This case study describes an
integrated chronic care clinic that utilizes a robust HIV program as a platform
for NCD screening and treatment.
A unique model, the integrated chronic care
clinic provides longitudinal care for patients with an array of chronic
diseases including HIV and common NCDs, allowing for a single visit for all of
a patient's conditions. Set in Malawi's remote Neno District, this clinic
structure aims to
- increase access to care for NCD patients,
- maximize efficiency given the severe human resource shortages, and
- replicate strong HIV outcomes for patients with other chronic conditions.
Currently, 6781 patients on antiretroviral therapy and
721 patients with NCDs are benefitting, including 379 with hypertension, 187
with asthma, 144 with epilepsy, and 76 with diabetes. Among the NCD patient
population, 15.1% are HIV-positive. Success hinged largely on several factors,
including clear leadership and staff ownership of their specific duties, and a
well-defined and uniform patient flow process. Furthermore, deliberate and
regular conversations about challenges allowed for constant iteration and
improvement of processes.
Moving forward, several tasks remain. We are refining
the data management process to further consolidate medical records, along with
integrating our tracking processes for clients who miss appointments.
Additionally, we are exploring opportunities for further integration, including
family planning.
A follow-up patient satisfaction survey is planned for the
coming months to track the impact of the clinic's redesign. Given limited human
and financial resources, innovative solutions are required to address the
growing burden of chronic disease in Malawi.
We have found that an integrated,
patient-centered approach maximizes efficiency and reduces barriers to care for
the hardest to reach patients.
Below: Decentralization of the ART clinic, 2013
Full article at: http://goo.gl/M3f4eC
By: Wroe EB1, Kalanga N2, Mailosi B3, Mwalwanda S4, Kachimanga C5, Nyangulu K6, Dunbar E7, Kerr L8, Nazimera L9, Dullie L10.
- 1Brigham & Women's Hospital, Division of Global Health Equity, Boston, MA, USA; Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: ewroe@pih.org.
- 2Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: nkalanga@gmail.com.
- 3Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: brghtmls@gmail.com.
- 4Malawi Ministry of Health, Neno, Malawi. Electronic address: starmwalwanda@gmail.com.
- 5Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: chembekachimanga@yahoo.co.uk.
- 6Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: ksnyangulu@gmail.com.
- 7Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: edunbar@pih.org.
- 8Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: lkerr@pih.org.
- 9Malawi Ministry of Health, Neno, Malawi. Electronic address: lnazimera@gmail.com.
- 10Abwenzi Pa Za Umoyo, Neno, Malawi. Electronic address: ldullie@pih.org.
More at: https://twitter.com/hiv
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