Antiretroviral (ARV) toolkit

District management & supervision

In the IMAI approach to decentralized HIV care, ART and prevention delivery, the district office is responsible for many administrative and supervisory activities crucial to the proper functioning of the range of services required for HIV control.

The decentralized approach has to address the needs of the district in terms of ART and other HIV services targets (such as testing, PMTCT, Chronic HIV Care) and has to build on what is already available and involve the local partners, stakeholder and resources. Although the process is similar in all districts only local managers, familiar with the local reality would be able to "tailor" the approach to a specific district.

A typical district has a population of more than 100,000 people. Depending on the size and resources of the district, the office may have one person or a team of people who act as the focal point for HIV related activities. 

District planning needs to address several components:

  • Assessment of  HIV scale up needs (ART target, testing, PMTCT, etc),
  • Assessment of available services,
  • Assessment of lacking services,
  • Planning for scale up (including management of the available resources and estimation of what is needed),
  • Orienting and optimizing entry points,
  • Preparing the community and social marketing,
  • Planning capacity building,
  • Establishing distance communication for clinical team support,
  • Follow-up support and supervision after training: The district office will also be responsible for ensuring follow-up after IMAI training. On-site visits are an important part of capacity building, particularly when new HIV services are being introduced. Additionally, the system of referral and clinical mentoring is also important to ensure on-going learning by health workers and should be managed by the district office,
  • Medicine diagnostics and health supplies,
  • Patient monitoring should be managed and supervised by someone on the district management team, often a health information officer,
  • Prevention acceleration.

Scaling-up HIV care, ART and prevention

Please note that the District Coordinator Course is in development and that the most recent version should be requested if being used.  This course focuses on the role of the district HIV coordinator in the context of rapid scale-up of HIV care/ART and an emergency response to the HIV epidemic. It does not teach clinical skills and knowledge. 

The target of this training course is the district (and regional) HIV coordinator. This person may be someone who works solely on HIV control, but often is someone who has additional duties, such as communicable diseases. The course assumes previous training on general management and planning and on district TB program management.

The process of scale-up requires a careful mapping of existing HIV services and an estimation of the need in the district. From this, training of health workers can be efficiently planned, using an integrated approach that combines modules on chronic HIV care/ART with other needed training modules on PMTCT, TB-HIV, provider-initiated testing and counseling, etc. 

There are ten modules in this course and an exercise workbook. Forms for gathering data on the current status of services in the district are sent out before the course, then used during exercises during the course:

This course has been field-tested and iteratively improved in Zambia, Uganda, Ethiopia, Lesotho and Eastern Cape RSA.