B1. SCALING UP ACCESS TO ARV THROUGH A COMPREHENSIVE, COMMUNITY BASED APPROACH IN THYOLO, MALAWI
Labana S., Bwirire D, Teck R, Fitzgerald M (Médecins Sans Frontières Luxembourg, Thyolo)
Community home-based care (CHBC) has become a very popular model of managing HIV/AIDS patients, orphans and vulnerable children in developing countries. Health professionals and community members are accustomed to taking care of chronically ill at home using locally available resources. With the HIV/AIDS pandemic, however the scope of this practice has expanded tremendously. The aim of this study is to describe the community based approach to anti retro-viral (ART) in Thyolo District.
Voluntary, counselling and testing (VCT) centers were set up in the district in 2001 both at hospital and health facility level. A comprehensive approach for the patient was developed which included initial access to VCT as well as a follow up integrated care package if the patient was living with HIV/ AIDS or chronically ill. Community based volunteers are recruited and trained to deliver a range of services which include: social and psychological support, management of opportunistic infections and prophylaxis, timely referral system, preparation of eligible patients for ART initiation, support for ART adherence, palliative care and community mobilization for support to orphans and vulnerable children.
From 2001-4 a total of 465 CHBC volunteers were recruited, supervised by nine CHBC Nurses. A total of 5,106 HIV/AIDS patients received care and support from the volunteers, almost all (99.5%) referred from VCT. Forty three per cent of the adults were on ARV treatment based on WHO clinical staging, backed by the CD4 count. Over half of all patients (54%) patients were started on ARV in Thyolo District Hospital. Cumulative figures to the end of 2004 indicate that 95% of those initiated on ARV are alive, 4% have died, 0.1% defaulted and 0.8% has stopped for medical reasons.
Preliminary results show that CHBC is a key strategy not only to select and prepare patients eligible for ARV but also to follow up and support people at home.