At the 2017 Community Health Worker Symposium in Kamapala, Uganda, Andrew McKenzie presented on Increasing Access to Chronic HIV Care: The Value of CHWs in Models of Differentiated Care.
From 2004, HIV positive patients were officially started on ART in Cape Town, South Africa. Health facilities in high prevalence areas quickly became overburdened with HIV positive patients. This led to congestion, concerns about poor quality of care and patients being lost to follow up. In response, differentiated care options were developed, including Adherence Clubs. These provided ART support to groups of approximately 30 stable patients who would meet every 8 weeks and were managed by either facility-based or community-based community health workers (CHWs). By the end of March 2016, approximately 32% of 142,000 ART patients in Cape Town were in clubs. The combined study showed that CHWs can provide high quality care more effectively for chronic stable HIV+ve patients.
An epidemiological analysis focussing on retention-in-care (RIC) and viral load (VL) suppression was conducted to check the quality of care in the CHW-managed adherence clubs. A qualitative study focused on factors influencing implementation of this model. Management, staff and clients in a sample of 15 clinics were interviewed and observed.
The quantitative results from a sample of 3,216 patients showed comparable RIC (over 90%) and VL suppression (95%) for patients in clubs compared to those managed by nurses and doctors. The task-shifting to CHWs enabled quicker through-put of stable patients through the club system while an acceptable quality of care was maintained. The qualitative study identified several innovations that have contributed to this success including: mobile messaging within club groups and for tracing of poorly adherent patients, information systems, and decentralised pre-packaged drug distribution mechanisms.
Task-shifting to CHWs has enabled a differentiated care model that allows stable HIV positive people to receive quicker and more efficient routine management in clinic and community settings. Lessons have already been transferred to programmes for care of other chronic conditions.
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