title: Outcome assessment of a dedicated HIV positive health care worker clinic at a central hospital in Malawi: a retrospective observational study.
abstract: BACKGROUND
  Malawi has one of the world's lowest densities of Health Care Workers (HCW) per capita. This study evaluates outcomes of a dedicated HCW HIV clinic in Malawi, created at Zomba Central Hospital in January 2007.
  
  
  RESULTS
  Retrospective cohort data was analyzed comparing HCW clinic patient baseline characteristics and treatment outcomes at 18 months after inception, against those attending the general HIV clinic. In-depth interviews and focus group discussions were conducted to explore perceptions of patients and caregivers regarding program value, level of awareness and barriers for uptake amongst HCW. 306 patients were enrolled on antiretroviral therapy (ART) in the HCW HIV clinic, 6784 in the general clinic. Significantly (p<0.01) more HCW clients were initiated on ART on the basis of CD4 as opposed to WHO Stage 3/4 (36% vs.23%). Significantly fewer HCW clients defaulted (6% vs.17%), and died (4% vs.12%). The dedicated HCW HIV clinic was perceived as important and convenient in terms of reduced waiting times, and prompt and high quality care. Improved confidentiality was an appreciated quality of the HCW clinic however barriers included fear of being recognized.
  
  
  CONCLUSIONS
  Outcomes at the HCW clinic appear better compared to the general HIV clinic. The strategy of dedicated clinics to care for health providers is a means of HIV impact mitigation within human resource constrained health systems in high prevalence settings.
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.forename: Moses
authors.initials: M
authors.lastname: Kumwenda
authors.forename: Lucy
authors.initials: L
authors.lastname: Gawa
authors.forename: Alice
authors.initials: A
authors.lastname: Kadzanja
authors.forename: Austin
authors.initials: A
authors.lastname: Mnthambala
authors.forename: Marion
authors.initials: M
authors.lastname: Kambanji
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006678:HIV / Q000276:immunology* / Q000472:pathogenicity*; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D006679:HIV Seropositivity; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D016730:Program Development; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult