Framework for Universal Access to
HIV Prevention, Treatment and Care in
the Health Sector
Presented by
Professor Charles Gilks,
Director, Co-ordinator TPS,
Department of HIV/AIDS
Technical Meeting for the Development of a Framework for
Universal Access to HIV/AIDS Prevention,
Treatment and Care in the Health Sector
Geneva 18-20 October 2005
1
Aim of the work presented
Identify the set of core HIV interventions that address HIV
prevention, treatment and care in the health sector
Propose a framework for action that can help guide
countries as they strive to achieve universal access in the
health sector
Adopt a sectoral approach, recognizing that for any
national response to be successful it must be developed
and delivered in a multisectoral environment
2
Health Sector Definition
"The health sector is wide-ranging and encompasses
organized public and private health services
(including those for health promotion, disease
prevention, diagnosis, treatment and care); health
ministries; nongovernmental organizations;
community groups; and professional associations; as
well as institutions which directly input into the health
care system (e.g. the pharmaceutical industry, and
teaching institutions)."
Global Health Sector Strategy for HIV/AIDS 2003-2007, WHO
3
Where we are
Successful scale-up is taking place in many countries, with
significant experience and lessons being learnt
Scale-up is being done in different ways often using diverse
plans and models; complex and inter-related processes are
involved - and there may be an unbalanced service delivery
Lack of agreement on what constitutes the core elements of HIV
prevention care and treatment services
Difficult to identify what processes are necessary to drive
current scale-up services forward to achieve and sustain
universal access
Countries are increasingly asking WHO, UNAIDS and other
partners for clarity and provide guidance on these issues
4
Rationale for a Framework
The framework is intended to provide a structure for discussion
of the proposed elements for Universal Access leading to a shared
understanding for all partners
The framework:







Simplifies complex and interrelated processes
Highlights the importance of target-driven approaches
Identifies the ingredients for country scale-up
Specifies the core prevention, treatment and care interventions
Recognises that universal access needs action in all core areas
Offers an approach which is flexible to different epidemiology
Supports health systems strengthening
The framework is a work in progress.
5
Framework for Universal Access to HIV Prevention, Treatment and Care
Within the Health Sector
TRACKING PROGRESS
Country Targets
Set of core
interventions
for HIV
Prevention,
Treatment and
Care
A Public Health
Approach
•Comprehensive scale-up plan
•Strategic Partnerships
•Sound management capacity
•Involvement of PWAs
•PSM for commodities
•Health sector planning
•Financial resource management
•Health information system
•Operational guidance
- tools and guidelines
- national adaptation
Implementation
Locus:
•Home action
•Community action
•Facility action
•District action
•National action
Prevention,
Treatment and
Care for:
•General population
•High risk populations
•High risk settings
•Special groups
Output Outcome Impact
Ingredients and Products for
Country Scale-up
ESSENTIAL ENABLERS
6
Essential Enablers
An enabling environment is one in which political,
economic, social, legal and health structures support
scale-up and should include:
Building and maintaining political commitment
Good governance practices and structures
Promotion of a rights-based approach
Supportive legislative and regulatory environment
Enablers cut across all sectors and are not solely the
responsibility of the health sector
7
Principles of a Public Health Approach
for Scale-up of HIV services
A public health approach is necessary to reach as
many people as possible with the required services
Package of priority interventions for prevention,
treatment and care
Decentralized service delivery models
Simplified and standardized approaches
Standardized, integrated training
Harmonized tracking and reporting
8
A Target-driven process
Targets are set and owned at the national level


Progress can be measured against targets and milestones
Accountability with achievement of targets on time
Targets across the package of priority interventions



Ongoing work to propose a complete set
Targets are measurable and relevant
Methodologies are clearly stated and defined
Country methodologies and targets are harmonized
Regular (annual) reporting of progress


National reports
Global reports
Major milestones include 2010 (G8) and 2015 (MDGs)
9
Ingredients for Country Scale-up
Comprehensive, integrated scale-up plan
Ensuring strategic partnerships
Ensuring greater involvement of PLWHAs
Sound management capacity at all levels
Comprehensive health sector planning
Successful procurement and supply
management for commodities
Acquisition, management and reporting of
financial resources
Health Management Information System
Operational guidance
10
Set of inter-related Core HIV Interventions

Prevention, Treatment, Care

















Basic prevention
HIV testing and counseling (client initiated)
STI detection and treatment
Targeted interventions (MSM, SW, IDU, Others)
Positive prevention
PEP: non-occupational
Occupational health and safety
Blood safety
PMTCT
ART including adherence support
TB-HIV co-treatment
OI treatment
Substitution therapy
Provider initiated Testing and Counselling
OI prophylaxis
Nutritional support
Psychosocial support
Palliative care: symptom management & end-of-life care
11
Home and Person:
•Positive prevention
•Universal precautions
•ART, TB one-to-one
treatment support
•Psychosocial support
•Home-based palliative care
Community:
Locus of interventions
Above plus:
• CHWs: adherence, monitor, refill ART, TB, OI prophylaxis;
prevention: safer sex, condoms, FP; nutritional support
•HIV testing and counseling (CITC/ VCT)
•Targeted interventions (outreach)
•Broad-based prevention (emphasis on youth)
•Community mobilization for prevention,
treatment preparedness, use of services
Health centre:
Above plus:
•Provider-initiated T&C
•PEP- occupational, non-occupational
•PMTCT
•Safe medical injections
•STI detection and treatment
•Special care: IDU, sex worker; youth-friendly
•Initiate first-line ART in uncomplicated patients
•TB treatment, TB-HIV Co-management
•Treat most OIs
Hospital:
Above plus:
•IDU: drug substitution, detox
•Blood safety
•ART in complicated patients, second-line, IRIS, severe toxicity
•TB: smear negative, extrapulmonary, TB-ART co-management
•Complicated OIs
12
Home and Person:
•Positive prevention
•Universal precautions
•ART, TB one-to-one
treatment support
•Psychosocial support
•Home-based palliative care
Examples of operational tools from WHO and partners:
Integrated Management of HIV/AIDS at Facility
with Linked Community Interventions
(based on IMAI/IMCI/IMPAC)
Community:
Above plus:
•CHWs: adherence, monitor, refill ART, TB, OI prophylaxis;
prevention: safer sex, condoms, FP; nutritional support
•Client-initiated T&C (VCT)
•Targeted interventions (outreach)
•Broad-based prevention (emphasis on youth)
•Community mobilization for prevention,
treatment preparedness, use of services
Health centre:
Above plus:
•Provider-initiated T&C
•PEP- occupational, non-occupational
•PMTCT
•Safe medical injections
•STI detection and treatment
•Special care: IDU, sex worker, youth-friendly
•First-line ART in uncomplicated patients
•TB treatment, TB-HIV Co-management
•Treat most OIs
Hospital:
Above plus:
•IDU: drug substitution, detox
•Safe blood
•ART in complicated patients, second-line, IRIS, severe toxicity
•TB: smear negative, extrapulmonary, TB-ART co-management
•Complicated OIs
13
Tracking Progress
Need to be strategic in what we measure - and why
•
•
Standardised methodologies and agreed indicators
One harmonised M&E system (3 ones)
Improve quality of care and prevention
•
•
Local review of results
Continuous quality improvement
Demonstrate progress towards Universal Access
•
Process and Outputs:
•
•
Outcome and Impact:
•
•
•
Service Availability Mapping (SAM) and GIS systems
Treatment: STARTOMS
Build consensus on prevention indicators
National and global reports:
•
•
National authorities
Donors and funders
14
Summary
Our premise and the basis for our discussion:
A proposed framework intended to
provide guidance to countries in the use of
a harmonised approach to scaling up HIV
prevention, treatment and care services as
they strive to achieve Universal Access
15