Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care

Abstract

Summaryobjective 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.

A systematic review evaluating the impact of task shifting on access to antiretroviral therapy in sub-Saharan Africa

“…Task shifting to nonphysician clinicians was typically only one of several interventions reported in these studies. Many included separate task shifting to lay workers 15,16 , the use of first line tenofovir 19 and community support 22 . These interventions have also benefited from substantial external funding from NGOs and may not reflect what is feasible within the constraints of a public health system 28 .…”

“…In Thyolo, Malawi, task shifting from doctors to non-physician clinicians (primarily nurses) doubled ART initiation and allowed for universal access by 2009. 15 In Lusikisiki, South Africa, ART initiation by nurses within rural clinics allowed for the doubling of initiation of patients. 16 When this form of task shifting was reversed in 2006, with ART initiation restricted to physicians, ART initiation rates declined.…”

Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi

“…HIV care and ART scale-up were achieved and sustained by decentralising these services 15,16 and, since 2006, increasing numbers of health facilities have also benefi ted from an increase in decentralised laboratory capability for diagnosing TB. By the end of 2009, sputum samples could be examined in seven microscopy sites, and an additional eight sites were able to perform full preparation (smearing and fi xation) of slides for reading.…”

“…The district achieved and sustained universal ART access from 2007 onwards (sustained access for at least 80% of those in need). 15,16 We hypothesised that such a large scale-up and coverage of ART at the population level might have been associated with a decrease in district TB case notifi cations. We thus report on trends in new and recurrent TB case notifi cations at the…”

“…The district achieved and sustained universal ART access from 2007 onwards (sustained access for at least 80% of those in need). 15,16 We hypothesised that such a large scale-up and coverage of ART at the population level might have been associated with a decrease in district TB case notifi cations. We thus report on trends in new and recurrent TB case notifi cations at the For the purposes of this study, new TB cases include individuals starting TB treatment for the fi rst time with pulmonary (smear-positive or -negative) or extra-pulmonary TB (EPTB); recurrent TB includes relapse cases and the 'other' category.…”