Scaling-up Treatment Delivery Programmes: Issues, Challenges & Best Practices
Participant/Profession
Jean Claude Dusingize
Clinical Research
Muganzi Alex
Muganga
Clinical Research
Country/
Guidelines
Rwanda
National
guidelines
Uganda
WHO
guidelines &
National
guidelines
Tanguy Bognon
Benin
Public Sector Nurse
National
guidelines
Albino Kalolo
Tanzania
Public Sector Clinician
National
Patient
Make-up
Men (M): 90
Women
(W): 160
Children
(C): 0
M: 3,500
W: 6,500
C: 0
M: 0
W: 0
C: 181
M: 400
W: 798
C: 87
Topic
Learning Points & Challenges
Situations
1,3
Learning Points:
- promoting reproductive health/family planning
-psychological support challenges arising during
treatment
- adherence
- TB infection control
- SDD disclosure
- SDD afraid to seek treatment from local clinics
- seek treatment late and/or do not take medication
- HR limitations
- financial barriers
- inadequate laboratory and patient care
infrastructure
1,3
1, 4
1
Challenges:
- patient monitoring
- maintaining risk reduction behavior
- promoting reproductive health/family planning
-psychological support challenges arising during
treatment
- manpower
- medicines
- patient monitoring
- cost constraints
- increasing patient numbers; sustainability
- maintaining risk reduction behavior
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- treatment of children and family situations
- adherence
- TB infection control
- manpower
- medicines
- patient monitoring
- cost constraints
- motivation and promotion
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
- patient monitoring
- clinical mentoring
- management challenges
- multidisciplinary approach to team work
- lack of manpower challenge
- task-shifting
- pharmacy only visits
- expert patients being used as counselors
- children
- patient monitoring
- patient recruitment: PMTCT and nutritional rehab
centers
- challenges with the research protocol of BK is
difficult in children
- family dynamics/ situations
- resolution to have a full staff
- networking with maternal wards
- community sensitization, counseling and testing on
VCT/PMTCT/PITC
- adherence
guidelines
Duncan Kwaitana
Malawi
Public Sector Research
Nurse
National
guidelines
Sunday Fagbenro
Nigeria
NGO Clinician
Global/Inter
national
guidelines &
National
guidelines
Joseph Gasper
Tanzania
Public Sector Clinician
National
guidelines
- treatment of children and family situations
- adherence
- TB infection control
M: 60
W: 120
C: 20
M: 1,711
W: 3,477
C: 700
M: 638
W: 1, 064
C: 74
1,3,4
1,4
1,2
- manpower
- medicines
- patient monitoring
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- treatment of children and family situations
- alcohol and substance abuse
- adherence
- TB infection control
- manpower
- medicines
- patient monitoring
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- alcohol and substance abuse
- adherence
- TB infection control
- manpower
- patient monitoring
- client preference for care at site distant from their
place of abode
- maintaining risk reduction behavior
- promoting reproductive health/family planning
-psychological support challenges arising during
treatment
- alcohol and substance abuse
- adherence
- co-infections
- routine HIV testing and counseling for STI clients
- ART giving Site
- Fast Track Nurse (oversees all routine follow-up
clients who do not have major complaints)
- referral hospital; patients bring HIV positive
documentation
- alcohol, drug abuse
- cultural beliefs
- pediatric ART
- patients enter through referral system
- switching clients to second line medication
- risk behavior reduction among patients on
medication
- comprehensive management of HIV/AIDS
- Mobile Clinics to serve rural population
- adherence
- pregnant HIV positive women
- family planning
Jules Bashi
Bagendabanga
Public Sector Research
& Education Program
Benin
National
guidelines
Olawale Fadare
Nigeria
NGO Clinician
National
guidelines
Emmanuel Odeke
Uganda
NGO Manager
National
guidelines
Tamadur Elnour
Elsadig
Sudan
WHO
M: 740
W: 1075
C: 0
M: 342
W: 690
C: 58
M: 662
W: 357
C: 80
M: 66
W: 45
C: 9
1
1
1,2,3
1
- manpower
- cost constraints
- few number of health facilities offer ART
services
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
- alcohol and substance abuse
- TB infection control
- medicines
- cost constraints
- maintaining risk reduction behavior
- promoting reproductive health/family planning
-psychological support challenges arising during
treatment
- treatment of children and family situations
- alcohol and substance abuse
- adherence
- TB infection control
- manpower
- medicines
- patient monitoring
- cost constraints
- cultural beliefs limiting health-seeking attitude
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- treatment of children and family situations
- alcohol and substance abuse
- adherence
- manpower
- patient monitoring
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
- eligible versus non-eligible patients
- changing ART regimes
- TB infection control
- social service to help indigent patients
- adherence
- TB/HIV
- patients are self-referrals and transfer-in
- patient monitoring and toxicity
- HIV positive pregnant women
- referrals from partner organizations
- loss to follow-up with patients
- scaling up ART
- adherence, clients on ART from far distances
- pediatric patients
- referrals from embassies that require HIV testing
for visa purposes
Public Sector Clinician
Yeshiwork Mekuria
Tefera
NGO Social Worker
guidelines
for resource
poor settings
Ethiopia
National
Guidelines
Ghada Shaka
Namibia
Public Sector Pharmacist
WHO
guidelines &
National
guidelines
- treatment of children and family situations
- adherence
- TB infection control
Daily:
M: 10
W: 35
C: 5
M: 45
W: 140
C: 10
1,4
1,4
- manpower
- medicines
- patient monitoring
- cost constraints
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- treatment of children and family situations
- alcohol and substance abuse
- adherence
- manpower
- cost constraints
- no laboratory facility, no specialist
- maintaining risk reduction behavior
- promoting reproductive health/family planning
- providing psychological support/ counseling
-psychological support challenges arising during
treatment
- treatment of children and family situations
- alcohol and substance abuse
- adherence
- TB infection control
- manpower
- patient monitoring
-getting medicine to patients in remote areas
- transportation
- lack of training/knowledge of other health
professionals
- retest and post-test counseling and continuous
support
- voluntary testing
- awareness on VCT(HCT) and ART
- social/behavioral affects of ART
- pharmacy counseling
- adherence
- reproductive health
- family planning
- transport to facilities