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Multidisciplinary Care Team Delivery of Integrated HIV Services Joan Holloway Vice President, Global Health Initiatives
WHAT IS MULTIDISCIPLINARY CARE? a partnership between health care professionals and other health care workers from different disciplines working together toward a common purpose: improving the quality of and achieving efficiencies in the delivery of care, treatment and support to and for their patients.
I II III • Interdisciplinary training • Multidisciplinary care teams • Rational reallocation of tasks
THE GLOBAL HIV/AIDS CRISIS • 36% of adults and children living with HIV received ART in 2009. • 53% of women who needed PMTCT services received them. • The lack of a well trained health care workforce is a major barrier to scaling up HIV care and treatment.
INTERDISCIPLINARY EDUCATION AND TRAINING • The Commission on the Education of Health Professionals for the 21 st Century calls for competency-driven inter-professional education reform. • PEPFAR’s MEPI and NEPI programs are exploring innovative models of interdisciplinary education. • WHO is developing guidelines on transformative health professional education including an examination of interdisciplinary training models.
TASK SHIFTING TO INCREASE ACCESS TO ART • Task shifting is not “task dumping” • Task shifting is the rational redistribution of tasks among the health care team • Task shifting can strengthen and expand the health workforce to rapidly increase access to HIV and other health services
BUILDING A STRONG AND LASTING RESPONSE
INTEGRATED SERVICE DELIVERY USING MULTIDISCIPLINARY CARE TEAMS • Evidence from studies in the US, Canada, the UK and Australia show that efficiencies can be achieved and patient outcomes and satisfaction improved when professionals from different disciplines work together as multidisciplinary care teams to care for patients. • The PEPFAR Guidance on Prevention of Mother-to. Child Transmission of HIV states that “…integration (of services) may also require service delivery by a multidisciplinary team. ”
CHALLENGES FOR ART DELIVERY • Little to no research has been done in LMI countries to identify successful models of integrated service delivery using multidisciplinary care teams to scale up access to ART • IAS Environmental Scan identifies research into the most effective services delivery models for ART programme delivery and integration with other heath services as the most urgent research priority for addressing barriers to access to ART for women. • Cochran Review concluded “…more research is urgently needed in other settings to allow a definitive conclusion about the effectiveness of integrated …interventions with other health services. ”
IAPAC: STRENGTHENING THE HIV/AIDS HEALTH WORKFORCE Developing and implementing a multidisciplinary care team approach to patient management: • Consultation held in Washington DC to examine existing evidence • Consultation to be held in Ethiopia to identify successful African models • Working with the WHO on treatment optimization and transformative education guidelines
WHAT WE LEARNED The first consultation, held in 2010 with representatives of WHO, PAHO, University of Stellenbosch and PEPFAR identified 7 characteristics of a multidisciplinary approach: • Services should be provided by teams of professionals and other health care workers and be accountable to and governed by the local community • Target unit is the “family” or structure that surrounds or organizes the community • There must be a supportive regulatory and policy environment and training and certification systems need to be in place to support the health workers and allay community concerns
WHAT WE LEARNED, CONT. • Information systems are needed to collect and manage data and foster communication among the workers and the health system • Balance between disease prevention and care and treatment is essential • Quality should be tracked, reported and continuously improved • Pilot programs may use HIV as the entry point but examination of the impact should include other priority health outcomes such as, MCT, viral load, adherence to treatment plans, retention in care and decrease in severity of linked diseases (metabolic, cardiovascular, mental health).
NEXT STEPS Consultation in Africa in 2011 • Identify African models and the characteristics of the models • Explore the policy and regulatory processes in place or in need of change to support MCT • Identify countries willing to participate in pilot MCT models. • Implement and evaluate models
THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE … ADVANCING COMMITMENT, BATTLING COMPLACENCY ~ a non-profit professional medical association of more than 17, 000 HIV/AIDS treating physicians and other health professionals in over 100 countries. Our mission is to expand access to and improve the quality of HIV/AIDS care and treatment. www. IAPAC. ORG