AIDS has seen a dramatic change in the last three decades. What was once a rapidly fatal disease, can now be a chronic disease, with treatment available that can enable PLHIV to live long and productive lives. The key is access, and adherence, to these treatments. This means that, more than ever, there is a need for patient centered research which gives an insight into the factors that affect access, and barriers, to treatment, care and support for PLHIV. For many years PLHIV groups have been vocal about the lack of rigorous research and information on treatment, care and support. Historically studies in the region have been ad-hoc, and not representative of the needs and experiences of those affected by the disease. The Global Fund Against AIDS, TB and Malaria (TGF) Board approved APN+ GF Multi-country Proposal for Round 10 in January 2011. The goal of the approved proposal is to improve access of PLHIV to treatment, care and support services in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam. The main objective of the program is to develop the APN+ Regional Treatment Access Database. This database is a tool to document, monitor and advocate issues related to treatment access for PLHIVs in these seven countries. The program also aims to strengthen National PLHIV Networks in the seven program countries to facilitate and improve treatment acceptance in the community.
Implementation of Phase 1 (Oct-2011-Sep 2013) of the grant
APN+ as Principal Recipient (PR) led the design and implementation of a study on Community Access to Treatment Care and Support (CATs) in the seven countries. Initial study design was done in collaboration between APN+ and their national partners in the program countries. The objective of the study was to:
- To monitor and document current uptake of key HIV treatment, care and support services by PLHIV.
- To understand barriers to access to treatment, care, and support of PLHIV.
- To recommend policy actions to improve access to treatment, care and support services in the Asia and the Pacific region.
During phase 1 of MATA the national partner networks were given training in financial and grant management, as well as in all aspects of research and data collection relevant to CAT-S. Nearly 100 data collectors were recruited from national PLHIV communities, and trained to carry out the interviews for this study. A total of 7,843 PLHIV were interviewed for the study from across the seven countries. Results from this first phase of the study are available here. (text link to the regional profile page) In Phase 1, APN+ has been granted A1 rating for four consecutive quarters and an overall A1 rating for its annual financial and programmatic performance review. At the end of Phase I, APN+’s most recent grade was A2.
Implementation of Phase 2 of the grant
Collection of information will continue in phase 2 (Oct 2013-Sep 2016), with participants being revisited, so as to analyze and document the changes over time. In addition the study will be tailored to the specific issues and contexts of each country that have been identified in Phase 1. Qualitative research will be undertaken to analyze policies, which affect PLHIV communities, and document community stories, in each of the program countries. Utilising insights gained from the studies undertaken, national networks will undertake advocacy and lobbying activities to direct the discourse on treatment, care and support issues within their country, and encourage programming which addresses the specific issues identified in CAT-S.
CAT-S Phase II Study is implemented in six countries, namely Bangladesh, Nepal, Pakistan, Indonesia, the Philippines and Vietnam. Training of trainers for data collection was conducted in March 2016, while the training of data collectors at the country level has also been completed thereafter. Data collection work has already begun in April and as of June 2016, countries are wrapping up data collection tasks and preparing for data entry. APN Plus has negotiated with Biophics, a research institute at Mahidol University, in data collection and cleaning.
Monitoring Access to Treatment in Asia
The Monitoring Access to Treatment in Asia (MATA) program is envisioned as a way of bridging the gap in patient centered information around treatment, care and support for HIV and AIDS, and at the same time empowering people living with HIV/AIDS (PLHIV) networks through the ownership of that information collection, and dissemination. It is the aim of MATA that this information will be used by PLHIV networks to campaign and lobby at the national level for improvements to HIV/AIDS programs. In the process, MATA will also help build the capacity of national PLHIV networks around research and grant management skills, enabling them to undertake more studies on their own in the future. MATA currently focuses on seven countries in the Asian and the Pacific Region: Bangladesh, Indonesia, Lao PDR, Nepal, Pakistan, Philippines, and Vietnam, with funding from the Global Fund Against AIDS, TB and Malaria (GFATM), thorough round 10, regional grant. MATA utilizes four key sources of information and data collection, with all synthesis and analysis of that information being presented online through www.apnmata.org. This information portal will be used by activists, community organisations, NGOs and National Authorities to better understand, and address, issues hindering access to treatment, care and support, in the program countries and beyond.
Community Access to Treatment, care and support Study (CAT-S)
As one of the major pillars of MATA, CAT-S is a large PLHIV focused study being implemented in the Asia and the Pacific region. Over 7,000 PLHIV have participated in the study, giving a rich source of information on the factors that affect access to treatment, care and support, directly from the perspective of those affected by the disease. The design of CAT-S was done in partnership between APN+ and the national partners, with PLHIV giving significant and meaningful input into the design of the questionnaire. The initial collection of data, which has already been completed, is intended as a baseline which will be able to show the trends over time as participants are revisited in the second phase of the project.
Program Team Members
Sushil Koirala, MPH, is the Program Manager and also takes on the role of Monitoring and Evaluation Manager. Sushil has over 13 years experience in public health surveillance, HIV Health service design and program monitoring and evaluation in the South East Asia region.
Treatment Database Officer
Sanchai Lertcharoenchoke is responsible for all data management and analysis. Sanchai has over 15 years of experience in research, data analysis and database management.
Worapon Rattanawarawong earned a Bachelor’s degree in Political Science majoring in Politics and International Relations. He has experiences in several international organizations and NGOs affairs such as United Nations and others youth lead organizations in region.