Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care
Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care
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DOI：
10.1111/j.1365-3156.2010.02649.x
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发表时间：
2010-12-01
影响因子：
3.3
通讯作者：
Massaquoi, Moses
中科院分区：
文献类型：
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作者：
Bemelmans, Marielle;van den Akker, Thomas;Massaquoi, Moses
方法2003年年中，卫生部和无国界医生组织为Thyolo区（人口587 455）开发了一种护理模式，将护理工作分散到保健中心和社区站点，并将任务转移。结果将艾滋病毒检测和咨询委托给非专业咨询人员后，接受检测的人数从2003年的每月1300例增加到2009年的每月6500例。将开始抗逆转录病毒治疗（ART）的责任转移给非医师临床医生几乎使抗逆转录病毒治疗的登记人数增加了一倍，其中大多数开始在外围卫生中心进行。截至2009年底，已有23 261人开始接受抗逆转录病毒治疗，其中11 042人在保健中心一级接受了抗逆转录病毒治疗。到2007年底，实现了普遍可及的目标，有近9000名患者存活并接受抗逆转录病毒治疗。实现这些目标的平均年费用为每位居民每年2.6英镑。结论：Thyolo规划表明，在卫生资源有限的情况下，在全区范围内获得抗逆转录病毒治疗是可行的。将线索/艾滋病服务能力扩大和下放到初级保健一级，再加上任务转移，尽管工作人员短缺，但艾滋病毒服务的获得机会增加，方案取得了良好成果。
OBIECTVE 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 Medecims Sans Frontieres 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 (sic)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 HINT/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.