Operational plan for comprehensive HIV and AIDS care and ...

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Table of Contents EXECUTIVE SUMMARY .................................................................................................12 SECTION ONE - PREVENTION, CARE AND TREATMENT OF HIV AND AIDS I Prevention, Care and Treatment ...................................................................54 II Nutrition-Related Interventions....................................................................79 III Traditional Medicine ....................................................................................86 SECTION TWO – HUMAN RESOURCES AND FACILITIES IV Accreditation of Service Points ....................................................................95 V Human Resources and Training .................................................................102 VI Provincial Site Assessments .......................................................................128 SECTION THREE – OPERATIONAL ISSUES: DRUGS AND LABORATORIES VII Drug Procurement ......................................................................................143 VIII Drug Distribution........................................................................................155 IX Laboratory Services....................................................................................161 SECTION FOUR – COMMUNITIES X Social Mobilisation and Communications..................................................174 SECTION FIVE – INFORMATION, MONITORING & RESEARCH XI Patient Information Systems.......................................................................185 XII Monitoring and Evaluation.........................................................................193 XIII Pharmacovigilance .....................................................................................202 XIV Research Priorities......................................................................................209 SECTION SIX – MANAGEMENT AND BUDGET XV Programme Management............................................................................227 XVI Budget.........................................................................................................237 ENDNOTES..................................................................................................................259
LIST OF TABLES Table 0.1: Total Programme Budget Estimate (Millions of Rands)................................... 48 Table 0.2: New Patients Starting ARVs and Total Cumulative Numbers on ARVs ......... 52 Table 1.1: Criteria for ARV Initiation in Adults and Adolescents..................................... 63 Table 1.2: Adult ARV Regimens and Routine Monitoring During Treatment.................. 64 Table 1.3: Staging CD4 and Viral Load Monitoring.......................................................... 66 Table 1.4: Criteria for ARV Initiation in Children < 6 Years Old ..................................... 69 Table 1.5: Paediatric ARV Regimens and Routine Monitoring on ARVs......................... 70 Table 1.6: Cotrimoxazole Use in HIV-positive Children................................................... 71 Table 1.7: Adherence Strategies ......................................................................................... 75 Table 2.1: Food Requirements for ARVs selected for use in South Africa ....................... 83 Table 5.1: Total Patients receiving CD4 tests and ARV Treatment by Year*................. 105 Table 5.2: Patient Visits per Year..................................................................................... 105 Table 5.3: Core Staffing Requirements Per Service Site to Treat 500 Patients with ARVs .................................................................................................................................. 106 Table 5.4: Workload By Category of Health Care Worker, by Patient Contact-hours per Day ........................................................................................................................... 106 Table 5.5: Total Additional Staff to be Recruited ............................................................ 108 Table 5.6: Community Service Class of 2003 and Placements for 2004 ......................... 117 Table 5.7: Number of FTEs Needed................................................................................. 122 Table 6.1: Facility readiness for HIV and AIDS Care and Treatment ............................. 134 Table 6.2: Projected AIDS Patient Loads by District and Facility................................... 136 Table 6.3: Sites Identified by Provinces for Initial HIV and AIDS Care and Treatment Implementation and Current Assessment Visit Status ............................................. 139 Table 12.1: Output Indicators for Monitoring and Evaluation......................................... 195 Table 12.2: Outcome and Impact Indicators for Monitoring and Evaluation .................. 196 Table 13.1: Expected Rates of Toxicities for ARVs used in Programme Regimens ....... 204 Table 13.2: Number of ADR reports associated with ARV agents.................................. 205 Table 16.1: Estimated New AIDS Cases by Province (excluding Medical Aid)............. 240 Table 16.2: Total Additional Staffing Costs (Millions of Rand)...................................... 242 Table 16.3: Total Additional Staff (FTEs) to be Recruited.............................................. 242 Table 16.4: Nutritional Supplement Protocol................................................................... 245 Table 16.5: Total Costs of Nutrition Support and Supplementation ................................ 245 Table 16.6: Cost of Diagnostic Monitoring of Asymptomatic HIV+ Patients................. 246 Table 16.7: Total Patients Enrolled in Care Programme and ARV Treatment ................ 247 Table 16.8: Planned Number of Patients on Antiretroviral Treatment ............................ 248 Table 16.9: Expected Total Number of Cases on Antiretroviral Treatment by Province 248 Table 16.10a: Laboratory Monitoring Costs of Each Regimen ....................................... 249 Table 16.10b: Laboratory Monitoring Costs for Infants Under 18 Months ..................... 249 Table 16.11: Total Cost of Diagnostic Monitoring of Patients on ARVs ........................ 250 Table 16.12: Drug Prices per Patient per Year................................................................. 250 Table 16.13: Total Drug Costs ......................................................................................... 250 Table 16.14: National Department of Health Additional Funding (Rand)....................... 251 Table 16.15: National Programme Implementation and Health System Capability Upgrading Costs (Millions of Rands)....................................................................... 253 Table 16.16: Split of Funding Requirements Between Recurrent and Start-up Investment for Health System Capability Upgrading (Millions of Rand) .................................. 254 ii
Page 1: OPERATIONAL PLAN FOR COMPREHENSIVE
Page 5 and 6: LIST OF ACRONYMS ADR AIDS ALT API A
Page 7 and 8: Foreword I would like to thank the
Page 9 and 10: We hope that all South Africans who
Page 11 and 12: 16. Dr. Fazel Randera, Health Advis
Page 13 and 14: Executive Summary BACKGROUND 1. The
Page 15 and 16: 6. Following the discussion of this
Page 17 and 18: health status and to prolong life),
Page 19 and 20: extreme inequalities and disparitie
Page 21 and 22: 9.5 Providing a Comprehensive Conti
Page 23 and 24: efforts through additional investme
Page 25 and 26: elements in a containment strategy
Page 27 and 28: 18. The programme detailed in this
Page 29 and 30: monitoring of patients for TB, a co
Page 31 and 32: 40 The drug procurement strategies
Page 33 and 34: follow-up and monitoring for patien
Page 35 and 36: CHAPTER III - TRADITIONAL MEDICINE
Page 37 and 38: 74 The minimum service point accred
Page 39 and 40: 85. Task Team projections of AIDS p
Page 41 and 42: patented and/or branded drugs suppl
Page 43 and 44: 102. It proposes a significant expa
Page 45 and 46: measure the outcomes of the program
Page 47 and 48: 119. Examples of specific research
Page 49 and 50: Table 0.1: Total Programme Budget E
Page 51 and 52: the existing health care system and
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Table 0.2: New Patients Starting AR
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DRAFT - Confidential Chapter I Prev
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