6th IAS Conference On HIV Pathogenesis, Treatment and Prevention

Human Resources: a Critical Factor for Success MOPDD01
Type:
Oral Poster Discussion Back
Venue: SR 3
Time: 13:00 - 14:00, 18.07.2011
Code: MOPDD01
Chair: Alexey Bobrik, Russian Federation



Presentations in this session:

13:00
MOPDD0101
Abstract
Powerpoint		Prevention of occupational exposures to blood-borne pathogens among HCW in Brazil: using surveillance data to guide the use of safety-engineered devices
Presented by Guilherme Côrtes Fernandes, Brazil
C. Rapparini1, V. Saraceni2,3, G.C. Fernandes2,4, A.A. Machado2,5, PSBio Network - Surveillance System of Occupational Exposures to Blood-borne Pathogens among HCWs/Brazil
1Projeto Riscobiologico.org / UFRJ, Rio de Janeiro, Brazil, 2Projeto Riscobiologico.org, Rio de Janeiro, Brazil, 3SMSDC-RJ, Rio de Janeiro, Brazil, 4Santa Casa de Misericórdia, Juiz de Fora, Brazil, 5Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto, Brazil

13:05
MOPDD0102
Abstract
Powerpoint		Evaluation of a national program to improve injection safety in Tanzania
Presented by Koku Kazaura, Tanzania, United Republic of
K. Kazaura1, T. Pyun2, E. Chenya3, H. Ngonyani4, I. Benech2, D. Selenic2
1Centers for Disease Control and Prevention, US Embassy, Dar es Salaam, Tanzania, United Republic of, 2Centers for Disease Control and Prevention, Global AIDS Program, Dar es Salaam, Tanzania, United Republic of, 3John Snow Inc., Dar es Salaam, Tanzania, United Republic of, 4Ministry of Health and Social Welfare, Dar es Salaam, Tanzania, United Republic of

13:10
MOPDD0103
Abstract
Powerpoint		Innovative and efficient approaches for meeting the human resource needs of the male circumcision scale up in Southern and Eastern Africa
Presented by Kelly Curran, United States
K. Curran1, A. Mirelman2, E. Njeuhmeli3, K. Dickson4, T. Adamu1, P. Cherutich5, T.K. Mavuso6, J. Albertini7, L. Fitzgerald8, N. Bock9, J. Reed10, D. Stanton3
1Jhpiego - an Affiliate of Johns Hopkins University, Baltimore, United States, 2Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 3United States Agency for International Development, Washington, United States, 4World Health Organization, Geneva, Switzerland, 5Ministry of Health Kenya, Nairobi, Kenya, 6Ministry of Health Swaziland, Mbabane, Swaziland, 7United States Agency for International Development, Mbabane, Swaziland, 8Jhpiego - an Affiliate of Johns Hopkins University, Mbabane, Swaziland, 9Centers for Disease Control and Prevention, Atlanta, Georgia, 10Centers for Disease Control and Prevention, Atlanta, United States

13:15
MOPDD0104
Abstract
Powerpoint		Task-shifting of HIV care and ART initiation: three year evaluation of a mixed-care provider model for ART delivery
Presented by Megan McGuire, Kenya
M. McGuire1, G. Pedrono2, S. Goossens3, A. Heinzelmann3, O. Chikwaza4, E. Szumilin3, M. Berthelot3, M. Pujades-Rodriguez5
1Epicentre, Nairobi, Kenya, 2Médecins Sans Frontières, Chiradzulu, Malawi, 3Médecins Sans Frontières, Paris, France, 4Chiradzulu District Hospital, Chiradzulu, Malawi, 5Epicentre, Paris, France

13:20
MOPDD0105
Abstract		The effect of task-shifting antiretroviral care in South Africa: a pragmatic cluster randomised trial (STRETCH - streamlining tasks and roles to expand treatment and care for HIV)
Presented by Lara Fairall, South Africa
L. Fairall1, M. Bachmann2, C. Lombard3, V. Timmerman1, K. Uebel1, M. Zwarenstein1,4, A. Boulle5, D. Georgeu1, C. Colvin5, S. Lewin6,7, G. Faris1, R. Cornick1, M. Tshabalala8, E. Kotze9, C. van Vuuren10, D. Steyn10, E. Bateman11
1University of Cape Town Lung Institute, Knowledge Translation Unit, Cape Town, South Africa, 2University of East Anglia, School of Medicine, Norwich, United Kingdom, 3Medical Research Council, South Africa, Biostatistics Division, Cape Town, South Africa, 4University of Toronto, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, Toronto, Canada, 5University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa, 6Norwegian Knowledge Centre for the Health Services, Oslo, Norway, 7Medical Research Council, South Africa, Health Systems Research Unit, Cape Town, South Africa, 8Free State Department of Health, Bloemfontein, South Africa, 9University of the Free State, Department of Computer Science and Informatics, Bloemfontein, South Africa, 10University of the Free State, Department of Medicine, Bloemfontein, South Africa, 11University of Cape Town, Department of Medicine, Cape Town, South Africa

13:25
Moderated discussion

Powerpoints presentations
Prevention of occupational exposures to blood-borne pathogens among HCW in Brazil: using surveillance data to guide the use of safety-engineered devices - Guilherme Côrtes Fernandes

Evaluation of a national program to improve injection safety in Tanzania - Koku Kazaura

Innovative and efficient approaches for meeting the human resource needs of the male circumcision scale up in Southern and Eastern Africa - Kelly Curran

Task-shifting of HIV care and ART initiation: three year evaluation of a mixed-care provider model for ART delivery - Megan McGuire




Rapporteur report

Track D report by Melissa Neuman


Session MOPD01 Human Resources, a critical factor for success
 This poster discussion session focused on two aspects of human resources for HIV care, treatment and prevention. The first was the safety of health care workers and in particular needlestick and injection safety. The second was the shortage of human resources and possible ways to alleviate it.
The session highlights the difficulties in generating high quality evidence to support policy change when considering complex interventions
The most rigorous evaluation of task shifting, the STRETCH cluster randomized trial in South Africa demonstrated that a complex health system intervention to shift management of HIV care and treatment to a nurse-managed approach resulted in equivalent viral load suppression (70%) 6 months after randomization in those already taking ART but was unable to show an improvement in the one year mortality among those on the waiting list to start ART (HR 0.92 NS). Other endpoints and a planned sub-group analysis did demonstrate benefit, which reinforces the South African policy to move to nurse-initiated management of ART.
 A situation analysis of the human resource needs for MMC programmes in Kenya and Swaziland used the MOVE (models to optimize volume and efficiency) framework and suggested different approaches that each country might use, with Kenya changing policy to allow nurses to perform circumcisions, while Swaziland indentified more nurses who were unemployed or on leave who could be brought back into service with suitable incentives.
Analysis of routine data from the large ART programme in Chiradzulu in Malawi also addressed the question of devolving responsibility to nurses but is harder to interpret as the cohorts seen by nurses, clinical officers or a mixture are likely to differ systematically. 
 A description of  6,888 exposure episodes in the Brazilian PSBio database which collects surveillance data on needlestick exposures in 22 centres, (predominantly hospitals), demonstrated that hypodermic needles are often(84%) used for finger- or heel-prick sampling (which made up 13% of episodes), where a lancet would be safer. 
The Tanzanian National Programme to improve injection safety conducted a baseline(n=197) and follow-up (109) survey to determine whether practice had improved after the implementation of a Making Medical Injections Safer Programme. Multiple comparisons and small samples from particular clinical locations limit the interpretation, but needle recapping was considerably lower after the intervention.
 
 

   

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