Increasing access to palliative care at Hospitals

This is a new activity for FY07. It is linked to the following activities: access to home water treatment and basic hygiene counseling (# 6630), promote positive living and self reliance for HIV/AIDS affected beneficiaries of urban nutritional support program (# 1061), palliative care (# 5618), care and support for PLWHA (# 5734). In FY07, AAHAPCO, as prime partner, will subcontract Organization for Social Services for AIDS (OSSA) to implement and expand HIV/AIDS palliative care program at hospitals in collaboration with US university partners.

HIV infection leads to chronic and recurrent illness that necessitates long-term care and support for patients, their families and other caregivers. Expanded counseling and testing services will identify more HIV+ persons who require care, treatment and support services within facilities and in the community; such services will improve the quality of life of patients and their families.

OSSA is an indigenous organization founded in 1989 by the MOH and major faith-based organizations. OSSA was developed in response to the AIDS epidemic to provide community care and support. Currently, OSSA operates in fourteen towns in seven regions. OSSA provides VCT services in nine free standing sites and one mobile unit, a hotline service in five towns, care and support for PLWHA and orphans in 11 towns, IGA for PLWHA and AIDS orphans in nine towns and a community awareness program using Anti-AIDS clubs. By 2005, OSSA provided VCT services to 22,473 clients (HIV prevalence 10.9%), care and support services to 2,982 PLWHA, and referred 578 AIDS patients to hospitals to access free ART.

OSSA, with PEPAFR Ethiopia support, established a model free standing VCT site, a mobile unit and a home based VCT program in Addis Ababa. People who test positive face difficulties because of the inadequate range of comprehensive care and support packages. OSSA has many years of local experience and the capacity to provide care and support for PLWHA. All hospitals providing ART have limited resources to address the full package of comprehensive care services for PLWHA.

In collaboration with PEPFAR Ethiopia, OSSA will: (1) support 70% of ART hospitals by providing adherence counseling, psychological support and education on basic care, nutrition and the preventive care package; (2) assist critically ill patients to access different services within the hospital and link patients with home-based care run by OSSA at discharge; (3) establish patient peer support groups in the hospitals to support adherence to care and treatment; (4) distribute patient education materials and translate some into local languages; (5) link all patients needing community care service to OSSA's care and support program through which it will provide counseling, basic nursing, hygiene, and will support patient access to safe water, nutrition, and HBC services; (6) assist HIV/AIDS patients to disclose test results to sexual partners and family members and encourage HIV testing for couples and families; (7) provide preventive and supportive post-test services for concordant HIV+ and discordant couples; (8) provide care for terminally-ill patients at their home and support family members to prepare for loss; (9) provide support to family members (including orphans) to maintain their living through IGA; (10) recruit and train community care providers to provide care and support services at hospitals; and (11) work closely with major religious organizations that provide care & support for HIV/AIDS patients to reduce stigma.

This is a continuing activity from FY05, FY06. As of April 06 date, the partner received 48 % of FY06 funds and is on track according to the original targets and workplan. We have increased funding based on the achievements from FY05 and partially FY06. This COP activity merged two activities; 1.Strengthening National mode sites (COP ID # 5667) and support of expansion of mobile unit at rural hotspot (COP ID # 6638). The activity linked to palliative care # new 1052 (Palliative care-basic).

I. Through the support of PEPFAR-E, the two National Model sites (Zewditu Memorial Hospital and 4 satellite sites and Organization for Social Services for AIDS (OSSA) Mobile unit) provided VCT to 29,316 clients in FY 05. Out of 2389 HIV+ 85% were referred to care and treatment services. The mobile VCT has been successfully implemented on the streets of Addis Ababa and about 8000 people received the service in 11 months. VCT promoters played a major role in creating demand for testing. AA Education Bureau satellite VCT site reached 5 high schools and tested more than 800 students in the last two quarters of COP 05. The model sites replicated standard procedure VCT service by training 214 counselors from all regions and orienting 50 individuals to VCT implementation. In the first quarter of FY06 9307 individuals and couples received VCT services in the model sites. In COP 07: (1) The model sites will continue to provide VCT services in all outlets. Satellite sites will increase by four (a 50% increase) to total 12. The mobile VCT will provide services to high risk populations in the red light districts during night hours. Based on lessons learned in COP 06, the HBC VCT services will be expanded, and all identified HIV+ individuals will be linked to ART and other care and support services. A priority in COP 07 is initiating family counseling and testing services to encourage testing of children with their parents. In collaboration with the City Administration, RHB and other relevant organizations, PEPFAR-E will support HIV testing campaigns during World AIDS Day and the Annual National VCT day. (2) The OSSA site will continue to provide counseling and HIV/AIDS information through telephone hotline services. (3) AAHAPCO will work closely with ART clinics and PLWHA associations to encourage partner referral to HIV testing. (4) AAHAPCO will expand OSSA's services to provide continuing preventive and supportive counseling services for HIV+ clients with special emphasis on discordant couples. The program will capture 70-80% of all HIV+ tested in the model, mobile and satellite sites, and 50% positive clients referred from other public hospitals in AA. (5) AAHAPCO will continue to use volunteer promoters to create demand for VCT and to deliver community education to reduce stigma towards HIV+. Additionally AAHAPCO will work closely with JHU CCP and other organizations to create demand for couple counseling with the goal of increasing the demand for couple counseling services to 50% (from 16% in FY 05). (6) The OSSA VCT model site has provided technical support to establish a computerized VCT client data management system to 8 OSSA VCT sites operating in the regions. During COP 07 the OSSA and Zewditu model sites will expand this support to additional public and NGO facilities. (7) The model sites will continue to provide internships for newly trained VCT counselors to acquire skills and learn the process of service delivery. Community counselors (lay counselors) will be trained to work as counselors and volunteer promoters. To address the increased demand for C and T services since the launching of the free ART program, the model sites will review the VCT protocol to reduce the duration of counseling time by 50%. (8) In collaboration with Counselors Support Association, the sites will continue to hold regular case conferences for counselors in AA to share best practices. AAHAPCO will organize refresher training and burnout management sessions for counselors and other staff, and will offer counselors continuing education on HIV/AIDS related topics. (9) AAHAPCO will conduct a five year project evaluation of the two model sites to assess program effectiveness.

AAHAPCO will continue to provide administrative support to the sites to strengthen project administration and supply management.

II. Expansion of Mobile VCT services to hot spots of rural Ethiopia to break urban-rural transmission. This is an ongoing activity and relates to activities of COP 06 plus up fund ID no 6638.

AAHAPCO sub contracted OSSA, a local NGO, to implement mobile VCT service in five regions. During COP 07 (1) AAHAPCO/OSSA will expand the mobile VCT service based on experiences gained from COP 05 & 06 program implementation in Addis Ababa and the regions. AAHPACO plans to expand mobile VCT coverage with an additional 5mobiles, such that 10 mobiles will operate in 8 regions. The mobiles will provide services in rural hotspot areas—including daily or weekly market places--to reduce urban-rural transmission. The mobile units will target high risk populations (mobile workers, truckers, CSW, traders and uniformed personnel) and high risk areas including large farms and military camps and barracks. Special services will be provided during the wedding season for premarital couples. Services will be provided through well trained lay counselors. (2) The mobile units will deliver community education to promote safer sexual behavior, stigma reduction, positive living and promote community care service to HIV infected and affected individuals and families. (3) To overcome the challenge of referring HIV+ to care and treatment services from mobile units, OSSA will establish support groups of PLWHA, teachers, HEW, Traditional Healers, and other community agents. After appropriate training the support group will provide post services to HIV+ individuals and couples, and referrals to the health network model in the catchment area. (4) The mobile unit will initiate screening of syphilis using RPR. Clients with RPR positive results will receive referral for treatment and education, and will be encouraged to notify their partner(s). (5) Client data will be compiled and analyzed at branch offices and reported to RHB and CDC Ethiopia bodies. (6) OSSA will conduct a rapid needs assessment before introducing the additional 5 mobile services to determine the demand for service, demographic data of given catchment areas, and availability of community services. OSSA, in collaboration with the RHB, CDC-E and US These activities will help to meet Care and Treatment PEPFAR-E and MOH targets.