Zimbabwe Who-Books Pdf

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Zimbabwe Antiretroviral Therapy,Issues and Opportunities for Initiation and. Ms Marilyn Noguera,Mr David Alt,Dr Lisa Hirschhorn. Dr Chiedza Maponga,Dr Patrick Osewe,Dr Amos Sam Abbenyi. February 2003, DELIVER a five year worldwide technical assistance support contract is funded by the Commodity Security. and Logistics Division CSL of the Office of Population and Reproductive Health of the Bureau for Global. Health GH Field Support and Research of the U S Agency for International Development USAID. Implemented by John Snow Inc JSI contract no HRN C 00 00 00010 00 and subcontractors Manoff. Group Program for Appropriate Technology in Health PATH Social Sectors Development Strategies Inc. and Synaxis Inc DELIVER strengthens the supply chains of health and family planning programs in. developing countries to ensure the availability of critical health products for customers DELIVER also. provides technical support to USAID s central contraceptive procurement and management and analysis of. USAID s central commodity management information system NEWVERN. This document does not necessarily represent the views or opinions of USAID It may be reproduced if credit is. given to DELIVER John Snow Inc,Recommended Citation.
Noguera Ms Marilyn Mr David Alt Dr Lisa Hirschhorn Dr Chiedza Maponga Dr Patrick Osewe and Dr. Amos Sam Abbenyi 2003 Zimbabwe Antiretroviral Therapy Program Issues and Opportunities for. Initiation and Expansion Arlington Va DELIVER John Snow Inc for the U S Agency for International. Development, This report presents the findings of a four week assessment of the readiness and capacity of Zimbabwe s health. sector to deliver the range of services and manage the health commodities required for effective antiretroviral. ART treatment HIV AIDS prevention diagnostic and treatment programs cannot succeed without a reliable. and consistent supply of condoms high quality drugs HIV test kits laboratory reagents and the consumable. laboratory and medical supplies The country s public and private sector health providers have a great depth of. experience and the team identified the service delivery and logistics experience as well as lessons learned from. the few providers already using ARV treatment that will serve as a sound foundation for initiating and. expanding ART The report also specifies the critical logistics management and clinical issues that the. government must address to ensure the safe and effective implementation of a national ART program. John Snow Inc,1616 North Fort Myer Drive 11th Floor. Arlington VA 22209 USA,Phone 703 528 7474,Fax 703 528 7480. Email deliver project jsi com,Internet deliver jsi com. Acronyms v,Acknowledgments vii,Executive Summary ix.
Logistics Management x,Clinical Service Initiation and Expansion xi. Background 1,HIV AIDS Prevalence and Impact 1,Government and Donor Response 1. Government Plan for Nationwide ART Program 1,Assessment Framework and Methodology 5. Purpose and Objectives 5,Assessment Framework 5,Methodology 8. Assessment team 8,Stakeholder interviews 9,Public health facilities selected 10.
Limitations 10,Findings 13,HIV AIDS Related Services Customer Service 13. HIV counseling and testing services 13,Prevention of mother to child transmission 13. Primary HIV care TB and OI treatment services 14,Services available at sites visited 15. Highly active antiretroviral therapy HAART 17,Personnel capacity 19. Laboratory capacity 19,Facility readiness to provide ART services 21.
Logistics Management 24,Forecasting 24,Procurement 25. Product quality assurance 27,Inventory management storage and distribution 28. Organizational capacity 31,Logistics management information system 31. Funding sources for drugs and other requirements 32. Zimbabwe ART Program Issues and Opportunities for Initiation and Expansion. Conclusions and Recommendations 33,Logistics Management 33. Clinical Service Initiation and Expansion 35,Secondary recommendations 37.
Appendix A Facility Logistics Management Questionnaire 43. Appendix B Facility Services And Infrastructure Questionnaire 59. Appendix C Persons Contacted for ARV Assessment 87. Public Health Sector 87,Private Sector 89,National NGOs 90. Donors and Collaborating Agencies 90,Appendix D List of ARVs Registered in Zimbabwe 95. Appendix E Proposed Stages of Readiness to Guide Assessment of Site Readiness for ARV. Introduction 105,Stage 1 Support maintenance and expansion 105. Stage 2 Action 106, Stage 3 Preparation pre action on the verge sites 106. Stage 4 Contemplation 107,Stage 5 Precontemplation 107.
References 109,Adherence 110, Table 1 Organizations Contacted for Assessment October 2002 9. Table 2 Health Facilities Visited in ARV Assessment 2002 10. Table 3 Availability of HIV related Diagnostic and Treatment Services in Health Facilities. Visited in the Assessment October 2002 16,Table 4 WHO Laboratory Guidance 20. Table 5 Criteria and Assessment of Facility Readiness to Provide ART Services. ARV Assessment October 2002 22, Table 6 Availability of HIV related Diagnostic and Treatment Services in Corporations. isited in the Assessment October 2002 23, Figure 1 Commodities for a Comprehensive HIV AIDS Program 7. Figure 2 Patient Logistics in an Antiretroviral Therapy Program 8. Figure 3 Map of Zimbabwe 11,AA Anglo American Group.
AIDS acquired immune deficiency syndrome, ALT AST Alanine Aminotransferase Asparate Aminotransferase. ART antiretroviral therapy,ARVs antiretroviral drugs. AZT zidovudine also ZDV,BI Boehringer Ingelheim, BTS National Blood Transfusion Service of Zimbabwe. CIMAS Medical AID Society,CQI continuous quality improvement. DANIDA Danish International Development Agency, DFID British Department for International Development.
DOTS directly observed treatment short course,EDLIZ Essential Drugs List for Zimbabwe. ELISA Enzyme Linked Immunosorbent Assay,EU European Union. GFATM Global Fund to Fight AIDS Tuberculosis and Malaria. GMS Government Medical Stores,HAART highly active antiretroviral therapy. HAQOCI HIV AIDS Quality of Care Initiative,HBC home based care. HIV human immunodeficiency virus,JSI John Snow Inc.
LGH Louisa Guidotti Hospital,LMIS logistics management information system. MAC Matebeleland AIDS Council,MCAZ Medicines Control Authority of Zimbabwe. MDR TB multi drug resistance TB,MOHCW Ministry of Health and Child Welfare. NAC National Aids Council,NACP National Aids Control Program. NatPharm National Pharmaceutical Corporation,NAFT National AIDS Trust Fund.
NETA National Emergency Taskforce on AIDS,NHLS National Health Laboratory Services. NNRTI non nucleoside reverse transcriptase inhibitors. NVP nevirapine,OI opportunistic infection,PCR Polymerase Chain Reaction. PEP post exposure prophylaxis,PLWH A people living with HIV AIDS. PMTCT prevention of mother to child transmission,PSI Population Services International. QA quality assurance,RH reproductive health,RPR Rapid Plasma Reagin.
RTD Rapid Test Devices,STGs standard treatment guidelines. STI sexually transmitted infection,TB tuberculosis. TPHA Treponema Pallidum Hemagglutination Assay, USAID United States Agency for International Development. Zimbabwe ART Program Issues and Opportunities for Initiation and Expansion. VCT voluntary counseling and testing,VL viral load. WHO World Health Organization, WTO TRIPS World Trade Organization Trade Related Aspects of Intellectual Property Rights.
ZACH Zimbabwe Association of Church Related Hospitals. ZDV zidovudine also AZT,ZEDAP Zimbabwe Essential Drugs Action Program. ZINQAP Zimbabwe National Quality Assurance Program. ZNFPC Zimbabwe National Family Planning Council,Acknowledgments. This report Zimbabwe Antiretroviral Therapy Program Issues and Opportunities for Initiation and. Expansion would not have been possible without every individual who took time to meet with the. team during our four weeks in Zimbabwe The team would like to extend a heartfelt thank you to each. The assessment team wishes to make a special acknowledgment of the wonderful support received. from Ms Joyce Maziya and Ms Chipo Sisimayi of the USAID Zimbabwe HIV AIDS team They. cheerfully and tirelessly worked with us to arrange the meetings and site visits without which there. would have been no assessment, Finally a warm thank you is extended to USAID Zimbabwe for funding this assessment. The assessment team would like to dedicate this report to all Zimbabweans living with HIV and the. people dedicated to provide their medical care We hope the recommendations in this report will lead. to immediate support for sites where antiretroviral therapy can be quickly initiated or expanded and in. technical assistance for other sites to take the necessary steps to enable them to implement a quality. antiretroviral therapy program in the near future,Ms Marilyn Noguera Team Leader DELIVER JSI. Mr David Alt Logistics Advisor DELIVER JSI, Dr Lisa Hirschhorn Senior Clinical Advisor on HIV AIDS JSI.
Dr Chiedza Maponga Pharmacy Department University of Zimbabwe. Dr Patrick Osewe Senior HIV AIDS Advisor USAID,Dr Amos Sam Abbenyi HIV AIDS Advisor DELIVER JSI. Zimbabwe ART Program Issues and Opportunities for Initiation and Expansion. Executive Summary, HIV AIDS prevention care and treatment programs cannot succeed without a reliable and consistent. supply of condoms high quality drugs HIV test kits laboratory reagents and the consumable. laboratory and medical supplies needed to support service delivery. While global efforts to scale up HIV AIDS interventions include increased investment in commodity. procurement not enough attention has been focused on the supply chains responsible for management. and delivery of the commodities in the affected countries Effective and efficient supply chains help. to maximize use of resources reduce wastage improve quality of service and ultimately ensure that. customers receive the products they need, The Zimbabwe government in collaboration with nongovernmental organizations NGOs and. donors has begun to respond to the HIV AIDS epidemic Local and international resources have been. mobilized to train health personnel and provide essential drugs equipment and supplies Prevention. programs have been implemented and access to HIV AIDS related diagnostic and treatment services. has improved throughout the system and country, Efforts are now underway to introduce antiretroviral therapy ART in selected sites in preparation for. eventual nationwide expansion of the program HIV AIDS programs are complex and the logistics. management of some HIV AIDS products is particularly challenging More than 120 different health. commodities are required to provide the full range of prevention diagnostic and treatment services of. an HIV AIDS program Laboratory services for screening and monitoring must also be available at. different levels of care The logistics requirements are unique because they must ensure safe and. effective lifelong use of the medications, A six member team of staff and consultants from JSI DELIVER and USAID Zimbabwe conducted.
this assessment over a four week period September 23 to October 18 2002 The team included. logistic specialists and clinicians specializing in HIV AIDS. The purpose of the assessment was to assist the Ministry of Health and Child Welfare MOHCW in. identifying the major issues that need to be addressed to support initiation and expansion of ART. services in the country The assessment focused on two areas logistical requirements for ensuring a. reliable and consistent supply of quality antiretroviral drugs ARVs and related commodities and. infrastructure and personnel requirements necessary to ensure their safe and effective use by patients. The assessment findings and recommendations are intended to be used by the MOHCW in furthering. the development initiation and expansion of the national ART program. This report presents the assessment team s findings and recommendations Approximately 120 people. from 40 different public and private sector organizations were interviewed representing a wide range. of different stakeholders involved in various aspects of HIV AIDS care in the country Field visits. were also made to 10 public sector facilities to review how they currently manage HIV AIDS related. products and services The services covered included voluntary counseling and testing VCT. prevention of mother to child transmission PMTCT home based care for HIV related illnesses. management of opportunistic infections sexually transmitted infections STIs and tuberculosis TB. diagnosis and treatment Only one of the facilities visited was already providing ART Among the. organizations interviewed five corporations are currently or are actively considering providing ART. to their employees In addition people living with HIV AIDS PLWH A were interviewed in two. settings for this report, Zimbabwe ART Program Issues and Opportunities for Initiation and Expansion. There is tremendous interest at the national level and within specific facilities to expand HIV care to. include the full spectrum of care and support including ART The public and private sectors have a. great depth of experience that will serve as an excellent foundation for initiating and expanding ART

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