of Data Manager

• Refurbishment of Reproductive Health Facility

Refurbishment of Reproductive Health Facility

• Support for Cluster Coordination Activities

Support for Cluster Coordination Activities

• Establishment

Establishment of LR Technical Support Group

• f LR Technical Support Group
• Monitoring and Oversight

Monitoring and Oversight

Facility Support Component: Hub Facility Support Component: Hub

SLIDE 14

Implementation of Linked Response Implementation of Linked Response Facility Support Component: Satellite Facility Support Component: Satellite

• Construction or Renovation of VCCT

Construction or Renovation of VCCT

• Refurbishment of Reproductive Health Facility

Refurbishment of Reproductive Health Facility

• Training of HCW: (Nurses, Midwives, Lab, DBS collection)

Training of HCW: (Nurses, Midwives, Lab, DBS collection)

• Support Mentoring from

Support Mentoring from Hub Hub to to Satellites Satellites

SLIDE 15

Implementation of Linked Response Implementation of Linked Response

Facility Support Component: Linked Health Center Facility Support Component: Linked Health Center

• Training for counseling and blood draw for HIV

Training for counseling and blood draw for HIV testing testing

• Refresher Training

Refresher Training

• Support for blood sample transport activities

Support for blood sample transport activities

• Monitoring and Oversight

Monitoring and Oversight

SLIDE 16

• Train designated PMTCT team member to focus on pregnant

Train designated PMTCT team member to focus on pregnant women women

• Support pregnant women through testing, necessary treatment,

Support pregnant women through testing, necessary treatment, prophylaxis, safe birthing, newborn testing prophylaxis, safe birthing, newborn testing

• Coordinate with midwives and

Coordinate with midwives and TBAs TBAs to identify pregnant women and to identify pregnant women and educate on linked response network educate on linked response network

• Cover referral incentives and transportation costs as needed

Cover referral incentives and transportation costs as needed

Community Community Support Support Component: HBC teams Component: HBC teams

Implementation of Linked Response Implementation of Linked Response

SLIDE 17

Linked Response: Monitoring Tools Linked Response: Monitoring Tools

(-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age

ANC for All Women

r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name

ANC for HIV+ Women

Home Healt h HBC OI/AR T ANC VC C T self ref civil y n <4 weeks >4 weeks <4 weeks >4 weeks AZT+NVP NVP AR T W00001 <> ??? R 00005 six boxes patients will continue from ANC , same code from there AR V Administered during Transferred from Date of delivery (dd/mm/yy) Woman took AR T During P regnancy Woman took AZT prophylaxis duing pregnancy Delivery location C

• de #

re F acility for del

Maternity

/ / / / / / / / / / / / / / / / / / / / Date of birth Date registered Site Code Exposed Infant Code Sex Address (Commune, District, Province) Contact Information (Telephone)

Exposed infants

V is it D a te R e a s

• n

fo r V is it C

• m

p le te d

• n

T im e Y /N F

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w

• u

p R e q u ire d Y /N P e rs

• n

R e s p

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s ib le fo r F

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w

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p R e s u lt o f F

• llo

w

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p

P a tie n t A p p

• in

tm e n ts

C

• d

e /N a m e / / / / S ite N a m e /C

• d

e : W e e k

• f:

Patient Appointment Book

Y e s N

• / /

/ / / / / / / / P a rtn e r T e stin g In fo rm a tio n BS A d dress, T ele p h

• n

e N u m b er S ite C

• d

e P a tie n t N um be r P atie n t C

• d

e N a m e Female Pregnant (Y/N) Male P re g a n cy T e st D a te R e sult Age Marital Status Profession* R e fe r F ro m HBC Civil Society ANC STI

HIV Testing

(-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name Home Healt h HBC OI/AR T ANC VC C T self ref civil y n <4 weeks >4 weeks <4 weeks >4 weeks AZT+NVP NVP AR T W00001 <> ??? R 00005 six boxes patients will continue from ANC , same code from there AR V Administered during Transferred from Date of delivery (dd/mm/yy) Woman took AR T During P regnancy Woman took AZT prophylaxis duing pregnancy Delivery location C

• de #

re F acility for del (-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name Y e s N

• / /

/ / / / / / / / P a rtn e r T e stin g In fo rm a tio n BS A d dress, T ele p h

• n

e N u m b er S ite C

• d

e P a tie n t N um be r P atie n t C

• d

e N a m e Female Pregnant (Y/N) Male P re g a n cy T e st D a te R e sult Age Marital Status Profession* R e fe r F ro m HBC Civil Society ANC STI Home Healt h HBC OI/AR T ANC VC C T self ref civil y n <4 weeks >4 weeks <4 weeks >4 weeks AZT+NVP NVP AR T W00001 <> ??? R 00005 six boxes patients will continue from ANC , same code from there AR V Administered during Transferred from Date of delivery (dd/mm/yy) Woman took AR T During P regnancy Woman took AZT prophylaxis duing pregnancy Delivery location C

• de #

re F acility for del (-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name V is it D a te R e a s

• n

fo r V is it C

• m

p le te d

• n

T im e Y /N F

• llo

w

• u

p R e q u ire d Y /N P e rs

• n

R e s p

• n

s ib le fo r F

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P a tie n t A p p

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C

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e /N a m e / / / / S ite N a m e /C

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• f:

Y e s N

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• n

e N u m b er S ite C

• d

e P a tie n t N um be r P atie n t C

• d

e N a m e Female Pregnant (Y/N) Male P re g a n cy T e st D a te R e sult Age Marital Status Profession* R e fe r F ro m HBC Civil Society ANC STI Home Healt h HBC OI/AR T ANC VC C T self ref civil y n <4 weeks >4 weeks <4 weeks >4 weeks AZT+NVP NVP AR T W00001 <> ??? R 00005 six boxes patients will continue from ANC , same code from there AR V Administered during Transferred from Date of delivery (dd/mm/yy) Woman took AR T During P regnancy Woman took AZT prophylaxis duing pregnancy Delivery location C

• de #

re F acility for del (-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name / / / / / / / / / / / / / / / / / / / / Date of birth Date registered Site Code Exposed Infant Code Sex Address (Commune, District, Province) Contact Information (Telephone) V is it D a te R e a s

• n

fo r V is it C

• m

p le te d

• n

T im e Y /N F

• llo

w

• u

p R e q u ire d Y /N P e rs

• n

R e s p

• n

s ib le fo r F

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w

• u

p R e s u lt o f F

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w

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p

P a tie n t A p p

• in

tm e n ts

C

• d

e /N a m e / / / / S ite N a m e /C

• d

e : W e e k

• f:

Y e s N

• / /

/ / / / / / / / P a rtn e r T e stin g In fo rm a tio n BS A d dress, T ele p h

• n

e N u m b er S ite C

• d

e P a tie n t N um be r P atie n t C

• d

e N a m e Female Pregnant (Y/N) Male P re g a n cy T e st D a te R e sult Age Marital Status Profession* R e fe r F ro m HBC Civil Society ANC STI Home Healt h HBC OI/AR T ANC VC C T self ref civil y n <4 weeks >4 weeks <4 weeks >4 weeks AZT+NVP NVP AR T W00001 <> ??? R 00005 six boxes patients will continue from ANC , same code from there AR V Administered during Transferred from Date of delivery (dd/mm/yy) Woman took AR T During P regnancy Woman took AZT prophylaxis duing pregnancy Delivery location C

• de #

re F acility for del (-) (+) Ind W00001 / / / / H00002 / / / / / / / / / / / / S elf R eferred S TI TB OPD C ivil HIV Test R esult Date of pre- test counselling Name Profession Male partner accepting testing for HIV Transferred from HBC VC C T C

• de #

Date of post- test counelling OI/AR T Age r Anemia: F irst test Y es No HBC VC C T OI/AR T S TI TB OP D F P S elf C ivil Y es No date six boxes W00001 R 00005 Hemoglobin/Hematocrit R esult C D4 R esult of Baseline Test R esult at 28 weeks

• f

P regnancy date AR T C

• de #

E stimated date of delivery (dd/mm/yy) R eferred from Mother knew HIV status before enrollement in ANC ? Name

SLIDE 18

l-r

No

elxkUd

PMTCT Code

Gayu

Age

TIlMenA

Address

éf¶eFVIetsþQamrk HIV

Date of HIV Test

éf¶ExcuHbBa¢I PMTCT Date

• f Enrollment in PMTCT

Programn(ANC for HIV+ Women)

GayuKP’

Age of Pregnancy

éf¶ Ex TTYllT§pl CD4

Date receiving CD4 result

lT§pl CD4

Result of CD4

éf¶Excab;epþIm ART éf¶Excab;epþIm ARV

prophylaxi

eQμaHRkumEfTaM

HBC Name

EfTMaeday RH,HC

Follow-up by RH, HC

TIkEnøgerobcMsMral

Intended Place of Delivery

karsMerccitþkñúkarbMe)AkUn

intended feeding choice

cnYndgénkarBinitüépÞeBaH

Total number of ANC visits to date

1

R0027 32

éRBrka eRcs emsag

21-8-06 28-12-07 1M 5-2-08 504 15-6-07 CCASVA HC

2 2

R0028 28

RtBaMgsala eQIkac; )aPñM

24--5-05 20-2-08 8M 12-6-08 379 29-1-07 Women RH

4 3

W01875 30

kMBg;cMlg elIEdk¬k¼N¦

29-4-08 29-4-08 RH

4

R0029 20

Et,g RtBaMgERs emsag

28-12-07 20-5-08 8M 22-12-07 340 29-1-07 CLA RH

4 5

R0030 30

Esñran bwgRBH )aPñM

27-01-07 28-5-08 5M 26-1-07 60 27-12-07 Women HC

1 6

R0031 34

ERBktUc ERBkdac; elIkEdk

29-10-07 28-5-08 26-10-07 122 29-5-06 Women RH at Home

TwkedaHmþay

1 7

R0032 36

pøÚv rlYs eCIgPñM )aPñM

3-6-08 2-6-08 13-6-08 406 2/6/2008 Women RH at Home

TwkedaHmþay

1 8

R0033 25

b¤sSI fáÚv kMBg;RtEbk

15-5-08 4-06-08 7M 6-6-08 199 5/6/2008 Women HC RCPP

TwkedaHmþay

3 9

R0034 30

GMBil rMeck RBHesþc

22-4-08 5-6-08 7M 6-6-08 51 1/8/2008 Women RH RH NL

TwkedaHeKa

3 10

R0035 35

eBan eRcs emsag

05-5-08 9-6-08 8M 13-6-08 610 9/6/2008 CCASVA HC HC Svay Chrum TwkedaHmþay

4 11

R0036 28

kMera esnaraC ]tþmÖ RBHesþc

23-5-08 7-7-08 7M 13-6-08 179 15-8-08 Chec HC

3 12

27

RCYlfμI rkSC½y

23-6-08 Baphnom 7M 25-7-08 324 12/8/2008 Women HC

4 13

R0037 38

taGYk rkSC‘y )aPñM

4-4-05 18-7-08 3M 16-11-07 240 24-6-08 Women HC

1 14

R0038 36

Pumi dUg XuM éRC kMBg;RtEbk

24-2-06 31-7-08 8M 3-4-08 170 3/4/2006 Women HC

3 15

R0039 34

Pumi eKa bnÞaycRkI

14-3-08 7-8-08 2M 7-8-08

Notyet received

OI Chec HC

16

R0040 25

]tþm ERBkxSay¬k¦

30-7-08 15-8-08 5M 28-8-08

Notyet received

OI Women HC

2 17

R0041 40

kBg;eBa kMBg;PñM elIEdk

19-8-08 19-8-08 1 M 26-10-07 255 19-3-08 Women RH

1 18

R0042 31

éRBkdac; -elIEdk-kN

24-11-05 25-8-08 3 M 15-03-08 199 3-3-06 Women RH

1 19

R0043 28

PUmiRKYs-éRBeXñs-emsag

18-8-05 28-8-08 5M 22-2-07 CD4 :2 28-8-08 250 3-7-07 CLA RH

1

Linked Response: Follow up Tools Linked Response: Follow up Tools

SLIDE 19

Result of Implementing LR Phase 1

SLIDE 20

HIV testing coverage, Prey HIV testing coverage, Prey Veng Veng catchment catchment: 6 months, 2007 and 2008 : 6 months, 2007 and 2008

SLIDE 21

ANC1 coverage, Prey ANC1 coverage, Prey Veng Veng catchments: 6 months, 2007 and 2008 catchments: 6 months, 2007 and 2008

SLIDE 22

Facility Deliveries, Prey Veng catchments: 6 months, 2007 and 20 Facility Deliveries, Prey Veng catchments: 6 months, 2007 and 2008 08

SLIDE 23

Contraceptive Use, Prey Contraceptive Use, Prey Veng Veng catchments: 6 months, 2007 and 2008 catchments: 6 months, 2007 and 2008

SLIDE 24

Patient tracking for the 24 HIV+ women identified since implementation of “Linked Response” in PVG:

• 11 HIV-positive women have delivered; one woman gave birth to twins
• Of 11 exposed infants, 7 are reported exclusively breastfed, 3 are exclusively formula fed, and 1 is

reported to be mixed-fed

• 10 exposed infants have been linked to a home-based care network
• 5 infants have received first PCR test results: 4 negative, 1 positive (died)

5 10 15 20 25 30 Pregnant women integrated into Linked Response Deliveries Infants: ZDV, NVP Infants: Cotrim HIV-positive deliveries 11: 7 on ART 3 on prophylaxis 1 received nothing Not yet delivered: 8 5 on ART 1 on prophylaxis + OI 1 on OI only Aborted: 5 Facility deliveries 8: 5 on ART 2 on prophylaxis 1 received nothing Home deliveries: 3 2 on ART 1 received nothing Infants received NVP, ZDV after delivery Infants did not receive NVP, ZDV after delivery: 1 Infants initiated on Cotrim Infants not yet of age: 2

11 10 9 8

11 babies born

SLIDE 25

Preliminary data Preliminary data Kirivong Kirivong OD HIV testing in ANC, OD HIV testing in ANC, Pre Pre-

• Post LR

Post LR

SLIDE 26

Preliminary data, Preliminary data, Kirivong Kirivong OD RH, Pre OD RH, Pre-

• and Post

and Post-

• LR

LR

SLIDE 27

Patient tracking for the 14 HIV+ women identified since implementation of “Linked Response” in Kirivong, Takeo:

Not yet delivered: 8 5 on ART 1 on prophylaxis + OI 1 on OI only Aborted: 5 Facility deliveries 8: 5 on ART 2 on prophylaxis 1 received nothing Infants received NVP, ZDV after delivery

Number of HIV+ pregnant women HAART ARV prophylaxis Abortion Other 14 5 5 1 3 (1 moved to BMC, 1 to

PP, 1 in first trimester)

Babies Received ZDV, NVP during delivery On Cotrim DNA PCR: TOTAL 8 8 7

(1 not yet of age)

6

Positive: 0 Negative: 2 Awaiting result: 4

Deliveries HAART ARV Location of delivery 8 3 5 8 facility deliveries

SLIDE 28

Conclusion: Implementing Linked Response Phase 1 Conclusion: Implementing Linked Response Phase 1

• Increased comprehensive PMTCT uptake:

Increased comprehensive PMTCT uptake:

• Increased HIV testing coverage among pregnant women (PW)

Increased HIV testing coverage among pregnant women (PW)

• Strengthened Referral and Follow up for HIV+ PW and Exposed

Strengthened Referral and Follow up for HIV+ PW and Exposed infants: HAART, ARV prophylaxis, DNA infants: HAART, ARV prophylaxis, DNA-

• PCR

PCR

• Increased access to information on the advantages of HIV

Increased access to information on the advantages of HIV testing and PMTCT in community testing and PMTCT in community

• Built capacity and ownership of OD Management

Built capacity and ownership of OD Management

• Low cost Intervention and High Quality of Health Service and hig

Low cost Intervention and High Quality of Health Service and high h Impact Impact

SLIDE 29

Next Steps (1) Next Steps (1)

• Introducing Continuum of HIV Prevention, AIDS Care and

Introducing Continuum of HIV Prevention, AIDS Care and Treatment, and Support to PLHA at District level: Treatment, and Support to PLHA at District level:

• Positive Prevention:

Positive Prevention:

• Strengthening Referral and Follow up for the exposed infants

Strengthening Referral and Follow up for the exposed infants born from pregnant women who are receiving OI and ART born from pregnant women who are receiving OI and ART (25,000 women) (25,000 women)

• Reducing drastically HIV transmission from PLHA to their

Reducing drastically HIV transmission from PLHA to their partners (MMM, PLHA Network, Health care givers, HBC partners (MMM, PLHA Network, Health care givers, HBC workers... workers...

• Increasing presence of VHSG workers and tailoring their

Increasing presence of VHSG workers and tailoring their message to further HIV education and prevention message to further HIV education and prevention

SLIDE 30

Next Steps (2) Next Steps (2)

• Increasing HIV testing coverage for Targeted

Increasing HIV testing coverage for Targeted Population: Population:

• Spouse of HIV + Men

Spouse of HIV + Men

• Entertainment Establishment Workers

Entertainment Establishment Workers

• MSM

MSM

• DU including IDU

DU including IDU

• Mobile people in country and across border including MMM

Mobile people in country and across border including MMM ═► ═►Encouraging HIV negative clients to keep their negativity Encouraging HIV negative clients to keep their negativity

SLIDE 31

Next Steps: LR Phase II (3) Next Steps: LR Phase II (3)

• Increasing the ANC 3 Coverage:

Increasing the ANC 3 Coverage:

• Strong Linkage between HC and Community Base Support

Strong Linkage between HC and Community Base Support including PHC Service including PHC Service

• Increasing Birth Spacing Coverage: PHC Service

Increasing Birth Spacing Coverage: PHC Service

• Strengthening Referral and Follow Up Linkage with PAC

Strengthening Referral and Follow Up Linkage with PAC

• OI/ART Service: Refer HIV Mothers to STI Service, ANC, Safe

OI/ART Service: Refer HIV Mothers to STI Service, ANC, Safe Delivery Service, PAC to follow up their Babies Delivery Service, PAC to follow up their Babies

• Increasing Safe Delivery at Health Facility ( Need more Discussi

Increasing Safe Delivery at Health Facility ( Need more Discussion

• n

and Commitment) and Commitment)

SLIDE 32

LR Phase II: TB/HIV Care and Treatment LR Phase II: TB/HIV Care and Treatment

• TB/HIV at HIV Setting: 3Is

TB/HIV at HIV Setting: 3Is

• Intensify TB Case Finding amongst HIV Newly Diagnosis at all

Intensify TB Case Finding amongst HIV Newly Diagnosis at all VCCT (Public and NGO) and to be referred to OI/ART Service VCCT (Public and NGO) and to be referred to OI/ART Service

• IPT (INH Preventive Therapy) amongst PLHA (Discarded from

IPT (INH Preventive Therapy) amongst PLHA (Discarded from TB) at OI and ART Service TB) at OI and ART Service

• TB Infection Control

TB Infection Control

• TB/HIV at TB Service: HC and RH

TB/HIV at TB Service: HC and RH

• Refer TB Newly Diagnosis to VCCT nearby or Transport Blood

Refer TB Newly Diagnosis to VCCT nearby or Transport Blood

• f TB to HIV Testing Service
• f TB to HIV Testing Service
• TB Diagnosis amongst PLHA Referred from OI/ART Service

TB Diagnosis amongst PLHA Referred from OI/ART Service

SLIDE 33

LR Phase II: Syphilis Screening among PW LR Phase II: Syphilis Screening among PW

• Syphilis screening at the Satellite linked Response Sites (HC):

Syphilis screening at the Satellite linked Response Sites (HC):

• Using Blood of PW for HIV Testing and Rapid RPR Testing for

Using Blood of PW for HIV Testing and Rapid RPR Testing for Syphilis Screening Syphilis Screening

• Positive Mother should be treated at HC or RH and should be

Positive Mother should be treated at HC or RH and should be received follow received follow-

• up

up

• Exposed

Exposed-

• infants to be referred directly to Pediatric Care Service

infants to be referred directly to Pediatric Care Service

• ANC: Recording and Reporting

ANC: Recording and Reporting

SLIDE 34

• Linking community and HC: Linked Response and PHC rely heavily

Linking community and HC: Linked Response and PHC rely heavily

• n the collaborative relationship of community workers and
• n the collaborative relationship of community workers and HCs

HCs in in

• rder to:
• rder to:
• rganize accessible, affordable, effective, and sustainable qual
• rganize accessible, affordable, effective, and sustainable quality health

ity health services, adapted to the specific community needs services, adapted to the specific community needs

• increase the Health Centers

increase the Health Centers’ ’ accountability to users regarding their duty to accountability to users regarding their duty to provide quality services by supporting; VHSG representatives are provide quality services by supporting; VHSG representatives are responsible for responsible for relaying messages regarding available service and service needs relaying messages regarding available service and service needs

• encourage and enable the VHSG to promote informed health seeking

encourage and enable the VHSG to promote informed health seeking behavior to behavior to community members community members

• provide an improved framework for all health actors working at t

provide an improved framework for all health actors working at the community he community level to promote the sustainability of community participation level to promote the sustainability of community participation

• identify funding mechanisms to finance the sustainability of com

identify funding mechanisms to finance the sustainability of community munity participation structures participation structures

Linked Response through Primary Health Care Services (1) Linked Response through Primary Health Care Services (1)

SLIDE 35

The Linked Response will work to revitalize the links between th The Linked Response will work to revitalize the links between the e below groups in order to further dialog and strengthen below groups in order to further dialog and strengthen connections between communities and health centers: connections between communities and health centers:

• Village Health Support Group

Village Health Support Group: At the village level two : At the village level two volunteers, one man and one woman, are elected by their volunteers, one man and one woman, are elected by their community. community. ═► ═► To be Modified: 4 Volunteers (1 Man who are member of the To be Modified: 4 Volunteers (1 Man who are member of the Village Authority, 1 woman: age between 18 Village Authority, 1 woman: age between 18-

• 25, one mother and

25, one mother and

• ne woman age between 30
• ne woman age between 30-
• 45)

45)

• Health Center Management Committee:

Health Center Management Committee: The Health Center The Health Center Management Committee oversees the Health Center, accepting Management Committee oversees the Health Center, accepting community feedback (One Representative from Commune community feedback (One Representative from Commune Council, Head of HC, One representative from Midwives, one Council, Head of HC, One representative from Midwives, one representative from nurses, representative from the 3 categories representative from nurses, representative from the 3 categories

• f the Village: zone A, B, C)
• f the Village: zone A, B, C)

LR Through Primary Health Care Service (2) LR Through Primary Health Care Service (2)

SLIDE 36

How to integrate LR into PHC: How to integrate LR into PHC:

Steering Committee: Chaired by PHC Secretariat

NMCHC NCHADS CENAT CNM MoH/DoH Partners

OD

TSG

RH

HC Villagers

TBA TH PP

VHSG

: Consumers

Ownership & Good partnership

Common vision:

• Policy
• WP
• Monitoring

Providers

PHD

SLIDE 37

Thank you for your attention