Community support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi

Abstract

CitationCommunity support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi. This article was originally published in a journal published by Elsevier, and the attached copy is provided by Elsevier for the author's benefit and for the benefit of the author's institution, for non-commercial research and educational use including without limitation use in instruction at your institution, sending it to specific colleagues that you know, and providing a copy to your institution's administrator. Summary A study was carried in a rural district in Malawi among HIV-positive individuals placed on antiretroviral treatment (ART) in order to verify if community support influences ART outcomes. Standardized ART outcomes in areas of the district with and without community support were compared. Between April 2003 (when ART was started) and December 2004 a total of 1634 individuals had been placed on ART. Eight hundred and ninety-five (55%) individuals were offered community support, while 739 received no such support. For all patients placed on ART with and without community support, those who were alive and continuing ART were 96 and 76%, respectively (P < 0.001); death was 3.5 and 15.5% (P < 0.001); loss to follow-up was 0.1 and 5.2% (P < 0.001); and stopped ART was 0.8 and 3.3% (P < 0.001). The relative risks (with 95% CI) for alive and on ART [1.26 (1.21-1.32)], death [0.22 (0.15-0.33)], loss to followup [0.02 (0-0.12)] and stopped ART [0.23 (0.08-0.54)] were all significantly better in those offered community support (P < 0.001). Community support is associated with a considerably lower death rate and better overall ART outcomes. The community might be an unrecognized and largely 'unexploited resource' that could play an important contributory role in countries desperately trying to scale up ART with limited resources. All other uses, reproduction and distribution, including without

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

“…8 Communities can also contribute in a comprehensive manner to ART delivery as seen in Malawi (Table 3). 23,24 Community workers also have a positive influence on health-seeking behaviour among people with HIV/AIDS, help to reduce stigma and discrimination 24,25 and often play a critical role in adherence support. 26 People with HIV/AIDS have also been effectively mobilized as partners in the provision of care.…”

“…Evidence from Lusisiki in South Africa and Thyolo in Malawi showed that the use of nurses (Type II task shifting) 19 and community cadres (Type IV task shifting) 24 in the delivery of ART significantly improved overall ART outcomes (Table 4). Thus, from a public health perspective, the use of task shifting for HIV/AIDS care at two relatively new levels of the health system (health centres and the community) did not compromise quality but, on the contrary, was associated with significantly better ART outcomes.…”

“…36 In Malawi, Lesotho and Lusikisiki MSF provided theoretical and practical training for nurses, introduced tools adapted for nurses and provided on-site clinical mentoring, with good associated patient outcomes. 8,19,24 Accreditation of individuals and sites is one way to ensure that health workers have the necessary skills and capacity for specific interventions and that these are maintained over time. If standards are not met accreditation should be suspended or removed, as is practiced in Malawi for the delivery of ART.…”

“…24,50,51 Some countries in sub-Saharan Africa, facing serious shortages of human resources in the health sector and high HIV prevalence, have introduced remunerated HIVdedicated lay cadres. In Malawi the health surveillance assistant is a community cadre that has been fully integrated within the national system of service delivery and receives payment from government.…”

Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

“…A possible way forward might be to offer group counselling sessions for WHO stages 1 and 2 patients in the community and at the GOPD through task-shifting to existing people living with HIV/AIDS (PLWA) groups, community volunteers and expert patients. [11][12][13][14] If these services were to be offered, there is a higher probability that continued followup visits would take place.…”