Expanding IMAI: Driving a
decentralized approach in
Senegal and in other West and
Central African Countries
Papa Salif SOW MD, MSc
Department of Infectious Diseases
Dakar University Teaching Hospital Sénégal
WHO Satellite Meeting, ICASA Abuja, December 5th, 2005
The Senegalese Initiative on
Access to Antiretroviral Drugs
(ISAARV): August 1998
HIV Seroprevalence in Senegal in the
general population
0,5%
1,0%
2,2%
1,7%
0,7%
0,8%
1,2%
2,0%
2,6%
2,3%
2,8%
Decentralization for access
to care and treatment
National Level
Regional Level
)
District Level
• 17 Hospitals level 1
• 58 Health Districts
• 828 Health Posts
The Senegalese Initiative
for Access to ARV:
(ISAARV): The challenges
• Decentralization: from pilot study (98-01) to
public health reality (from 2001)
– Limited Human Ressources outside the capital city
– Limited Capacity of Health infrastructures
– Necessity for assuring the Continuum of care
– Challenges of integrating HIV monitoring into the
public health system
• Need to build a model of decentralization
The Senegalese Model
• Training health staff in the regions
– Theoric training
– Pratic training
•
•
•
•
•
•
•
•
Harmonisation of the ARV regimens 1st and 2nd line
Regional Laboratories equipment for CD4 (Dynabeads)
Regional Hospitals : reference center for the region
Update of guidelines
Mentoring approach by national expert
Regional Coordination Team
Simplified and Standardized questionnaire for data
IMAI Approach for scaling up at district level +++
The mentoring approach
• Mentoring – « Coaching »
• National expert on charge for one region
– Permanent contact with his région (Tel,
Email…)
– Diagnostic and therapeutic advices
– Discussion on the indications and ARV
regimens
• Regular supervision mission every 3
months by a multidisciplinary team
– Medical record – update training sessions
– Capacity building
The Impact of the model
• Increase of the ARV sites prescription
– From 6 sites (1998 – 2001)
– To 32 sites today 2005 • Increase the number of MD ARV prescriptors
– 12 (1998 – 2001)
– 94 today 2005 -
• Significant decrease of distance for
access to ARV
The Senegalese target
• December 2005
= 4200 patients on ARV
• October 2005
= 3825 patients traited
Number of patients on ARV in all the
11 regions in Senegal 30th Octob. 05
147
166
91
110
2366
152
8
200
57
194
88
The impact of the model
• The decentralization of HIV Counseling
and Testing sites
– VCT : 13 in all the country
– VST : 76 (voluntary services testing)
• The decentralization of PMTCT
– 1998 – 2004 : 1 region (Dakar , capital city)
– 2004 – 2005 : 9 other regions
Monitoring and Evaluation
• Documents for data collection in all sites
• Computer available at regional level for
data collection
• Low process to set up the M&E system
ISAARV: lessons learnt
• Political committment : gratuity for care
– HIV testing, drugs for OI , ARV, hospitalisation,
artificial breasfeeding
• Collaboration between NACP and the university
expertise
• Public-private parternship
– Pfizer Foundation : Diflucan Donation Program
• South – North Collaboration
• Research : Clinical trials for one daily regimens
and improving adherence
Scaling-up HIV care and
antiretroviral therapy
using the IMAI approach
IMAI process in Senegal
• Adoptation
• Adaptation
• Validation
• Implementation
IMAI implementation in Senegal
• First step: IMAI introduction workshop
Ouagadougou , November 8-13th, 2004
• Second step: Translation into French and
adaptation to the Senegalese context :
december 2004 – March 2005
• Third step: National workshop for IMAI
documents validation, April 2005
• Fourth step: International workshop for
IMAI TOT, Dakar May 2005 (20
Francophone countries)
IMAI implementation in Senegal
• Last step: Utilization of the IMAI approach for
boosting the decentralization for access to care
and treatment: Package for Integrated
Management of HIV/AIDS, care, treatment and
prevention
– Health post: Nurses and midwives
– Health Center: MD, nurses, widwives, social
workers
– Regional Hospital
– University Teaching Hospital
IMAI Manuels Senegal
IMAI Manuels in Senegal
IMAI Manuels in Senegal
IMAI process in Senegal
• Health district HIV Care implementaition
– August – September 2005 : 15 districts trained
– The 38 other districts will be trained during 2006
• Dakar: collaboration WHO for IMAI approach
– Sharing experience with other countries on IMAI
• Burkina Faso : june 2005
• Burundi
: august 2005
• Haiti
: september 2005
Increase the Entry Points to
care: HIV serology testing
• VCT
• PMTCT-Plus
• Centres for Tuberculosis Treatment
• Centres for Sexual Treatment Infections
• Vulnerables groups
• Clinical Services
L’insuffisance de traitement antirétroviral:
une urgence sanitaire mondiale
Pour atteindre l’objectif de “3 millions d’ici 2005”,
il faut un nouvel engagement et des nouvelles
méthodes de travail pour l’ensemble de la
communauté sanitaire mondiale.
LEE Jong-wook, Directeur Général OMS,
22 Sept 2003
Assemblée Générale de l’ONU,
New York
"3 by 5"
For a Universal Access
to Care, treatment
and Prevention