Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care.

Hdl Handle:
http://hdl.handle.net/10144/116359
Title:
Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care.
Authors:
Bemelmans, Marielle; Van Den Akker, Thomas; Ford, Nathan; Philips, Mit; Zachariah, Rony; Harries, Anthony; Schouten, Erik; Hermann, Katharina; Mwagomba, Beatrice; Massaquoi, Moses
Journal:
Tropical Medicine & International Health : TM & IH
Abstract:
Objective  To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. Method  In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587 455) based on decentralization of care to health centres and community sites and task shifting. Results  After delegating HIV testing and counseling to lay counsellors, uptake of testing increased from 1300 tests per month in 2003 to 6500 in 2009. Shifting responsibility for antiretroviral therapy (ART) initiations to non-physician clinicians almost doubled ART enrolment, with a majority of initiations performed in peripheral health centres. By the end 2009, 23 261 people had initiated ART of whom 11 042 received ART care at health-centre level. By the end of 2007, the universal access targets were achieved, with nearly 9000 patients alive and on ART. The average annual cost for achieving these targets was €2.6 per inhabitant/year. Conclusion  The Thyolo programme has demonstrated the feasibility of district-wide access to ART in a setting with limited resources for health. Expansion and decentralization of HIV/AIDS service-capacity to the primary care level, combined with task shifting, resulted in increased access to HIV services with good programme outcomes despite staff shortages.
Affiliation:
Médecins Sans Frontières, Blantyre, Malawi  Médecins Sans Frontières, Cape Town, South Africa  Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa  Médecins Sans Frontières, Brussels, Belgium  International Union Against TB and Lung Diseases, Paris, France  Ministry of Health, Lilongwe, Malawi and Management Sciences for Health, Lilongwe, Malawi  Institute for Tropical Medicine, Antwerp, Belgium  District Health Office, Thyolo, Malawi.
Issue Date:
Dec-2010
URI:
http://hdl.handle.net/10144/116359
DOI:
10.1111/j.1365-3156.2010.02649.x
PubMed ID:
20958897
Language:
en
ISSN:
1365-3156
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorBemelmans, Marielleen
dc.contributor.authorVan Den Akker, Thomasen
dc.contributor.authorFord, Nathanen
dc.contributor.authorPhilips, Miten
dc.contributor.authorZachariah, Ronyen
dc.contributor.authorHarries, Anthonyen
dc.contributor.authorSchouten, Eriken
dc.contributor.authorHermann, Katharinaen
dc.contributor.authorMwagomba, Beatriceen
dc.contributor.authorMassaquoi, Mosesen
dc.date.accessioned2010-11-25T21:45:02Z-
dc.date.available2010-11-25T21:45:02Z-
dc.date.issued2010-12-
dc.identifier.citationProviding universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care. 2010, 15 (12):1413-20 Trop. Med. Int. Healthen
dc.identifier.issn1365-3156-
dc.identifier.pmid20958897-
dc.identifier.doi10.1111/j.1365-3156.2010.02649.x-
dc.identifier.urihttp://hdl.handle.net/10144/116359-
dc.description.abstractObjective  To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. Method  In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587 455) based on decentralization of care to health centres and community sites and task shifting. Results  After delegating HIV testing and counseling to lay counsellors, uptake of testing increased from 1300 tests per month in 2003 to 6500 in 2009. Shifting responsibility for antiretroviral therapy (ART) initiations to non-physician clinicians almost doubled ART enrolment, with a majority of initiations performed in peripheral health centres. By the end 2009, 23 261 people had initiated ART of whom 11 042 received ART care at health-centre level. By the end of 2007, the universal access targets were achieved, with nearly 9000 patients alive and on ART. The average annual cost for achieving these targets was €2.6 per inhabitant/year. Conclusion  The Thyolo programme has demonstrated the feasibility of district-wide access to ART in a setting with limited resources for health. Expansion and decentralization of HIV/AIDS service-capacity to the primary care level, combined with task shifting, resulted in increased access to HIV services with good programme outcomes despite staff shortages.en
dc.language.isoenen
dc.rightsArchived on this site with the kind permission of Wiley-Blackwell, [url]http://www.blackwell-synergy.com/loi/tmi[/url]en
dc.titleProviding universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care.en
dc.contributor.departmentMédecins Sans Frontières, Blantyre, Malawi  Médecins Sans Frontières, Cape Town, South Africa  Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa  Médecins Sans Frontières, Brussels, Belgium  International Union Against TB and Lung Diseases, Paris, France  Ministry of Health, Lilongwe, Malawi and Management Sciences for Health, Lilongwe, Malawi  Institute for Tropical Medicine, Antwerp, Belgium  District Health Office, Thyolo, Malawi.en
dc.identifier.journalTropical Medicine & International Health : TM & IHen

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