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Table 3 Service structures at the different health system levels for PLHIV in Zambia

From: Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions

Location and actors Services
Tertiary level hospital (specialists) One advanced treatment centre in Lusaka with specialised doctors who can treat patients with third line ART, address serious complications, screen for treatment resistance and one specialised Psychiatric hospital for serious complications in mental health
Second level hospital (doctors and some specialists) Range of diagnostic, medical care and treatment for PLHIV, management of complicated cases from the first level hospitals and PHC level
First level hospital (doctors and clinical officers) Provision of ART first and second line treatment, attending to complications from PHC level, PCR testing specimen investigations, not sufficiently equipped to address mental health problems of patients
Primary health care facilities (nurses and clinical officers) Health promotion and prevention activities on HIV /AIDS, voluntary counselling and testing, prevention of mother to child transmission, screening of sexually transmitted infections, provision of first line ART, treatment of opportunistic infections, adherence counselling and in some districts provision of mosquito nets and water filters for PLHIV
Community level (community caregivers, community health assistants, neighbourhood health committees) Community Home based care for bedridden patients, follow-up visits to promote treatment adherence, nutritional advice, counselling, both spiritual and psycho-social, referrals, economic support, instructions to family members on caring for their HIV infected relative. Task of CHAs is mainly on prevention, basic hygiene, referral to health facility if needed
Household level (patients, family members) Relatives function as treatment buddies, peer patients may also take up this function, availability of support groups for PHIV