TASK SHIFTING for Rapid Scale up of Treatment of HIV/AIDS

 

Problem: 

 Treatment and counseling of HIV positives were limited to doctors and nurses respectively in Ethiopia. In addition, the entire HIV/AIDS intervention package was only limited to prevention until 2005. As a result, twenty five years after the identification of the first HIV case in Ethiopia, HIV/AIDS programs had focused on prevention without treatment with unsatisfactory results. Meanwhile, over a million known HIV positives were left alone with limited or no care and support. Daily deaths were uncountable thousands of children were orphaned. Introducing treatment at lower level of health facilities using non-medical doctors remained to be unaccepted solution to the problem by the Ministry of health due to fear of the spread of resistant strains as a result of high lost to follow up.  In 2005, only few selected government hospitals were accredited to provide free ARV services. It took only few months for those hospitals to be overcrowded and halt all other services, including acute and infectious cases and delivers   Even then not more than 10% of all AIDS cases got access to these hospitals from the nearby localities.

Intervention: 

 The Ministry of Health of Ethiopia had no option left but scale up the treatment program to health centers fully supported by USAID/E. The Ministry’s concern of spreading resistant HIV strains, and high lost to follow up cases as a result of task shifting from doctors to mid-level health workers and from hospitals to healthy centers was addressed distinctly with USAID support by developing several monitoring tools and providing appropriate and close mentoring support. The intervention required identifying selected government owned health centers, supplying them with basic furniture, appropriate Health Management Information System (HMIS) materials, organizing short term trainings, assigning data clerks and case managers, and continuous regular mentoring.

 

Results: 

 In as early as second year of the start up of the  HIV/AIDS Prevention Care and Support Program, that focused on task shifting, significant results were observed as demonstrated by the immediate relieve of hospital beds and enrollment of thousands of HIV /AIDS cases in the health centers. The number of AIDS cases on treatment grew from less than 10,000 in 2007 to over 80,000 in 2011. The number of health centers providing AIDS treatment grew from 125 to over 300. In addition, over 250 other health centers were fully equipped to provide chronic care to more than 200,000 HIV positive individuals that were not eligible for treatment based on CD4 count or clinical staging. Over 80% of those enrolled in HC treatment programs were alive 12months after they start treatment. Deaths were significantly averted. Thousands of children who otherwise could have been orphaned were saved; infected and affected families remain intact; prevention was reinforced. Life of those infected and affected became meaningful. Bright light at the end of the tunnel became more visible.

 

Lessons: 

 In theory, the spread of drug resistant viruses were a serious concern of the Ministry as a result of task shifting.  The findings, however, indicated less number of lost to follow up patients in health centers as compared to hospitals and informally it was observed fact that patients who default from treatment tend to die faster than those that are on treatment or even faster than those who did not start treatment at all. It is quite a lesson that in any medical emergency, task shifting is a reliable alternative in resource limited countries like Ethiopia. This system will benefit not only HIV/AIDS programs but also all other medical emergencies that could possibly appear in the years to come.

 

Report Author(s): 
Haile Wubneh
Organization(s): 
Management Sciences for Health
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