task-shifting in delivery of hiv care
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Task-shifting in delivery of HIV care
Partners In Health Perspective
Louise Ivers MD, MPHDirector, HIV Equity Initiative, Partners In Health, HaitiHarvard Medical School
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
Haiti: PIH/Ministry of HealthRural Central Haiti
9 health centers
Doctors, nurses, social workers
Lay providers - community health workers- X-ray technician - Laboratory assistants
‘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
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
How has this model affected health care? - access, quality
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
< 2 % total cohort needing 2nd line ART
Despite significant political instability 2004, not a single patient missed ART dose
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
Rwanda: PIH/Clinton Foundation/MOH
2 District Hospitals
6 health centers
Similar model of care
Rural eastern Rwanda
Over 2500 patients on ART
First cohort 2 years on therapy
Only 2 patients on second line ART
Collaborators - Thanks!Dr Gregory JeromeDr Wesler Lambert Ministry of Health: Haiti and RwandaClinton FoundationPartners In Health TeamPatientsCommunity health workersStaffWHO