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. Partners In Health. Non-profit organization - healthcare delivery - socioeconomic programs

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Task-shifting in delivery of HIV care

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Task shifting in delivery of hiv care

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

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 health

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


Shift in tasks by type

‘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


Task shifting in delivery of hiv care

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 (< 40 tests per year)

  • Severe lack of local doctors / nurses


Task shifting in delivery of hiv care

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


Task shifting in delivery of hiv care

< 2 % total cohort needing 2nd line ART

Despite significant political instability 2004, not a single patient missed ART dose


Not just hiv care

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

Rwanda: PIH/Clinton Foundation/MOH

  • 2 District Hospitals

  • 6 health centers

  • Similar model of care

  • Rural eastern Rwanda


Task shifting in delivery of hiv care

  • Over 2500 patients on ART

  • First cohort 2 years on therapy

  • Only 2 patients on second line ART


Collaborators thanks

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


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