HIV Prevention for People Living with HIV/AIDS: Indicators for HIV Care and Treatment Settings

Transcription

1 HIV Prevention for People Living with HIV/AIDS: Indicators for HIV Care and Treatment Settings Daniel Kidder, PhD Pam Bachanas, PhD Amy Medley, PhD HEATLHQUAL All Country Learning Network (ACLN) Meeting 16 March 2011 Department of Health and Human Services Centers for Disease Control and Prevention Division of Global HIV/AIDS

2 Outline Prevention with People Living with HIV (PwP) in clinic settings PwP PEPFAR indicator HEALTHQUAL prevention indicator Questions and discussion

3 Prevention with People Living with HIV (PwP) Prevention interventions with people living with HIV (PLHIV) improve their health and reduce the risk of transmission to partners/children Prevention is a critical part of the care of PLHIV throughout their illness

4 PwP in clinic settings Health care providers meet with patients regularly Can deliver consistent, targeted prevention messages and strategies during routine visits Health care providers are considered authority figures and trusted sources of health information Prevention information on infection control is regarded as quality standard of care

5 PwP in clinic settings (2) Health care providers can address biomedical prevention strategies E.g., family planning, STI management Given clinic burden and complexity of patients needs, many patients need more in-depth counseling on prevention issues E.g., disclosure, condom use, alcohol use Incorporating counselors into clinic settings is essential for comprehensive prevention activities

6 HIV Prevention for People Living with HIV/AIDS: Intervention Activities for HIV Care and Treatment Settings Health Care Providers 1. Give basic prevention recommendations (disclosure, partner testing, safer sex, and alcohol reduction) 2. Assess and support adherence 3. Provide family planning and safer pregnancy counseling 4. Assess and treat STI symptoms 5. Distribute condoms Refer for behavioral counseling on prevention, positive living, adherence, and alcohol reduction. Refer for provision of family planning, pregnancy advice, and STI management. Lay Counselors 1. Conduct Group Education - Basic Education on HIV/AIDS - Protecting Your Partner - Protecting Your Children - Treatment Adherence - Positive Living 2. Provide Individual Counseling 3. Provide HIV Counseling and Testing, where permitted - Individuals: Walk-in and partner(s) of clinic patients - Couples: Concordant and discordant)

7 Country PwP Activities Many countries developing and/or strengthening national policies and guidelines for PwP activities Integrating prevention services into routine care of PLHIV so prevention becomes a part of the continuum of care Part of National Care and Treatment guidelines National Prevention Strategies or Frameworks include PwP activities and services Example countries include Ethiopia, Kenya, Namibia, Nigeria, Rwanda, Zambia

8 PwP Monitoring and Evaluation Need to be able to monitor and evaluate clinic-based PwP activities PEPFAR PwP Next Generation Indicator (released Aug 2009) Essential/Reported indicator Captures delivery of the minimum package of services for PLHIV Will assist field in monitoring and evaluating coverage of prevention services for PLHIV

9 PwP PEPFAR Indicator Number of people living with HIV/AIDS (PLHIV) reached with a minimum package of Prevention with PLHIV (PwP) interventions To count for indicator, PLHIV must have received the minimum package at last visit In clinic/facility-based or community/homebased services

10 PwP Minimum Package Assessment of: Sexual activity provision of condoms/lubricant, risk reduction counseling Partner HIV status provision of (or referral for) partner testing STIs provision of (or referral for) STI treatment, partner treatment Family planning needs provision of contraception, safer pregnancy counseling, or referral for family planning services Adherence support or referral for adherence counseling Need for community-based services (e.g., home-based care, support groups, post-test clubs) refer or enroll

11 Indicator Rationale Prevention is more than just condoms Minimum package is evidence-based for improving health of PLHIV and decreasing transmission risk Minimum package will help drive programming and improve services Integrate prevention into continuum of care and treatment All or none indicator Countries may not yet be doing all, but want to move toward that point

12 Why at last visit? Prevention services should be delivered routinely and not just at intake Life situations change over time Prevention needs change and require ongoing attention Acknowledge that there are potential difficulties with capturing information

13 Where are clinics now? All services may not currently be delivered during routine care visits Services may be delivered but not currently documented Is there a component of the PwP indicator that could be targeted as a starting point to improve service delivery and documentation? HEALTHQUAL prevention indicator

14 Prevention Indicator What is the priority prevention goal for PLHIV? Get partners tested and identify discordant couples Can then intervene to reduce transmission risk Steps to identify discordant couples: Disclosure Partner tested Knowledge of partner status

15 Possible Indicators (1) Disclosure Pros: If mutual disclosure, may have less risky behavior and greater support/care of positive partner Cons: Don t know for certain that partner has been tested Patient may assume partner s status based on patient s status ( I am positive, so (s)he must be positive )

16 Possible Indicators (2) Partner tested Pros: Documents that HIV test has occurred Cons: Patient may not know partner s test outcome. If no disclosure, can t identify concordant/discordant couples Don t know if negative partner has been retested as needed (e.g., every 6 months) If partner not tested in clinic or don t have documentation of results, then can t be certain of results

17 Possible Indicators (3) Knowledge of partner HIV status Pros: Identifies discordant couples and can prioritize for interventions Cons: Don t know if partner was actually tested Don t know if mutual disclosure has occurred Don t know when partner was last tested (negative partners need routine retesting)

18 Questions and Discussion If there can be only one HEALTHQUAL indicator for PLHIV, what would it be? What about other possible indicators? Risk behavior (e.g., consistent condom use, # of partners) STIs Family planning Adherence Can the indicator include multiple questions? E.g., partner tested (Y/N), test date, HIV status

19 Thank you!