Team PATA

PATA Programmes – Conference Presentation

SA Aids Conference, 2011

The 2011 South African Aids conference was held in Durban from 7-10 June 2011. Taru Jaroszynski from PATA presented the successes and challenges of the Expert Patient Programme funded by One to One Children's Fund in a session called "Innovative models for delivering health services".

Considering the WHO recommendations 20 and 21 in 2008 publication Treat Train, Retain, Taskshifting for HIV Care and Treatment and Care in Africa, we analysed data collected over the last 2 years which includes 61 interviews with Expert Patients, their supervisors and PATA management and 83 supervisor reports.

Although there are may taskshifting initiatives which include community members in the clinic globally, PATA refers to this group participating in the multidisciplinary team as ‘Expert Patients' in acknowledgement of their personal expertise in ART adherence and their knowledge of the clinic based on their own experience of living with HIV or caring for a child affected by HIV.

At the centre of the PATA Expert Patient programme is the PATA treatment team, who are responsible for the recruitment, training, supervision and mentorship of Expert Patients in their role. The ultimate goal of the programme is to have the Expert Patient/s involved in the treatment team as a key member who brings new knowledge, skills and a deeper community understanding to the team and helps in the continuous quality improvement project.

This approach to task-shifting is flexible, adaptable and context driven and thus addresses specific clinic shortages and bottlenecks. Its strength is that it is driven by a team of frontline health care workers however it is this that means there is a lack of standardisation and in some cases no overarching national endorsement of task-shifting.

The success of the programme for the clinic include

• Expanded services
• More time for clinic staff to spend with each patient
• A more child/adolescent friendly environment
• Improved quality of life for the Expert Patients
• Better links between the clinic and the community

On the other hand, the programme faces many challenges for individual Expert Patients who often lack job security and career advancement opportunities. At the clinic level, there is a need for training of staff in order for them to supervise and mentor Expert Patients more effectively. At the level of programme management, quality assurance is an ongoing struggle and there is a need to develop better cooperation between PATA and other NGOs that also engage in task shifting and CHCW initiatives. PATA hopes to become a platform for such a dialogue. If you know of an organisation that would be interested in being part of this dialogue, please contact Roseanne at Roseanne@teampata.org.

For the full version of this presentation please click here.

Mexico World Aids Conference, 2008

The impact of PATA's Expert Patient programme was presented at the XVII World Aids Conference in Mexico City from the 3 - 8 August 2008 in a paper titled "Task shifting in paediatric ARV clinics through employment of 'expert patients".

Poster Abstract: Task shifting in paediatric ARV clinics through employment of 'expert patients'?

Issues: Health care workers (HCWs) for children with HIV/AIDS in Sub-Saharan Africa are in short supply. Efficiency is hampered by routine tasks, which can be performed by experienced laypersons.

Description: Paediatric Aids Treatment for Africa (PATA) (www.teampata.org) is a network of paediatric ARV clinics in 22 Sub-Saharan countries. Teams meet annually to share experiences, learn from each other and discuss health care quality. Thirty-two teams, (each with nurse, pharmacist, counsellor and physician) from 18 countries attended the second PATA forum in Nairobi during November 2006. At this forum clinic teams were invited to submit grant proposals to recruit and employ expert patients. These are defined as PLWHA who are appropriately skilled caregivers of HIV-positive children; can perform administrative or simple clinical tasks in the clinic and extend activities into the community. Twenty-three clinics from 6 countries applied to recruit 74 expert patients. These were employed during 2007. They were employed in clinic play areas (13), as assistant clerks (3) disclosure supporters (6), in clinic triage (4), community liaison (2), as PMTCT feeding counsellors (18), home visitors (19), peer educators (3) lay counsellors (3) and in other positions (3). At the 3rd PATA forum in Swaziland, 31teams from 11 countries applied for access to 104 expert patients to perform a similar set of tasks.

Lessons learned: Health care workers in Sub-Saharan paediatric HIV/AIDS clinics welcome expert patients in their clinics. Employment of expert patients permits trained health care workers to devote more time to direct patient care rather than routine tasks. Organisations such as PATA can administer and extend expert patient programmes.

Next steps: The expert patient programme will be monitored. Process, outcomes and impact on performance of core health care activity will be measured and reported.