[procaare] Integration of HIV into health services

[AIDS2002 <procaare@usa.healthnet.org>]

Integration of HIV into health services
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Efforts to implement HIV/AIDS programs have too often resulted in vertically managed
unilateral services that are less effective and hard to sustain.
During the course of an oral session on Wednesday on the integration of HIV with other
health services, a number of successful projects from around the world were shared.

Dr Supawitkul, from Thailand, described how an integrated approach to TB and HIV in the
northern province of Chiang Rai had helped increase the outcomes of both programs
objectives. In a region with the highest HIV prevalence rates in the country, and where TB
is the most common infectious disease, an integrated approach was adopted to tackle both
diseases with a united front.

Activities undertaken as part of this new approach included joint TB/HIV counseling
services, peer support to increase drug adherence, provision of ioniazid preventive
therapy for HIV-positives and household contact case screening for TB in HIV cases.

As a result the quality of care for people living with HIV was improved, the number of
defaulters from preventative therapy was decreased greatly. The rates of multi drug
resistant TB, which can be more than ten times more costly to treat, were also reduced
from 6.5 to 2.8% over a four-year period

"The idea of this approach was not to create new services" Supawitkul said, "but to make
sure they were better integrated and more effective. The success of this approach has
proven that health service integration is effective and appropriate in resource poor
settings."

In a poor, slum area of São Paulo, called Sapopemba, the capacity of family health
professionals was developed in order that they could respond more fully to HIV/AIDS. A
field work team of 134 health workers were trained in human sexuality, contraception and
HIV/AID/STI counseling, in order that they would be able to do door-to-door outreach work.

During one year 312,482 contacts were performed by the trained teams and over 30,000
patients were cared for and treated. Dr Fernandes, from the Association of Family Health,
concluded that the success and sustainability of this model be scaled up nationally and
used as a model for other underserved populations.
In the US, greater attempts are now being made to integrate activities to prevent and care
for Hepatitis C virus (HCV), with those for HIV. In the US there is a great overlap in the
modes of transmission of HIV and HCV. For example, the rate of co-infection amongst
injecting drug users is estimated between 50 and 90%. Around 25% of HIV positives in the
US also have HCV.
Dr Laurie Schowalter of the National Alliance of State and Territorial AIDS Directors,
explained how the biggest challenges being faced in the area were; lack of funding, lack
of a referral infrastructure and lack of consolidated prevention messages getting across.
New moves to integrate services are currently being made however.

For example the Centres for Diseases Control (CDC) are now funding HCV-HIV co-ordinators
and measures are being taken to scale up pilot programs which involve representatives of
HCV-affected populations and development of provider training to improve detection and
treatment of HCV.

The lessons learned through these various projects imply that greater integration among
services for related diseases can lead to more holistic, efficient and successful
programs. As we have seen in the case studies described greater programmatic synergy
brings greater benefits to all, even in settings where resources are scarce.

Key Correspondent
Health & Development Networks

AIDS2002 Conference
Barcelona, July 7-12, 2002

Email: correspondents@hdnet.org
Web: http://www.hdnet.org

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