Task-shifting in delivery of HIV care

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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

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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

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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

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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

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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 (lt 40 tests per year)
• Severe lack of local doctors / nurses

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

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lt 2 total cohort needing 2nd line ART
Despite significant political instability 2004,
not a single patient missed ART dose
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Not just HIV-care

• All primary health care indicators improved
• Increase in vaccinations
• Catchment area of gt500,000 served with primary
  healthcare
• Over 2 million patient-visits 2006

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Rwanda PIH/Clinton Foundation/MOH

• 2 District Hospitals
• 6 health centers
• Similar model of care
• Rural eastern Rwanda

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

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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