Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study.
BACKGROUND
In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through a vertical "Day Hospital" approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public-sector PHC services.


METHODS
In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district-level management.


CONCLUSIONS
By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow-up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non-HIV aspects of primary health care.


CONCLUSIONS
The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss-to-follow-up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the integration process, HIV resources have been used to rehabilitate PHC infrastructure (including laboratories and pharmacies), strengthen supervision, fill workforce gaps, and improve patient flow between services and facilities in ways that can benefit all programs. Using aid resources to integrate and better link HIV care with existing services can strengthen wider PHC systems.
Pfeiffer
James
J
University of Washington Department of Global Health, Harborview Medical Center, Seattle, 98104, USA. jamespf@u.washington.edu
Montoya
Pablo
P
Baptista
Alberto J
AJ
Karagianis
Marina
M
Pugas
Marilia de Morais
Mde M
Micek
Mark
M
Johnson
Wendy
W
Sherr
Kenneth
K
Gimbel
Sarah
S
Baird
Shelagh
S
Lambdin
Barrot
B
Gloyd
Stephen
S
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D009073:Mozambique; D011320:Primary Health Care
D019380:Anti-HIV Agents