Namibia: A hospital integrates high-quality treatment with prevention and care (February 2006)

Since the USG-supported Shanamutango Center in Onandjokwe Lutheran Hospital started to offer ART in November 2004, 1,371 people have been enrolled in treatment, including 330 children who represent more than 24% of all patients. Quality is a hallmark of the site: the patient flow inside the center is well-organized, saving time and effort for patients, and considerable efforts are undertaken to ensure that patients are monitored and supported to adhere to ART regimens. This involves extensive hospital inquiries, home visits by hospital staff, telephone calls and counseling, and direct communications with patients and their treatment supporters. The Center also relies upon an accurate filing system and critical patient management software that facilitate access to service data, including pharmaceutical dispensing and drug stock records. According to the preliminary results of a pilot study, patient enrollment and ability to access ART is having a significant positive effect on morbidity and mortality. This, in turn, is shortening the number and overall duration of admissions to the hospital and minimizing associated costs to an already taxed hospital budget.

Families benefit from linkage of the treatment program to the hospital's PMTCT program. From January to September 2005, 371 women were newly enrolled for PMTCT at this center, and an additional 469 children were enrolled and followed up regularly with prophylaxis against opportunistic infections, clinical follow-up and laboratory investigations. Among them, 12 children "graduated" - that is, their HIV test at the age of 18 months was negative. Additionally, since starting rapid testing at two sites inside the hospital, 4,536 rapid tests were done in the last 4 months of the reporting period, saving a substantial amount of money. In the maternity ward, 94% of delivering mothers had unknown HIV status before introduction of rapid testing; now this percentage has declined to only 10%. As more patients have been tested and made aware of their HIV status, more have been enrolled in PMTCT programs and placed on ART when eligible, and more protection has been provided to babies of HIV-positive mothers.

Through cooperation with other USG partners under the Emergency Plan, Shanamutango also leverages the assistance of community counselors and psychologists, as well as a home-based care network. Through ongoing training of staff from the hospital and district clinics, activities at this Center are generating lessons learned that can be applied elsewhere in Namibia.

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