Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #120214

Mark A. Micek, MD, MPH¹, Kenneth Gimbel-Sherr, MPH², Sarah Gimbel-Sherr, RN, MA², James T. Pfeiffer, PhD, MPH³, Pablo Montoya, MD, MPH⁴, Wendy Johnson, MD, MPH⁴, Rosa Marlene Manjate, MD, MPH⁵, and Stephen Gloyd, MD, MPH⁶. (1) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (206) 543-8382, mmicek@teledata.mz, (2) Epidemiology, University of Washington, 178 27th Avenue, Seattle, WA 98122, (3) Department of Health Services, University of Washington, HAI, 1107 NE 45th St, Suite 427, Seattle, WA 98105, (4) Health Alliance International, CP 583, Beira, Mozambique, (5) Department of Clinical Medicine, Ministry of Health, Rua Eduardo Mondlane, Maputo, Mozambique, (6) Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660

Objective: To describe the implementation of an HIV treatment clinic integrated into the Mozambique Ministry of Health (MOH) national ARV expansion plan.

Description: The Beira Day Hospital in Mozambique was the first MOH HIV treatment center in central Mozambique. The site was originally chosen as a Columbia University MTCT-Plus Initiative demonstration site, which served to provide operational funds, ARV procurement, training, and technical support. Staff primarily included MOH personnel including part-time clinicians. NGO technical staff assisted with developing patient flow and data systems, and provided clinical training. Referral links were developed with local HIV testing sites.

Lessons learned: Demand for HIV services is high, with approximately 200 new patients enrolled per month. Availability of HAART was initially limited to pilot projects, and the majority of care focused on counseling, pMTCT, and OI management. Data systems tracked the clinical and sociodemographic characteristics of enrollees, and identified areas for targeted interventions to improve referrals from pMTCT sites, TB centers, and hospitals. New national protocols and forms were implemented as they were developed, with feedback to the national level. HAART access dramatically increased with the arrival of ARVs through the national plan in June 2004, requiring a shift in focus from OI management to ARV-related activities. As patient enrollment increased, human resources became a major constraint to rapid scale-up. Additional staff and new patient flow systems were implemented, including decentralizing clinical decision-making to non-physicians. Treatment goals of 100 new patients started on HAART per month were reached by January 2005.

Recommendations: Rapid scale-up of ARV treatment is feasible in Mozambique. Effective data systems and communication can improve the efficiency of implementation on the local and national level. Human resource capacity is a major constraint, and can be alleviated by using simple protocols and decentralizing clinical decision-making.

Learning Objectives:

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.