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

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 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’

  • 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


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


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 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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