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Task-shifting in delivery of HIV care

Task-shifting in delivery of HIV care. Partners In Health Perspective Louise Ivers MD, MPH Director, HIV Equity Initiative, Partners In Health, Haiti Harvard Medical School. Partners In Health. Non-profit organization - healthcare delivery - socioeconomic programs

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Task-shifting in delivery of HIV care

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  1. Task-shifting in delivery of HIV care Partners In Health Perspective Louise Ivers MD, MPH Director, HIV Equity Initiative, Partners In Health, Haiti Harvard Medical School

  2. Partners In Health Non-profit organization - healthcare delivery - socioeconomic programs HIV treatment • Within context of primary health care • In collaboration with Ministries of Health • Community-based care

  3. Haiti: PIH/Ministry of Health Rural Central Haiti 9 health centers Doctors, nurses, social workers Lay providers • community health workers • X-ray technician • Laboratory assistants

  4. ‘shift in tasks by type’ • Largest shift seen in management of patients prior to and after starting ART • Nurses prescribe and manage patients • CHW identify side effects of ART, signs of opportunistic infections • facilitated referrals

  5. How has this model affected health care? - access, quality Previously - essentially non-functional clinics • 10-50 visits per day on average • Stock outs, absent staff • No ART • HIV testing available in just one stand-alone site (< 40 tests per year) • Severe lack of local doctors / nurses

  6. Currently • 200-300 visits per day at each center • 50,000 voluntary HIV tests per year • > 3000 people living with HIV on ART • > 8500 people living with HIV followed

  7. < 2 % total cohort needing 2nd line ART Despite significant political instability 2004, not a single patient missed ART dose

  8. Not just HIV-care • All primary health care indicators improved • Increase in vaccinations • Catchment area of >500,000 served with primary healthcare • Over 2 million patient-visits 2006

  9. Rwanda: PIH/Clinton Foundation/MOH • 2 District Hospitals • 6 health centers • Similar model of care • Rural eastern Rwanda

  10. Over 2500 patients on ART • First cohort 2 years on therapy • Only 2 patients on second line ART

  11. Collaborators - Thanks! Dr Gregory Jerome Dr Wesler Lambert Ministry of Health: Haiti and Rwanda Clinton Foundation Partners In Health Team Patients Community health workers Staff WHO

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