title: Keeping health staff healthy: evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi.
abstract: BACKGROUND
  In Malawi, the dramatic shortage of human resources for health is negatively impacted by HIV-related morbidity and mortality among health workers and their relatives. Many staff find it difficult to access HIV care through regular channels due to fear of stigma and discrimination. In 2006, two workplace initiatives were implemented in Thyolo District: a clinic at the district hospital dedicated to all district health staff and their first-degree relatives, providing medical services, including HIV care; and a support group for HIV-positive staff.
  
  
  METHODS
  Using routine programme data, we evaluated the following outcomes up to the end of 2009: uptake and outcome of HIV testing and counselling among health staff and their dependents; uptake and outcomes of antiretroviral therapy (ART) among health staff; and membership and activities of the support group. In addition, we included information from staff interviews and a job satisfaction survey to describe health workers' opinions of the initiatives.
  
  
  RESULTS
  Almost two-thirds (91 of 144, 63%) of health workers and their dependents undergoing HIV testing and counselling at the staff clinic tested HIV positive. Sixty-four health workers had accessed ART through the staff clinic, approximately the number of health workers estimated to be in need of ART. Of these, 60 had joined the support group. Cumulative ART outcomes were satisfactory, with more than 90% alive on treatment as of June 2009 (the end of the study observation period). The availability, confidentiality and quality of care in the staff clinic were considered adequate by beneficiaries.
  
  
  CONCLUSIONS
  Staff clinic and support group services successfully provided care and support to HIV-positive health workers. Similar initiatives should be considered in other settings with a high HIV prevalence.
authors.affiliation: Médecins Sans Frontières, Belgium, Thyolo, Malawi. mariellebemelmans@hotmail.com
authors.forename: Marielle
authors.initials: M
authors.lastname: Bemelmans
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Akker
authors.forename: Olesi
authors.initials: O
authors.lastname: Pasulani
authors.forename: Nabila Saddiq
authors.initials: NS
authors.lastname: Tayub
authors.forename: Katharina
authors.initials: K
authors.lastname: Hermann
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.forename: Winnie
authors.initials: W
authors.lastname: Jalasi
authors.forename: Harriet
authors.initials: H
authors.lastname: Chiomba
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Mit
authors.initials: M
authors.lastname: Philips
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D016273:Occupational Exposure / Q000517:prevention & control*; D017132:Workplace; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents