usaid/ethiopia pepfar mid-term evaluation of the ... - GH Tech

C. IMAI OverviewIMAI is a health care strategy promoted by the World Health Organization (WHO) that stresses thatHIV/ AIDS services must be integrated into the public health system in order to increase access forpatients and communities. IMAI promotes a chronic care model that includes the overall health ofthe patient. ART, prevention, and other HIV-related needs are in many cases transitioned down toprimary health care facilities with limited resources, with referral and back-referral to local hospitalsas indicated. IMAI is intended to integrate HIV care and prevention, increasing the provision anduptake of preventive interventions. The system is intended to strengthen health systems byproviding training, tools for patient monitoring, clinical team building, clinical mentoring, and localplanning. IMAI supports a team approach to patient care, along with patient partnership, inclusionof “expert patients”/peer support staff on the clinical team, and effective adherence support. Thisapproach is intended to permit rapid expansion of human resources for HIV care while providingthe skills and clinic capacity for effective management of other chronic illnesses. WHO supportsthese efforts with training materials, technical assistance, and M&E . Other components of IMAIinclude:• Acute care, with a syndromic approach to the most common adult illnesses, including mostopportunistic infections (OIs), and clear instructions so that health workers know which patientscan be managed at the first-level facility and which require referral to higher levels.• Chronic HIV care, which includes patient education, psychosocial support, “prevention forpositives,” clinical staging, OI prophylaxis, preparation for ART, clinical monitoring,management of ART side effects, adherence preparation and support, management of otherchronic problems, and data collection based on a simple treatment card.• Palliative care, with management of symptoms during acute or chronic illness; education of thepatient, family, and community caregiver to provide care at home; and end-of-life care. TheIMAI approach assumes that much of the care will be given by the patient’s family with backupby multipurpose health workers at first-level facilities.• Integration of HIV with other health issues. One area of particular emphasis is integration ofHIV and TB, including HIV testing in TB patients and co-management of TB-HIV, includingART and adherence to both TB and HIV treatments.WHO promotes similar principles for Integrated Management of Childhood Illness (IMCI),including integrated HIV prevention, care, and treatment within basic primary care.D. National Ethiopian Plan for Comprehensive HIV Care and IMAIIn January 2005, the government of E thiopia launched a program to provide free ART. The“Accelerating Access to HIV/ AIDS Treatment in E thiopia Road Map for 2004-2006” was finalizedin May 2005 and stressed the importance of embedding ART into a comprehensive HIV/ AIDStreatment and care approach. Central to this national plan was a network model that includedlinkages among national and regional hospitals, district hospitals, HCs, and health posts/ communityhealth services. The road map also proposed to strengthen and expand entry points and linkagesamong HIV services, including counseling and testing (C&T) and prevention of mother-to-childtransmission (PMTCT) services; TB clinics; STI services; other outpatient clinics; and inpatientservices. A strengthened and trained group of health workers was also seen as critical to thisexpansion. A second road map for 2007-2008 continued this focus, with guiding principles thatincluded:Mid-term Evaluation of Ethiopia IMAI Program 10