|
5th International AIDS Society Conference on HIV Pathogenesis and TreatmentCape Town - July 19 - 22, 2009 |
NURSE-DRIVEN, COMMUNITY-SUPPORTED HIV/AIDS CARE AND TREATMENT: 2 YEAR ANTIRETROVIRAL TREATMENT OUTCOMES FROM A PRIMARY CARE LEVEL PROGRAMME IN RURAL LESOTHO
IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOAD102
R. Cohen1, S. Lynch1, H. Bygrave1, N. Vlahakis1, L. Makakole2, N. Ford3, E. Goemaere4
1Médecins Sans Frontières, Morija, Lesotho, 2Scott Hospital, Morija, Lesotho, 3Médecins Sans Frontières, Johannesburg, South Africa, 4Médecins Sans Frontières, 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.
Download PDF of this abstract.
2009-07-22
MOAD102
Oral Abstract Session MOAD1 - Innovative Methods for Effectively Delivering HIV Care Interventions
Copyright © 2009 - International AIDS Society (IAS). All information and content relating to the abstracts from the 5th International AIDS Society Conference on HIV Pathogenesis and Treatment, such as text, graphics, logos, button icons, images, audio clips, and software is protected by copyright. Permission is hereby granted for the non-commercial use or reproduction of the information on this web site, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from the Elton John AIDS Foundation, National Library of Medicine, AIDS Walk of Orange County, and donations from users like you. Always watch for outdated information. This article first appeared in 2009. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2009. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. Permission is hereby granted for the non-commercial use or reproduction of the information herein, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.