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Decentralising HIV treatment delivery in middle- and low-income countries

  1. Tamara Kredo1,*,
  2. Nathan Ford2,
  3. Folasade B Adeniyi3,
  4. Paul Garner4

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 11 JUL 2012

DOI: 10.1002/14651858.CD009987


How to Cite

Kredo T, Ford N, Adeniyi FB, Garner P. Decentralising HIV treatment delivery in middle- and low-income countries (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD009987. DOI: 10.1002/14651858.CD009987.

Author Information

  1. 1

    South African Medical Research Council, South African Cochrane Centre, Tygerberg, Western Cape, South Africa

  2. 2

    Médecins Sans Frontières, Geneva, Switzerland

  3. 3

    Stellenbosch University, Community Health, Faculty of health sciences, Parow, Cape Town, South Africa

  4. 4

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

*Tamara Kredo, South African Cochrane Centre, South African Medical Research Council, PO Box 19070, Tygerberg, Western Cape, 7505, South Africa. tamara.kredo@mrc.ac.za.

Publication History

  1. Publication Status: New
  2. Published Online: 11 JUL 2012

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This is not the most recent version of the article. View current version (27 JUN 2013)

 
Table 1. Health service nomenclature in middle and low income countries

TierHighest cadreTerms often usedFacility and staffEquipment facilities

CommunityIndividual with maximum of few months training; paid or unpaid1a. Family led careFamily member 

 1b. Village volunteerTrained volunteer; health assistantsHIV tests, counselling,  replenish drugs

 1c. Primary care clinicNurse aide or community health worker with a few months training 

Health centreParamedic or nurse (2+ years training)Health centres; district hospitalsPurpose built with at least one paramedic or nurse with some health assistantsHIV tests; antiretrovirals; opportunistic infections medicines; point of care laboratories

HospitalDoctorHealth centres; district hospitalsPurpose built with at least one medical doctor with nurses / paramedics and assistantsCD4 count

Medicines

Not viral load

Advanced hospitalSpecialist doctorDistrict hospital; referral hospitalPurpose built with at least 2 specialist doctors with nurses / paramedics and assistantsViral load and full investigations

 
Table 2. Models of HIV care

Our termInitiationFollow up

Standard hospital modelHospitalHospital

Down referral (partial)HospitalHealth centre

Down referral (full)Health centreHealth centre

DelocalisedHealth centre (weekly clinics with hospital staff)Health centre (weekly clinics with hospital staff)

Radical communityPrimary (tier 1c)

Health centre

 
Primary (tier 1c)

(monitor six monthly by health centre)