Interview with Dr Olufemi Oke, WHO HIV Officer, Namibia
Katutura State Hospital, Windhoek, Namibia
Q: How is WHO supporting the antiretroviral treatment (ART) programme at Katutura State Hospital?
A: WHO's support for the efforts at Katutura Hospital dates as far back as 2003, when the ART programme first started. As in most other countries, the ART guidelines developed by WHO and partners have been adapted at country level; Namibia has used them to develop its own national ART guidelines, which are now being used for both training and service providers at Katutura Hospital, as well as other hospitals across the country.
Q: Katutura State Hospital has been chosen as a pilot site for a national HIV drug resistance assessment. Can you tell us more?
A: With the scale-up of ART services to all 34 district hospitals in the country, and with the experience of over three to four years at some of the ART sites, the possibility of the emergence of HIV drug resistance was clearly there. This finding is supported by WHO all over the world: the wider the use of ART, the (higher) the likelihood that HIV drug resistance may emerge. We discussed this with country nationals in Namibia, and they requested that WHO support the development of an HIV drug resistance strategy, following the WHO global strategy.
We had a technical assistance mission from headquarters, led by Dr. (Diane) Bennett - they were here, we put things in process, and now (the strategy) is being piloted at Katutura hospital where, already, we have an assessment of the "early warning indicators," and we are planning to feed back to hospital management with the findings of the assessment.
Q: What is IMAI, and how is it being adapted in Namibia?
A: IMAI is Integrated Management of Adolescent and Adult Illness. This strategy also looks at how you can ensure that caregivers in the health care services who are not medical doctors can participate in the management of people living with HIV/AIDS - including people living with HIV/AIDS themselves, trained to manage peers.
It's a really broad spectrum approach that has comprehensive training modules and training manuals that have been widely developed and widely used, and this is what Namibia is putting in place. WHO supports countries to nationalize and adapt those models and materials to the cultural settings of each of those countries, and to ensure that they are able to use those materials in appropriate ways for their countries.
Therefore, it allows for the bridging of the gap between the central health facilities and community services. In many countries in Africa, it is very difficult to link these two aspects. You will find that health facility management of people living with HIV/AIDS goes on very well, while the community component is lagging. In many of these countries, you have big, urban hospitals doing very well, but peripheral-level health facilities are unable to match that. You have patients that travel several kilometres just to receive their drugs and go back home, and this affects adherence, it affects the way patients are managed. The IMAI strategy helps to bridge this gap; it helps to strengthen the sub-national peripheral health facilities so that they can also participate in handling some of the management of patients.
Q: How are WHO and partners able to monitor the progress of patients who are taking antiretroviral treatment?
A: WHO has developed a monitoring tool for the tracking of people living with HIV/AIDS on treatment. It helps to take in patients as cohorts when they are enrolled (on treatment). So if you are enrolled in January 2009, you belong to the January cohort, and you can be followed up for 12 months.
So with this monitoring tool that WHO has helped to develop, you can look at a cohort and see what is the physical status of these patients after 12 months. For somebody who was incapacitated, who could not move, who was not ambulatory - at 12 months (his status) is charted on this tracking tool. In all its 34 district hospitals in Namibia, these tools are being used.
So, for example, at Katutura hospital, for the number of patients retained on treatment in 2007 and 2008, we can now say: 'This is the percentage of people that are still on treatment, this is the number that has dropped off and this is the number that has transferred out.' That is possible now.
HIV drug resistance strategy
(MP3)
IMAI in Namibia
(MP3)
Monitoring the progress of patients on ART.
(MP3)
Related links
- HIV drug resistance
- WHO-recommended global strategy on HIV drug resistance
- Integrated management of adolescent and adult illness (IMAI)
- Patient monitoring guidelines for HIV care and antiretroviral therapy