Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care.
OBJECTIVE
To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi.


METHODS
In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587, 455) based on decentralization of care to health centres and community sites and task shifting.


RESULTS
After delegating HIV testing and counseling to lay counsellors, uptake of testing increased from 1300 tests per month in 2003 to 6500 in 2009. Shifting responsibility for antiretroviral therapy (ART) initiations to non-physician clinicians almost doubled ART enrollment, with a majority of initiations performed in peripheral health centres. By the end 2009, 23, 261 people had initiated ART of whom 11, 042 received ART care at health-centre level. By the end of 2007, the universal access targets were achieved, with nearly 9000 patients alive and on ART. The average annual cost for achieving these targets was € 2.6 per inhabitant/year.


CONCLUSIONS
The Thyolo programme has demonstrated the feasibility of district-wide access to ART in a setting with limited resources for health. Expansion and decentralization of HIV/AIDS service-capacity to the primary care level, combined with task shifting, resulted in increased access to HIV services with good programme outcomes despite staff shortages.
Médecins Sans Frontières, Blantyre, Malawi. mariellebemelmans@hotmail.com
Marielle
M
Bemelmans
Thomas
T
van den Akker
Nathan
N
Ford
Mit
M
Philips
Rony
R
Zachariah
Anthony
A
Harries
Erik
E
Schouten
Katharina
K
Hermann
Beatrice
B
Mwagomba
Moses
M
Massaquoi
D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D017598:Efficiency, Organizational; D005240:Feasibility Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006268:Health Facilities; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008295:Malawi; D008507:Medically Underserved Area; D000078329:Workforce
D019380:Anti-HIV Agents