1 / 24

Task Shifting in HIV/AIDS Care in Thyolo, Malawi: Successes and Lessons Learned

This article explores the successes and lessons learned from task shifting in HIV/AIDS care in Thyolo, Malawi, highlighting the impact on universal ART access and TB case finding. By training and utilizing lower cadres of health workers, such as nurses and lay PLWA counsellors, the district has been able to increase HIV testing, consultations, ART inclusions, and active TB case detection. The results demonstrate the importance of task shifting in addressing the shortage of health staff and improving access to care.

campe
Download Presentation

Task Shifting in HIV/AIDS Care in Thyolo, Malawi: Successes and Lessons Learned

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Task-Shifting in HIV/AIDS Care in a Rural District of MalawiSome successes and lessons learnt from Thyolo Moses Massaquoi, Rony Zachariah, Ulrike von Pilar Médecins Sans Frontières (Operational research) – Brussels District Health Services, Thyolo, Malawi Ministry of Health and Population, Malawi

  2. MALAWI • Population 13 million • Adult prevalence 14,1% • HIV-infected people 900,000 • Life expectancy 39 yrs • TB cases/year 25, 000 (77%HIV+) • Hospital admissions 70% HIV+ • HIV/AIDS - deaths/year 90,000 HIV/AIDS & TB: A major burden on health services!

  3. MALAWIShortage of health staff • Vacant positions: • Nursing staff 64% • Clinical officers 53% • Doctors / Specialists 85-100% • Nurse/health facility • < 1.5 nurses per health facility in 15/29 districts • Doctors/district • 10 districts with no MOH doctor. • 4 districts have no doctor at all “2004: “Crisis” / Collapse of the health sector”

  4. Staff per 100,000 population(WHO, 2004)

  5. Background: Thyolo district

  6. OBJECTIVES To highlight some successes and lessons learnt in “task shifting” to achieve Universal ART Access in Thyolo.

  7. METHODS (1)Scale up: HIV-testing/ Clinic services CT: • Increase sites: from 3 to 26 (trained lay PLWA counsellors) HIV/AIDS clinics: • Drastically improve efficiency of “delivery systems” particularly for ART.

  8. METHODS (2) : Clinics “One track”doctor centred  “multiple flow tracks” • Screening & track allocation -Nurse • Slow track- Medical assistant • Complicated opportunistic infections (OI) • Side effects/referred patients • Medium track-Nurse • Less severe OI (eg candida, diarrhoea) • ART initiation /ART follow up (< 1month) • Fast track-PLWA counsellor • Stable patients & drug refills Doctor/Clinical officer – Supervision and support

  9. METHODS (3)Community: Involvement & Activities Community network : (Volunteers/PLWA’s) • Treatment : diarrhoea, fever, oral thrush…. • Community based counselling (ART) • Support to family care givers at home • Referral : drug reactions and “risk signs”. • Cough screening (TB) • Social mobilisation.

  10. METHODS (4)Community: Volunteers

  11. METHODS (5) Community: Home care “kit”

  12. METHODS (6)Community: Nurses

  13. RESULTS (1)HIV- testing Period Jan 2003 – Dec 2006 • HIV-tested 146,411 • HIV-positive 36, 603 • PLWA counsellors 124,449 (>85%) • Over three quarters of all CT in the district done by PLWA counsellors !

  14. CT: Average/Month Thyolo, Malawi “Task shifting” : Nurses to PLWA’s Task shifting increased CT capacity by 5 times

  15. RESULTS (2) Consultations / Month Task shifting to medical assistants, nurses & PLWA’s Partial task shifting to medical assistants Three health centres ++

  16. RESULTS (3)ART: New inclusions/Month Task shifting to medical assistants, nurses & PLWA’s “Partial” task shifting to medical assistants Three health centres ++ Task shifting increased ART inclusion capacity by 4 times

  17. ART - Thyolo Universal Access - Dec 2007 ? • ART Target: 10,000 (+-1000) • On ART 6285 (March 2007) • ART initiations/Month 400 • Target Nov 2007 Without task shifting, this target would only have been achieved by 2012 !

  18. RESULTS (4)Community: Active TB case finding(Jan 2003-Dec 2004) Chronic cough:  3 weeks No referred (chronic cough) 806 No with Smear + PTB 161 (20%) Annual TB incidence (Households) 1997/100,000 Reported TB incidence (Malawi) 265/100,000 “Active” cough screening detects 8 times more infectious TB cases !

  19. RESULTS (5) Antiretroviral treatment (ART) Period Jan 2003-Dec 2004 • Total placed on ART 1634 • with community support 895 (55%) • without community support 739 (45%) Compare: ART outcomes among patients living in areas with and without community support

  20. CONCLUSIONS (1) • Universal access: Develop a Public Health ART scale-up model, standardize, keep it simple, be inclusive, use lower cadres & community. “Good for many” instead of “best for a few”

  21. CONCLUSIONS (2) Be innovative.. Challenge established practices, rules and regulations “professional turf protection”

  22. ACKNOWLEDGEMENTS • PLWA associations and groups • District health services, Thyolo • Ministry of Health - Malawi • Financial support: • G.D of Luxembourg, • DFID, NORAD, Global FUND, EU, USAID, FHI, KNCV TB foundation, CIFF, WHO STOP-TB….

More Related