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Closer to Home: Decentralized Models of Treatment and Care

This article explores the use of decentralized models of treatment and care in reducing the burden for patients and healthcare workers. It discusses the importance of delinking clinical consultation from ART refill for stable patients on ART and designing appropriate models based on environmental context, subpopulations, and medical needs. It also highlights the critical enablers, such as policy, resources, recognition of lay workers, and reliable monitoring systems, necessary for the successful implementation of decentralized care models.

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Closer to Home: Decentralized Models of Treatment and Care

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  1. Closer to home: Use of decentralized models of treatment and careEric GoemaereSouthern African MSF medical unit School of public health , UCT

  2. Main MSF models of differentiated ART deliveryAim: reduceburden for patients AND health care workers Delinking clinical consultation from ART refill for stable patients on ART

  3. Designing the appropriate model: logical framework Environmental context : Urban <> rural Subpopulation Paeds Adult MEDICAL NEED Stable <> unstable Intense Routine Pregnant and BF Key populations Low prevalence <> High prevalence

  4. Betterretentionthanconventional care Eligible & joined Eligible & did not join Project data, Chiradzulu, 2013, Luque-Fernandez, 2013,Kalenga, 2013,Preliminary data, Tete, 2015

  5. Moving towards the front end of the cascadeCommunity VL ( > 1000cp/ml),KZN , South Africa 2013 community survey Adapted linkage to care strategies Adapted Community testing strategies ( Fixed, MISS, D2D,)

  6. Differentiated care at front end of cascade,Bending the curves project, Eshowe , KZN 2016 TUPEE461: Demographic reach and costs associated with 3 models of community HIV testing in rural KwaZulu-Natal, R.Bedell and all

  7. Critical enablers Policy and ressources: criticalenablers Brendan Bannon André Francois Recognition of lay workers Acces to quality clinical management Miguel Cuenca Brendan Bannon Reliable monitoring system Robust drug supply Cost-effectiveness and access analysis from Khayelitsha Adherence clubs FunekaBango and all , UCT Health Economics Unit

  8. Food for thoughts • Individual <> Collective models ? Importance of social fabric / collective responsibility ? • Expanding these models across • the cascade of care • population sub-types • co-morbidities ( NCD ) <> NCD patients • Policy and resourcing barriers ? • Flexible regulatory issues around drug delivery • Reinforced supply chain • Electronic adapted M & E • Comes at an ( additional) cost

  9. Aknowledgments - Community health workers/expert patients in Mozambique ,SA, DRC, Malawi, Zimbabwe, Guinea • MSF Field teams • SAMU team mates i.e. Helen Bygrave, Saar Baert www.samumsf.org

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