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National Survey of the Impact of Rapid Scale-up of Antiretroviral Therapy on Health Care Workers in Malawi

National Survey of the Impact of Rapid Scale-up of Antiretroviral Therapy on Health Care Workers in Malawi. Effects on Human Resources and Survival. MoH HIV Unit and Partners Presenting Author Hannock Tweya , M&E Officer Lighthouse (accepted as paper in Bulletin of the WHO). Introduction.

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National Survey of the Impact of Rapid Scale-up of Antiretroviral Therapy on Health Care Workers in Malawi

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  1. National Survey of the Impact of Rapid Scale-up of Antiretroviral Therapy on Health Care Workers in Malawi Effects on Human Resources and Survival MoH HIV Unit and Partners Presenting Author Hannock Tweya, M&E Officer Lighthouse (accepted as paper in Bulletin of the WHO)

  2. Introduction • Health care workers (HCW) crisis in Africa, including Malawi • HCW are needed to deliver ART • weakening of other health services? • HIV continues to kill HCWs • ART helps HCW to survive and work longer • What is the balance of the effects?

  3. Objectives National survey during routine quarterly ART supervision • HCW-time used to deliver ART • number of HCW accessing ART and their outcomes

  4. Data Collection • Data collected • Total staff working at facilities with ARV clinics • HCW-time needed to run ARV clinics • Total of HCWs who ever accessed ART • HCW Survival on ART

  5. Results: Allocation of HCW to ART a this assumes 230 days worked by each staff member per year

  6. Results: Allocation of HCW to ART a this assumes 230 days worked by each staff member per year 1,000 HCW-days / week are needed to run all public ARV clinics in Malawi

  7. HCW Accessing ART 1,024 HCW ever accessed ART (June 2006) • Alive on ART: 793 78% • Dead: 119 12% • Stop ART: 5 1% • Transfer out: 65 6% • Lost to follow-up: 40 4% • TB common stage defining condition (18%)

  8. Kaplan-Meier Estimates for Retention of Healthcare Workers in ART Program n = 1,022 875 person-years of observation 100% 75% proportion of HCWs retained alive on ART 50% 25% 0% 0 6 12 18 24 months since ART initiation

  9. Kaplan-Meier Estimates for Retention of Healthcare Workers in ART Program n = 1,022 875 person-years of observation 100% 75% proportion of HCWs retained alive on ART 50% 25% 0% 0 6 12 18 24 months since ART initiation Survival Probability • 85% at 6 months • 81% at 12 months • 78% at 18 months

  10. Impact of ART on HCW Survival • 12-month mortality compared to patients without ART • WHO Stage 3 or 4: 70% reduction • WHO Stage 1 or 2: No significant reduction • Analysis of survival impact stratified by clinical stage at ART initiation • 12 months after ART initiation: • 257 HCW-lives saved

  11. Impact of ART on HCW Survival • 12-month mortality compared to patients without ART • WHO Stage 3 or 4: 70% reduction • WHO Stage 1 or 2: No significant reduction • Analysis of survival impact stratified by clinical stage at ART initiation • 12 months after ART initiation: • 257 HCW-lives saved • 1,000 HCW-workdays / week saved (combined workforce)

  12. Discussion/Conclusion • HCWs needed to run ART = HCW lives saved by ART • Higher proportion of HCW accessing ART than general population • 5.7% of all clinicians in Malawi have accessed ART • 8.3% of all nurses in Malawi have accessed ART • 1% of all adults in Malawi have accessed ART • Better survival and retention on ART than general ARV patients • more HCW start ART early

  13. Recommendations • Continued scale-up may shift the balance • Draw of HCW into ART delivery may increasingly compromise other health services • Need to use less skilled staff to deliver ART

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