AIDS 2016 AIDSconference The Science behind Test and
#AIDS 2016 | @AIDS_conference
The Science behind Test and Start and Nursing’s role in achieving universal access Susan Michaels-Strasser ICAP at Columbia University #AIDS 2016 | @AIDS_conference
Objectives of the bridging session Science Person centered care Community #AIDS 2016 | @AIDS_conference Leadership
Why Test & Start? § Early HIV treatment has benefits for the individual § Early HIV treatment has public health-prevention benefits § Early treatment has programmatic benefits - Increase in ART uptake - less loss to follow up in the Pre-ART period § Early treatment is cost-effective – Modelling shows that the increased cost of treating more people for longer will be offset by subsequent reduced cost from less morbidity and mortality and decrease in new HIV infections #AIDS 2016 | @AIDS_conference
NURSING’S ROLE IN ACHIEVING UNIVERSAL ACCESS #AIDS 2016 | @AIDS_conference
Critical Shortage of Health Workers http: //www. who. int/hrh/statistics/Spotlight_6_Nov 2008_benchmarking. pdf? ua=1 #AIDS 2016 | @AIDS_conference
• While there is a critical shortage of health workers–where a health worker does exist, –whether in urban or rural areas, » it is most likely to be a nurse! #AIDS 2016 | @AIDS_conference
Along the HIV cascade nurses are there Training community health workers #AIDS 2016 | @AIDS_conference Supportive and mentoring to community health workers Teasdale & Abrams, 2013
Option B+ in Malawi Number of new antiretroviral treatment (ART) initiations among pregnant and breastfeeding women, and percentage of all new ART initiations attributed to this population — Malawi, 2008– 2012 #AIDS 2016 | @AIDS_conference
PROPORTION OF HIV CARE AND TREATMENT CLINICS WHERE NURSES PRESCRIBE ARVS AT ART INITIATION AMONG ICAP-SUPPORTED CLINICS (n=1009) 100% Percent of clinics 69% 54% 52% 50% 35% 0% 2009 2010 2011 Calendar year Source: ICAP Care and treatment PFa. CTS Round 4 -7, July 2009 -July 2013. #AIDS 2016 | @AIDS_conference 2013
PROPORTION OF HIV CARE AND TREATMENT CLINICS WHERE NURSES ASSESS ART ELIGIBILITY AND PRESCRIBE ARVS, BY LOCATION (n=1009) 100% Percent of clinics 73% 76% 75% 74% 73% 77% 69% 67% 68% Overall (n=1009) Urban (n=175) Semi-urban (n=333) 72% 71% 76% 50% 0% ART eligibility assessment ART initiation Source: ICAP Care and treatment PFa. CTS Round 7, July 2013. #AIDS 2016 | @AIDS_conference Follow-up Rural (n=501)
ART Scale Up in South Africa: Patients on ART Before and After NIMART Tt Pts in care AFTER NIMART 3 FOLD INCREASE IN PATIENTS ON ART 2 175991 1 411965 BEFORE NIMART 783846 510317 2009 2010 *DHIS data #AIDS 2016 | @AIDS_conference 2011 2012
A message sent to a What’s up group by a NIMART training participant #AIDS 2016 | @AIDS_conference
NIMART IS HIGHLY EFFECTIVE BECAUSE • nurses are the largest and most trusted health profession, • nurses are able to practice NIMART safely and effectively with strong clinical outcomes, • inter professional networks of nurse trainers, practicing nurses and physicians are driving rapid ART scale up, • strong nursing leaders are managing clinics and ART services, • legislative and regulatory environments are finally catching up to practice, • communities agree and are working with PHC clinics! #AIDS 2016 | @AIDS_conference
Reach 90 Scale 90 Retention 90 A STRONG NURSING WORKFORCE IS ESSENTIAL FOR EPIDEMIC CONTROL #AIDS 2016 | @AIDS_conference
#AIDS 2016 | @AIDS_conference
Acknowledgements Prof. Wafaa El Sadr Agnes Chetty Dr. Mark Hawken Dr. Duncan Chege Doris Naitore Esther Mugai Lynette Kosgei - ICAP PEPFAR HRSA CDC Judy Khanyola Janel Smith Amina Khawja Tashtiana Price This work has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through U. S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) under the terms of the Global Nurse Capacity Building Program, cooperative agreement #U 92 HA 12772. The contents are the responsibility of ICAP and do not necessarily reflect the views of the United States Government. #AIDS 2016 | @AIDS_conference
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