Ninety-five percent of the world’s HIV/AIDS cases occur in developing nations where little or no access to affordable treatment exists. Even so, conventional wisdom in international circles often points to the lack of medical and economic infrastructure and the high cost of treatment as reasons why HIV/AIDS initiatives cannot work in poor countries. Haiti, the western hemisphere’s poorest and most HIV-affected nation, is one example of the intersection between poverty and disease. Recognizing that Haiti is rich in human resources, however, Partners in Health (PIH) defies the international community’s traditional HIV/AIDS treatment model and chose an intervention method of training community health volunteers, called accompagnateurs, to provide support to persons living with the disease.
Six percent of its adult population, or 250,000 people, are infected with HIV/AIDS. It is the leading cause of death and has left 200,000 children with one or both parents dead from the disease. Accompagnateurs must be at least 20 years old and have reading and writing abilities. They receive extensive training on tuberculosis and HIV/AIDS, including information about medications and their side effects, confidentiality, referral systems and strategies for promoting adherence to drug regimens. Accompagnateurs are also supervised by head nurses and receive a monthly salary or other forms of payment and support.
The primary function of accompagnateurs is to ensure consistent adherence to highly active antiretroviral therapy (HAART) for HIV-infected patients. Each HIV+ patient is partnered with a community health worker who performs daily visits to the patient’s home. During each visit, the accompagnateur observes the patient taking one dose of HAART and delivers the second treatment dose at this time. Accompagnateurs often visit patients more than once each day, even though it is not required, to ensure that the patient takes their second dose and provide additional emotional support.
Accompagnateurs also play an essential role in establishing links between patients, the Cange Health Center and the communities of Haiti’s Central Plateau. They connect patients to service providers in the greater community by meeting with new patients, and nutritional and family support providers in school, housing and financial services. They also work with social workers and other peer outreach and prevention groups to meet the needs of people living with HIV/AIDS.
PIH has reported extraordinary results from incorporating community health workers into HIV/AIDS treatment management. The majority of HIV-infected patients have demonstrated fewer side effects and decreased hospitalization and mortality rates. Most patients have returned to daily work and childcare activities and have remarkable clinical responses to therapy, including substantial weight gain and decreased detectable virus loads.
PIH also discovered unexpected benefits from providing low-cost HAART by training accompagnateurs: decreased stigma around HIV/AIDS issues and increased interest in prevention. As staff and community members saw people living with HIV/AIDS make significant recoveries after receiving HAART, patients felt safe openly discussing their diagnoses and reported less physical and emotional abuse from family and neighbors. Staff morale also increased as they learned effective skills to provide care for HIV-infected patients. As treatment and prevention training became more accessible, the community took more interest in being tested for HIV and using preventative measures to avoid exposure to the virus.
Because of trade embargoes and other political circumstances, PIH has had difficulty securing funding for their work on HIV/AIDS in Haiti. However, they have created cost-effective measures for implementing their program. Not only did they train accompagnateurs to provide low-cost assistance for people living with HIV/AIDS, but PIH also collaborated with the International Dispensary Association in the Netherlands and the World Health Organization to drive down the cost of HIV/AIDS drugs from $10,000 to $300 per patient each year.
In addition to exploring innovative ways to decrease treatment costs, PIH stresses that improved information management is required to scale-up this program. The organization has created a three-part system to deal with this challenge, and includes web-based medical record systems, an application for off-line entry of data and a drug inventory system.
PIH also uses accompagnateurs in Haiti for tuberculosis treatment and has introduced this model to facilities in Peru, Russia and the United States.
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