How big of a problem is ART adherence in Zambia? When people start feeling better, they stop taking their drugs. This is the biggest problem. People need to be educated about why it is so important that you take ALL of your drugs FOR LIFE. Is there a central monitoring entity/location (nationally, locally) in Zambia? National AIDS Council (project from Central Board of Health (CBoH), which is currently being dissolved into Ministry of Health) holds any statistics that exist. Refer to “The HIV/AIDS Epidemic in Zambia” (A few copies were sent to you) (esp. p.87) book which has charts, statistics. This is the type of information which is available and gathered on a national and local level. NGOs, etc gather statistics, but NAC takes the responsibility for compiling the statistics and gives an overall picture of statistics country wide. Is there a centralized database of HIV patients’ information? UTH is beginning to computerize medical records, so they probably have the information from UTH patients. However, UTH does not have information for other patients, and this system is just being started. This database is being based on the medical record number that the patient is given (this is the same medical record number used for patient’s blood samples that are sent to Kalingalinga lab). CIDRZ also keeps extensive medical records, and compiles all of this information in an electronic database. So all information for all CIDRZ patients (which is most people in Lusaka who are on ARVs) is in this electronic database. However many organizations have complained that CIDRZ does not share information horizontally (ie with other NGOs, clinics, hospices, etc). CIDRZ may share information with CBoH, but this would likely be aggregate data in a periodic report. Again, this database is based on a medical record number, not the patient’s name. How involved is the government with home-based care? Government is NOT involved with HBC. There is a person at CBoH who is supposed to oversee HBC, however she is not able to do much, as she is underfunded and understaffed. She does not even know what/where all of the HBC programs in Lusaka are. She does have an HBC manual produced by CBoH, but many HBC programs do not even use this manual (they have produced their own manuals). Government clinics in general do not even recognize the full capability and value of HBC workers. However CIDRZ has involved HBC workers with their ART program and patients. Do Zambians trust the local or national government? What about NGOs? When it comes to the constitution of the country, Zambians do not trust the government, they trust the NGOs. For ARVs, people trust NGOs more, because through NGOs (mainly CIDRZ) they get free ARVs, but through the government they have to pay for ARVs. Some NGOs have been working with the community for a long time (ex. Kara Counseling, where Dr. Steve Gerrish works, and World Vision), so people trust these programs. They provide continuous, reliable care, unlike the government.Healthcare is under the national government, not the local government. Local government is supposed to monitor sanitation and hygiene, but they don’t do a good job of monitoring this, so people don’t trust them. What services do HBC programs generally provide (ie. Treatment for opportunistic infections) and how often? Many HBC programs only provide basic household support (washing dishes, cleaning the house, fetching water), and basic care for the patient (bathing the patient, monitoring their progress and reporting it, providing adherence support, providing emotional support, and education. In some programs, a nurse will occasional visit the patients and prescribe drugs. However regular caregivers can not distribute drugs. The caregivers in HBC programs visit patients as often as 2-3 times/week or as infrequently as 1 time/month. Nurses visit patients even less often. HBC visits depend on location of the program and patients, transportation to get to the patients, number of staff in the HBC program. Another point is that some communities are inaccessible during the rainy season, so during the rainy season the caregivers within the community are solely responsible for the patients, with no external support. CARE International did an assessment of 12 HBC programs in Lusaka. Results of how many HBC programs provide different services were published in the report, and are as follows: HBC programs provide basic nursing care (11/12), symptom management (8/12), pain relief (8/12), spiritual and emotional support (12/12), inheritance guidance (6/12), bereavement counseling (11/12), hospice care (0/12), VCT (6/12), TB Treatment (7/12), support for OVCs (11/12), food aid (10/12), HIV awareness (12/12), ARVs (4/12 – 2 of the 4 programs that provide ARVs are based in a hospital). Report by CARE International: “Home Based Care in Zambia: A Rapid Assessment of Optimum Practices of 12 Home Based Care Organizations in Zambia” August, 2005 How involved are HIV patients on ART with the HBC programs? How can we motivate them to be more involved? Most of the counselors at VCT centers are HIV positive. It is better for VCT counselors to be positive because they can relate personal experiences, and say “I am going through this as well.” It makes more of an impact. Also there are support groups for HIV + people, which are generally also led by HIV+ people. The people in the support groups are good for educating others (about getting tested, how to take the ARVs properly, how to treat side effects, etc), encouraging people to get tested and get on/stay on ARVs. What would you identify as the biggest problems with ART access? Distance of ART centers from people’s community, and transportation to get patients to these ART centers, is the biggest problem. ART centers need to be in every community so that they are easy for patients to get to. Many people know that if they get to an ART center, they can get ARVs, but they just can’t get to the center (lack of transportation). This is even worse in the rural areas, where ARVs are in the government clinic, which is in the provincial town, but many people live outside of the provincial town, so for themto get to the government clinic is very difficult even once, let alone multiple times or every month. Do patients pay for treatment at all? Patients do not pay for ARVs. They are free through CIDRZ, and through the government. (Before