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

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