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Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care
Author(s) -
Bemelmans Marielle,
Van Den Akker Thomas,
Ford Nathan,
Philips Mit,
Zachariah Rony,
Harries Anthony,
Schouten Erik,
Hermann Katharina,
Mwagomba Beatrice,
Massaquoi Moses
Publication year - 2010
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02649.x
Subject(s) - decentralization , antiretroviral therapy , human immunodeficiency virus (hiv) , medicine , developing country , task (project management) , universal design , political science , family medicine , environmental health , economic growth , viral load , economics , computer science , law , management , world wide web
Summary Objective To describe how district‐wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. Method In mid‐2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587 455) based on decentralization of care to health centres and community sites and task shifting. Results After delegating HIV testing and counseling to lay counsellors, uptake of testing increased from 1300 tests per month in 2003 to 6500 in 2009. Shifting responsibility for antiretroviral therapy (ART) initiations to non‐physician clinicians almost doubled ART enrolment, with a majority of initiations performed in peripheral health centres. By the end 2009, 23 261 people had initiated ART of whom 11 042 received ART care at health‐centre level. By the end of 2007, the universal access targets were achieved, with nearly 9000 patients alive and on ART. The average annual cost for achieving these targets was €2.6 per inhabitant/year. Conclusion The Thyolo programme has demonstrated the feasibility of district‐wide access to ART in a setting with limited resources for health. Expansion and decentralization of HIV/AIDS service‐capacity to the primary care level, combined with task shifting, resulted in increased access to HIV services with good programme outcomes despite staff shortages.