|
Nurse-driven, community-supported HIV/AIDS care and treatment: 2 year antiretroviral treatment outcomes from a primary care level programme in rural Lesotho
Presented by Lipontso Makakole (Lesotho).
R. Cohen1, S. Lynch1, H. Bygrave1, N. Vlahakis1, L. Makakole2, N. Ford3, E. Goemaere4
1Medecins Sans Frontieres, Morija, Lesotho, 2Scott Hospital, Morija, Lesotho, 3Medecins Sans Frontieres, Johannesburg, South Africa, 4Medecins Sans Frontieres, Cape Town, South Africa
Background: Lesotho has the third highest adult HIV prevalence in the world (23.2%), which claims 18,000 lives each year. With just 5 doctors and 62 nurses per 100,000 population, the country faces a crisis in human resources for health. In 2006, Médecins Sans Frontières and the Ministry of Health and Social Welfare launched a joint pilot programme in Scott catchment area (population: 200,000) covering 14 clinics and one district hospital. Several important innovations were piloted. Nurses were empowered to assume high levels of clinical responsibility (including ART initiation), supported by lay counsellors who provided essential support for HIV services. Clinical innovations included early piloting of early initiation of ART (< 350 cells/mm3), including tenofovir-based first-line therapy. We describe two-year outcomes of this decentralized HIV/AIDS treatment programme.
Methods: Retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008.
Results: Overall, 11,367 people were enroled in HIV care (5% children), and 4,347 were initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children. The proportion of adults arriving sick (CD4 < 50 cells/mm3) decreased from 27% in 2006 to 13% in 2008. 12=month outcomes are highly satisfactory in terms of mortality (9.3% adults; 5% for children) and loss to follow-up (2.5% of adults and 2% of children). At 24 months, 80% of adults remained in care.
Conclusions: The two-year outcomes of this nurse-driven, community-supported programme provide further evidence that HIV/AIDS care and treatment can be provided effectively at health centres, to the benefit of primary health care services. The programme validates several critical areas for task-shifting that are being considered by other countries in the region, including nurse-initiated and managed ART for adults and children, and lay counsellor-supported testing, adherence, and case management.
|