title: Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care.
abstract: Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by 1 hospital and 12 clinics, Médecins Sans Frontières has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals-which seriously limits access for many people, if not the majority of people-1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement.
authors.affiliation: Médecins Sans Frontières, Lusikisiki, South Africa.
authors.forename: Martha
authors.initials: M
authors.lastname: Bedelu
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Katherine
authors.initials: K
authors.lastname: Hilderbrand
authors.forename: Hermann
authors.initials: H
authors.lastname: Reuter
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000600:supply & distribution; D015658:HIV Infections / Q000188:drug therapy*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D011057:Politics; D011320:Primary Health Care; D012424:Rural Population; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents