Background:
Current antiretroviral treatment (ART) models in Africa are labour intensive and require ahigh number of skilled staff. In the context of constraints in human resources for health, taskshifting is considered a feasible alternative for ART service delivery. In 2006, DignitasInternational in partnership with the Malawi Ministry of Health trained a cadre of expertpatients at the HIV Clinic at a tertiary referral hospital in Zomba, Malawi. Expert patientswere trained to assist with clinic tasks including measurement of vital signs, anthropometryand counseling.
Methods:
A descriptive observational study using mixed methods was conducted two years after thestart of program implementation. Semi-structured interviews were conducted with 20patients, seven expert patients and six formal health care providers to explore perceptionstowards the expert patients’ contributions in the clinic. Structured exit interviews with 81patients, assessed whether essential ART information was conveyed during counselingsessions. Vital signs and anthropometry measurements performed by expert patients wererepeated by a nurse to assess accuracy of measurements. Direct observations quantified thetime spent with each patient.
Results:
There were minor differences in measurement of patients’ weight, height and temperaturebetween the expert patients and the nurse. The majority of patients exiting a counselingsession reported, without prompting, at least three side effects of ART, correct actions to betaken on observing a side-effect, and correct consequences of non-adherence to ART. Expertpatients carried out 368 hours of nurse tasks each month, saving two and a half full-timenurse equivalents per month. Formal health care workers and patients accept and value expertpatients’ involvement in ART provision and care. Expert patients felt valued by patients forbeing a ‘role model’, or a ‘model of hope’, promoting positive living and adherence to ART.
Conclusions:
Expert patients add value to the ART services at a tertiary referral HIV clinic in Malawi.Expert patients carry out shifted tasks acceptably, saving formal health staff time, and also actas ‘living testimonies’ of the benefits of ART and can be a means of achieving greaterinvolvement of People Living with HIV in HIV treatment programs.