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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care
Tropical Medicine and International Health, Volume 15, No. 12, Year 2010
Notification
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Description
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. © 2010 Blackwell Publishing Ltd.
Authors & Co-Authors
Bemelmans, Marielle
Switzerland, Geneva
Medecins Sans Frontieres
van den Akker, Thomas
Switzerland, Geneva
Medecins Sans Frontieres
Ford, Nathan P.
Switzerland, Geneva
Medecins Sans Frontieres
South Africa, Cape Town
University of Cape Town
Philips, Mit P.
Belgium, Brussels
Medecins Sans Frontieres, Brussels
Zachariah, Rony R.Z.
Belgium, Brussels
Medecins Sans Frontieres, Brussels
Harries, Anthony David
France, Paris
International Union Against Tuberculosis and Lung Disease
Schouten, Erik J.
Malawi, Lilongwe
Ministry of Health Malawai
Hermann, Katharina
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Matanje-Mwagomba, Beatrice L.
Malawi, Blantyre, Southern Region
District Health Office
Massaquoi, Moses B.F.
Switzerland, Geneva
Medecins Sans Frontieres
Statistics
Citations: 177
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1111/j.1365-3156.2010.02649.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Malawi