In Burkina Faso, community organisations are building up medical records for people with HIV, to develop a profile that can be used for planning future access to ARVs. People are being trained in collecting the necessary information, which is then being entered into databases that can provide a more detailed basis for those plans than has previously been available.
In Mombasa, Kenya, an international consortium of NGOs (Shikely, Adungosi) is working with the Kenyan government to to prepare for ARV introduction with a systematic analysis of the strengths and weaknesses of the existing healthcare system. Their process may well be of interest to others doing the same, and has a lot in common with that outlined in HATIP #9, based on resources produced by John Snow, Inc. A very similar process is being undertaken in Rwanda too (Ostyn) and Ghana (Kwasi, Field-Nguer). Could this be what WHO has in mind for the emergency teams that it is preparing to offer to priority countries for ARV access?
Researchers in Mombasa carried out interviews with a number of people with HIV, some of whom had received ARVs, some of whom had received TB treatment, to assess the level of interest in and acceptability of a proposed modified DOTS system for delivering ARV treatment in the community. The main conclusion was that most would prefer to receive such treatment at a clinic rather than at home, since it would enhance their feeling of being in control, including control over disclosure of their HIV status. Another conclusion may be that one size does not fit all people, and that treatment which can support individual preferences and strategies for adherence which people choose for themselves may be more successful in the longer term.
Zambia has seen some extensive community-based discussion of the prerequisites for effective ARV programmes, in which the need for greater efficiency in various systems has been identified by everyone concerned (Dhaliwal). The test will be to see what happens when they actually receive some resources to start implementing effective treatment.
In Kisumu, Kenya, which apparently has the highest HIV prevalence in the country at around 25% of the adult population action to strengthen the health care services is seen as the clear priority before ARVs can be introduced (Otieno).
Similarly, in Kibera a slum district of Nairobi where volunteers work with health workers to provide HIV/AIDS related services, there was a clear need for improvement in training on recognising TB symptoms and access to diagnostics for malaria and other conditions, alongside any action that will be needed when ARVs are introduced there (Marum). Nonetheless, plans to do so are well advanced (Macharia, Muhenje, Njoroge).
In Botswana, which now has Africas highest-profile ARV treatment programme, efforts are now being made to ensure that children can be treated with ARVs by non-paediatric HIV specialists, with the development of dosing charts and schedules for the purpose (Ncube). No sign yet, however, of promised cheaper generic paediatric formulations of the drugs needed.
One of the many practical challenges now being met in Botswana is the establishment of efficient medical records. A hybrid computer-plus-paper system has been chosen for maximum resilience in the face of operating problems and seems to be working well (Hermann).
A proposed electronic system based on handheld computers and wireless connections, at the doubtless soon-to-be-renamed Moi Teaching and Referral Hospital in Kenya, sounds wonderful except that it would be reassuring to know that they, too, had some hard copy back-ups, just in case (Siika).
- Adungosi J. Assessment of health care services before introducing ART in Mombasa, Kenya. 13th ICASA, Nairobi, abstract 959883, 2003.
- Dhaliwal M et al. Community preparedness for ARV treatment in Zambia. 13th ICASA, Nairobi, abstract 375096, 2003.
- Field-Nguer ML et al. Making antiretroviral therapy a part of comprehensive care in Ghana, Kenya and Rwanda: the Start Initiative. 13th ICASA, Nairobi, abstract 398344, 2003.
- Hawken M et al. PLHA views on modified DOT strategy to promote adherence to HAART. 13th ICASA, Nairobi, abstract 493470, 2003.
- Hermann B et al. Developing and implementing a hybrid electronic records management system. 13th ICASA, Nairobi, abstract 291500, 2003.
- Kwasi T et al. Setting up ART program in a district based setting in Ghana. 13th ICASA, Nairobi, abstract 432735, 2003.
- Macharia D et al. Developing comprehensive AIDS care including ARVs in a Nairobi slum. 13th ICASA, Nairobi, abstract 345508, 2003.
- Marum E et al. Assessment of AIDS care and support for slum residents in Nairobi, Kenya. 13th ICASA, Nairobi, abstract , 2003.
- Muhenje O et al. Needs, attitudes and beliefs related to adherence to ARV in Nairobi slum. 13th ICASA, Nairobi, abstract 744637, 2003.
- Ncube P et al. Pediatric antiretroviral treatment dosing guidelines for non-pediatricians. 13th ICASA, Nairobi, abstract 567210, 2003.
- Nguyen V-K et al. Burkina: a community cohort to prepare for expanded access to treatment. 13th ICASA, Nairobi, abstract 295886, 2003.
- Njoroge A et al. Integration of TB/HIV services into a slum community program in Nairobi. 13th ICASA, Nairobi, abstract 438014, 2003.
- Ostyn B et al. Assessment of health care services before introducing ART program in Rwanda. 13th ICASA, Nairobi, abstract 502923, 2003.
* Otieno J et al. Hospital and community health services in anticipation of ARV programs. 13th ICASA, Nairobi, abstract 608866, 2003.
* Shikely K. Process for introducing a district-based ART program in Mombasa, Kenya. 13th ICASA, Nairobi, abstract 199396, 2003.
* Siika A et al. Establishing an electronic medical records system for outpatient care of HIV infected patients at Eldoret, Kenya. 13th ICASA, Nairobi, abstract 300019, 2003.