Objective 3: Lower PLH morbidity and mortality

Target population

Indicator

Expected Results

HIV+ persons in the six participating OECS countries.

3.1 Persons with advanced HIV infection who receive ART (#; disaggregated by age group & sex)

Reduction of 1%/yr in transition rate.

3.2 % of 1st line ARV clients who transition to 2nd line per year.

Overview of Approach: The activities under this Objective will target vulnerable populations in six OECS member countries: Antigua & Barbuda, Dominica, Grenada, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines. Since 2003 OECS has provided a sub‐regional framework to support the HIV programmes of these small island states; in February 2010 a GF R3 grant for the OECS Regional Coordinating Mechanism (RCM) was retired. OECS joined in this PANCAP project to share in the activities of the other Objectives and to support pooled procurement of medicines and improved access to treatment and care through Objective 3, which will be directed only at OECS (larger countries handle these needs at the national level).

Targeted vulnerable populations will include PLH, for which early detection and access to follow‐up care and treatment will improved and MARP groups which will be targeted for comprehensive service delivery under Activity 3.2.1 in conjunction with Activity 2.1.1. A key contribution will be a baseline behavioural Surveillance survey plus (BSS+) to estimate HIV prevalence in the general population, budgeted in M&E, coordinated with an Integrated Biological and Behavioural Survey (IBBS) aimed at specific MARP groups in Activity 3.2.1.

 SDA 3.1 Antiretroviral (ARV) treatment and monitoring [including pooled procurement of health products]

Activity

Expected Results

3.1.1 Strengthen pooled procurement systems at OECS and country levels, building the capacity of PPS and its national counterparts in product selection, forecasting, storage and distribution, and quality assurance.

Lowered unit costs of first line ART [overall cost per patient as % of standardised external cost for medicines]. Further outcomes: PPS will increase its ability to work with countries to rationalise drug selection and supply, update standards and undertake quality assurance, train staff in supply chain management, and advice on how to improve supply systems. Countries will be more able to forecast needs correctly and to upgrade storage and distribution facilities and procedures.

3.1.2 Meet procurement needs for drugs, lab supplies and other health products, with jointly financed purchase of ARV, opportunistic infection (OI), and other drugs and batch testing of products.

Timely, affordable, quality assured supply of adult and paediatric ARVs, OIs, and other health products.

3.1.3 Improve prescription and use of ARVs and access by vulnerable groups through clinical mentoring, updated guidelines, and chart reviews.

Reduction of 10% in average cost of ARVs per patient per year, attributable to system management and not to external improvement in price of ARVs.
Further outcomes: this will target public and private sector physicians and nurses. Regional outcomes will be improved treatment guidelines, quality of care indicators, and strategies for patient adherence; a regional database of trained service providers; and strengthened clinical mentoring programmes. Clinicians will prescribe ARV drugs appropriately using regional guidelines and will monitor patient adherence to reduce drug resistance.

SDA 3.2 Care and support for the Chronically Ill

Activity

Expected Results

3.2.1 Provide technical assistance to build capacity for scaling up early detection, care and support.

Country adult and paediatric programmes will review and upgrade their early detection and follow‐up programmes. Further outcomes: this will target in‐country HIV programmes and their ability to train public/private sector physicians, nurses and other health workers, benefiting the vulnerable groups that they treat. Outcomes will include development of HIV service delivery strategies to improve access to testing, counselling, care and support for all vulnerable groups.

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