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Acronyms
Forward
Acknowledgement
1. Introduction
2. Guiding principles
3. Goal
4. Program Management and Coordination
4.1. National level
4.2. Regional level
4.3. District level
4.4. Facility level
4.5. Community level
4.6. Private sector
4.7. National HIV/AIDS training and support network
5. ART Program Requirements 8 5.1. Policies and guidelines on ART
5.2. Protocols
5.3. Clinical tools
5.4. Clinical monitoring
5.5. Accreditation
5.6. Standard operating procedures
5.7. ART training
5.8. Health management information system
5.9. Drugs and supply management
5.10. Eligibility
5.11. Sustainability
6. Approach to Implementing ART Programs
7. ART Rollout Plan
8. Facility Planning for Service Delivery
8.1. Leadership
8.2. The care model
8.3. ART patient flow
8.4. Staffing needs
8.5. Clinical services
8.6. Laboratory services
8.7. Pharmaceutical services
8.8. Systems
9. Community Level Planning: Care Beyond the Hospital
9.1. Community health delivery structure
9.2. Key community stakeholders
9.3. Role of community stakeholders
10. Information Management and Communications
11. Strategic Information
Annex
References
Ethiopia is among the countries most heavily affected by the HIV epidemic.
The cumulative
number of PLWHA is about 1.5 million, with 95,000 under 15 years of age. The
2003 national
prevalence in the urban and rural population are 12.6% and 2.6% respectively.
Since 2004, there
are an estimated 105,453 and 27,226 new AIDS cases in the adult and children
population
respectively. Some 90,000 adults and 25, 000 children have died of AIDS. About
265,358
PLWHA need antiretroviral treatment, and of this population, only 2% can afford
to pay for
ARVs and healthcare services.
Ethiopia has significantly expanded its response to the epidemic since the enactment
of the
National HIV policy in 1998. In 2001, the National HIV/AIDS Prevention and Control
Council
declared that HIV was a national emergency, leading to various interventions
particularly
focusing on prevention and behavior modification. In 2003, fully cognizant of
competing
demands of equal magnitude such as famine, malaria and tuberculosis and the
uncertainty of
program sustainability, the Government of Ethiopia elected to introduce the
ART program with
the goal to prolong the lives, to restore the mental and physical functions
and to improve the
quality of life of PLWHA. This program will impact mortality, reduce fatalistic
attitudes,
promote increased voluntary HIV testing, and provide a rationale for making
healthy living
choices. The declaration of ART as a human rights issue and support for universal
access to ART
from world leaders will benefit the national ART program through several donor-led
initiatives.
The implementation of safe and effective ART is a serious challenge in such
a resourceconstrained
country, where there is little experience in managing this type of complex treatment
program.
In 2003, the MOH, DACA and HAPCO developed the National Guidelines on ARV
and began
providing ART training to teams of healthcare providers. As a result, 690 physicians,
nurses,
pharmacists and laboratory technicians from 58 centers have been trained in
ART, and as of July
2004, 10,400 patients receive ARVs. Several challenges have already been identified,
including
the need to strengthen the overall program oversight structure, to integrate
program monitoring
& evaluation, and to develop discipline-specific standardized clinical training.
Baseline viral
susceptibility studies and minimum assurance of standardized therapeutic monitoring
will also be
required. Public private partnerships need to be encouraged and supported.
In order to address these gaps and to prepare for rapid scale up of ART, the
MOH has developed
this guideline to help foster a flexible, creative, and energetic response.
This guideline is based
on sound scientific and ethical standards and promotes sustainability and equitable
access to
treatment. Its primary goal is to support the development of a standardized,
safe and effective
ART program nationwide. The target audiences of this guideline include health
providers,
community health workers, community based organizations’ staff, PLWHA,
and program
managers in the public and private sectors.
The National ART Program is based on the following guiding principles:
• ART, which is comprehensive services, will be an integral part of the
HIV continuum of care.
• The chronic care model will be applied to deliver ART.
• Treatment and clinical procedures will conform with national ARV treatment
guidelines, which are based on international standards and best practices.
• Greater involvement of PLWHA will be encouraged.
• Equitable universal access will be strongly promoted.
• National prevention strategies will be emphasized.
• The National ART Program will strengthen the national health care system.
• Efforts will be made to ensure sustainability.
• Only one National ART Implementation Guideline will be followed.
• Public-private partnership will be encouraged and promoted.
• National and international networking will be valued and supported.
