Management of HIV and AIDS at lower primary health care facility in Chalinze, eastern Tanzania

Abstract

Implementation of Antiretroviral Therapy (ART) services at health centres in Tanzania were delayed due to several reasons including shortage of qualified staff, inadequate infrastructure and logistics problems. However, patients from peripheral areas experienced difficulties in accessing ART services due to long distances from clinics. National AIDS Control Programme (NACP) and Non-Governmental Organizations (NGOs) embarked on ART services scale-up programme aimed at improved ART availability and accessibility. Through this programme ART services were established at health centres and selected dispensaries. However, no previous documented experiences existed at country level to guide provision of services. Therefore, this study was designed to gather experiences and share lessons learnt with other health care providers and programme implementing partners. This was a descriptive cross-sectional study involved patients enrolled to ART services between May 2007 and April 2009. Data collection involved observation of health providers’ performance and retrospective ART and care patients’ registers review. During the study period, 611 care and 284 ART patients were attended. Majority of patients (85.1%; 762/895) were adults aged 25-45 years. In total 61.5% (550/895) of the patients had CD4+T lymphocytes ≤350/µl the cut-off point for initiating ART. The frequency of symptoms was noted to significantly decrease with increasing CD4 counts (P<0.001). Numbness, parotid enlargement and genital discharge were not related to patient level of CD4+T-lymphocytes counts. Papular pruritic eruptions 98/282 (34.8%), tuberculosis 86/282 (30.5%) and oesophageal candidiasis 37/282 (13.1) were the most diagnosed AIDS defining illnesses. Sixteen patients on care died and 30 were lost to follow up. Overall the clinical management was poorly performed. ART services can successively be provided at health centre level and encourages HIV-infected persons to seek care. However, clinicians need regular clinical mentorship and supportive supervision.