Abstract
BackgroundMalawi 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.Methods and FindingsRetrospective 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/SignificanceOutcomes 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.
Highlights
In sub-Saharan Africa, the profound lack of human resources for health (HRH) is a major barrier to the scale-up of universal antiretroviral therapy (ART) coverage [1,2]
Between Jan 1st, 2007 and December 31st, 2008, a total of 306 patients had been initiated on ART at the Health Care Workers (HCW) HIV clinic and 6784 at the general HIV clinic
When reviewing the occupation of all ART patients initiated at the HCW HIV clinic, only 150/306 of the patients were recorded as HCW
Summary
In sub-Saharan Africa, the profound lack of human resources for health (HRH) is a major barrier to the scale-up of universal antiretroviral therapy (ART) coverage [1,2]. In Malawi, both the ‘‘brain drain’’ of professional health care workers (HCW) to foreign countries and the considerable number of staff who have complications of HIV-related disease are major contributors to the HRH crisis [3]. A 2007 survey in Malawi demonstrated that where HIV services have been accessed by HCW through public sector scale-up of ART, the outcomes have been good, with an estimated 250 HCW lives saved nationally, 12 months after ART initiation [7]. While there is some grey literature and case reports describing HCW initiatives in high HIV prevalence settings [8,9,10,11,12], very little has been published looking at outcomes of targeted clinics or programs that aim to increase HCW access to HIV related services. This study evaluates outcomes of a dedicated HCW HIV clinic in Malawi, created at Zomba Central Hospital in January 2007
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