Transcript TASK SHIFTING FOR HIV CARE PROVISION: Current Practices in TASO- Uganda

TASK SHIFTING FOR HIV
CARE PROVISION:
Current Practices in TASOUganda
WHO/ PEPFAR Meeting
Kigali,Rwanda.14th June 2007.
Presenter:Dr.Kenneth Mugisha
OUTLINE OF PRESENTATION
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Introduction
Drivers to Task Shifting in TASO/Uganda
Accreditation and Certification
Field Officers
Community ART Support Agents(CASAs)
Challenges
Conclusion
Introduction
• Over 1million people living with HIV/AIDS
in Uganda.
• An estimated 150,000 PLWHA in urgent
need of ART.
• Only 90,000 PLWHA accessing ART
• “The situation of people living and dying
with AIDS in parts of Africa is so desperate
that even the most basic help will bring
solace and hope.”- Stephen Lewis.
TASK SHIFTING
• Is a promising intervention for
strengthening HIV/AIDS care, treatment
and support services in countries with a
critical shortage of physicians and nurses.
• Refers to 2 processes:
-Shifting tasks from one cadre of health
workers to an existing lower-level; or
- Shifting tasks to a new cadre developed
to meet specific health care goals.
FORMS OF TASK SHIFTING IN
TASO/UGANDA
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Doctor- clinical Officer
Doctor- Nurse
Clinical Officer- Nurse
Nurse- Nursing Aide/Assistant
Nurse- Community Nurse
Field Officers
Community ART Support Agents(CASA)
Community Volunteers/Expert Clients/CATTS
DRIVERS TO TASK SHIFTING IN
TASO/UGANDA
• Critical Shortage of trained health workers
• Poor remuneration of health workers- brain drain
• Most health workers are based in urban
areas(>85%).
• The Need to extend HIV/AIDS care services to
rural communities.
• Greater Involvement of PLWHA
• Desire to Explore Community Based HIV/AIDS
care models.
Accreditation & Certification
• Historically,TASO has used lay persons to
offer care and support to PLHA after
undergoing counselor training.
• Accreditation and Certification takes a long
time.
• M.O.H.,has allowed practice to precede
policy; permitting innovation &
experimenting
SCOT(M.O.H./TASO/CDC/Partners)
• “Strengthening HIV/AIDS Counselor
Training in Uganda”.
• Develop and Standardize Counselor
training curricula.
• Furthering the process of Accreditation of
HIV counseling courses.
• Sponsorship for advanced counseling
courses
• Upgrading HIV/AIDS counselor training
institutions.
PATRAP
• “Partnership of HIV/AIDS Training
Providers”
• Collaborative effort of MOH/HIV Training
providing institutions.
• Addressing standardization of HIV/AIDS
training curricula for Medical personnel
• Further the process of Accreditation&
Certification.
Field Officer on visit to a client’s home
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Individual
Counseling
session at
home
FIELD OFFICERS’ ROLES
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Lay providers
Home-based delivery of ARV refills
Monitoring Adherence to ART
Home-based HIV counseling&
testing(HBHCT)
• Counseling &Conducting home visits
Finger stick rapid HIV test at home
F.O. Roles….
• Monitoring patients on ARTweight,temperature,Anaemia,Jaundice etc.
• Detection of ARV-related side effects
• Appropriate referral of clients that require
further management
• Hygiene, sanitation and nutrition education
• Home-based care education for
households-Prevention
• Data collection for operational research.
A Follow up visit of a client on
ART by a Field Officer
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A clinician supports FO home visit
F.O. Training Curriculum
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Comprehensive HIV/AIDS Care Course:
Principles and Practices of ART (1 Week)
Basic Clinical Care Skills (1 Week)
Basic Counseling Skills (2weeks)
Home-Based HIV counseling &TestingHBHCT(1 Week)
• Community Mobilization &Field Practicum
• Motor Cycle Riding Skills(UPF)
Household census update before HBHCT
Finger stick HIV rapid testing at home
Quality
assurance for
home based
HIV testing in a
TASO
laboratory
Counseling a TASO client’s spouse at home
Community ART Support
Agents(CASA)-Selection
• Should be a coping client on ART
• Demonstrated interest and commitment
• Responsible, of good repute, caring and
willing to volunteer
• Chosen by the community
• Able to read and write
• Has stayed in that community for not less
than 2 years
• Gender sensitivity, depending on clientele
Community ART Support
Agents(CASA)-Roles
• Monitoring adherence through pill counts
and self reports
• Monitor drug tolerance and reactions by
checking for common signs and
symptoms
• Monitor use of the basic care kit
• Mobilize clients to attend drug distribution
points &Sensitize families about HBHCT
Collection of dry blood spots for QA
CASA Roles….
• Report emergencies to TASO
• Making appropriate referrals
• Sharing information and experiences with
peers
• Participate in health education activities at
the drug distribution points
• Adherence counseling
Prevention with Positives Coordinator during
one of the client supportive follow-up visits.
Training for CASA
• CASA training curriculum covers:
-Basic Information on ART
-Basic knowledge and Skills in peer
education
-Basic Counseling skills
-Community ART model & Referral
networks
Facilitation For CASA
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Bicycle for transport
T- shirts for recognition & advocacy
Umbrella/Rain coat
Gumboots
A file with notes for reference
Box File for record keeping
Regular supply of condoms for distribution
Home based HIV testing - ICOBI
CHALLENGES
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High expectations from the task shifting trainees
Exodus of trained task shifting staff
Increased demand for HIV testing services
High levels of Discordance- 40%
Difficulties of Task shifting for Paediatric practice
Task shifting hard with HIV Resistance /
Complicated OI
• Monitoring of patients not easy
• Child counseling needs
• Household Poverty
A grandmother with many orphans before HBHCT
ACKNOWLEDGEMENT
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Ministry of Health, Uganda.
CDC/PEPFAR for the funding
ICOBI
Our Partners in HIV/AIDS Care
WHO
Dr.Alex Coutinho-TASO.
Conclusion
• “Issues of war are too huge to be left to
Generals alone”.-Napoleon Bonaparte.
• Task shifting can only succeed with
appropriate training, Close supervision for
quality assurance; and favorable HRM
practices.
• Even the most basic help, can bring
solace and hope.
FOR YOUR KIND
ATTENTION
I THANK YOU.