Ahoua, Laurence

Chazel, E

Goossens, S

Harries, A D

Jeannin, A

Kabwinja, A

Kamoto, K

Kukasha, W

Le Paih, M

McGuire, M

Mpunga, J

Munger, A

Szumilin, Elisabeth

English

MSF Field Research

XVII INTERNATIONAL
AIDS CONFERENCE
3-8 August 2008 | Mexico City
Poster Exhibition 
Track B - Health Systems and Delivery of ART II  
 
WEPE0106 - Nurses and medical assistants taking charge: task-shifting HIV care and HAART initiation in 
resource-constrained and rural Malawi  
 
M. McGuire1, S. Goossens1, W. Kukasha1, L. Ahoua2, M. Le Paih1, A. Munger1, A. Kabwinja1, J. Mpunga3, E. Chazel4, 
A. Jeannin4, E. Szumilin4, K. Kamoto5, A.D. Harries5 
  
1Médecins Sans Frontières, Chiradzulu, Malawi, 2Epicentre, Paris, France, 3Ministry of Health, Chiradzulu, Malawi, 
4Médecins Sans Frontières, Paris, France, 5Ministry of Health, HIV Unit, Lilongwe, Malawi 
  
Background: Persistent healthcare worker shortages pose the greatest impediment to access to HAART and the scale-up 
of HIV services in resource poor settings. Malawi has one of the largest HIV-related health burdens in the world, with only 
2 doctors per 100,000 people and an estimated 280,000 people in urgent need of treatment. In response, Médecins 
Sans Frontières, in collaboration with the Malawian Ministry of Health developed a task-shifting model, transferring 
HAART-naive patient HAART initiation from Clinical Officers (COs) to Nurses/Medical Assistants (N/MAs) in rural health centers.  
Methods: Data were analyzed on a sub-cohort of adult patients with symptomatic AIDS or CD4 count <250 cells/mm3. 
Patient ARV initiation indicators were compared, N/MAs-model versus COs; complicated patients, under-15, 
pregnant, diagnosed with Tuberculosis or Kaposi Sarcoma, were excluded for comparability. Data were extracted from 
the FUCHIA monitoring system (Epicentre-Paris).  
Results: Between May and December 2007, 1676 HAART-naive uncomplicated patients were initiated; 422 (25.2%) were by 
N/MAs. The mean age was 37.5; median time from enrollment to initiation was 21.5 days (IQR: 14-28) with N/MAs and 
35 days (IQR: 27-147) with COs. At initiation, 40% of patients by N/MAs and COs were WHO Stage III/IV; the median 
CD4 count was 146 cells/mm3 (IQR: 88-201) for N/MAs and 175 cells/mm3 (IQR: 104-219) for COs. Of the 275 
patients followed by N/MAs and 857 by COs for more than three months, 88% and 87% are still active. There was 
not significant difference between the outcomes of patients initiated by either group.  
Conclusions: This preliminary review of Nurse/MA initiation of HAART in AIDS adult patients suggested that trained 
Nurses/MA’s are capable of assessing and determining treatment appropriateness and sustaining follow-up compared to 
those achieved by COs. Additional operational research is needed to demonstrate that nurses/MA’s can perform as 
safe, responsible, and suitable HIV/AIDS treatment and care than practitioners in resource-constrained settings.    
Presenting author email: msff-blantyre-epi@paris.msf.org 

Nurses and medical assistants taking charge: task-shifting HIV care and HAART initiation in resource-constrained and rural Malawi

Nurses and medical assistants taking charge: task-shifting HIV care and HAART initiation in resource-constrained and rural Malawi

Abstract

Similar works

Full text

Available Versions

MSF Field Research