Task-shifting in delivery of HIV care Partners In Health Perspective Louise Ivers MD, MPH Director, HIV Equity Initiative, Partners In Health, Haiti Harvard Medical School

Partners In Health Non-profit organization - healthcare delivery - socioeconomic programs HIV treatment - Within context of primary health care - In collaboration with Ministries of Health - Community-based care

Haiti: PIH/Ministry of Health Rural Central Haiti 9 health centers Doctors, nurses, social workers Lay providers - community health workers - X-ray technician - Laboratory assistants

‘shift in tasks by type’  Largest shift seen in management of patients prior to and after starting ART  Nurses prescribe and manage patients  CHW identify side effects of ART, signs of opportunistic infections  facilitated referrals

Previously -essentially non-functional clinics visits per day on average - Stock outs, absent staff - No ART - HIV testing available in just one stand-alone site (< 40 tests per year) - Severe lack of local doctors / nurses How has this model affected health care? - access, quality

Currently visits per day at each center - 50,000 voluntary HIV tests per year - > 3000 people living with HIV on ART - > 8500 people living with HIV followed

< 2 % total cohort needing 2 nd line ART Despite significant political instability 2004, not a single patient missed ART dose

Not just HIV-care  All primary health care indicators improved  Increase in vaccinations  Catchment area of >500,000 served with primary healthcare  Over 2 million patient-visits 2006

Rwanda: PIH/Clinton Foundation/MOH  2 District Hospitals  6 health centers  Similar model of care  Rural eastern Rwanda

 Over 2500 patients on ART  First cohort 2 years on therapy  Only 2 patients on second line ART

Collaborators - Thanks! Dr Gregory Jerome Dr Wesler Lambert Ministry of Health: Haiti and Rwanda Clinton Foundation Partners In Health Team Patients Community health workers Staff WHO