Task-Sharing of HIV Care and ART Initiation: Evaluation of a Mixed-Care Non-Physician Provider Model for ART Delivery in Rural Malawi

Hdl Handle:
http://hdl.handle.net/10144/302214
Title:
Task-Sharing of HIV Care and ART Initiation: Evaluation of a Mixed-Care Non-Physician Provider Model for ART Delivery in Rural Malawi
Authors:
McGuire, Megan; Ben Farhat, Jihane; Pedrono, Gaelle; Szumilin, Elisabeth; Heinzelmann, Annette; Chinyumba, Yamikani Ntakwile; Goossens, Sylvie; Makombe, Simon; Pujades-Rodríguez, Mar
Journal:
PLoS ONE
Abstract:
Background: Expanding access to antiretroviral therapy (ART) in sub-Saharan Africa requires implementation of alternative care delivery models to traditional physician-centered approaches. This longitudinal analysis compares outcomes of patients initiated on antiretroviral therapy (ART) by non-physician and physician providers. Methods: Adults (≥15 years) initiating ART between September 2007 and March 2010, and with >1 follow-up visit were included and classified according to the proportion of clinical visits performed by nurses or by clinical officers(≥80% of visits). Multivariable Poisson models were used to compare 2-year program attrition (mortality and lost to follow-up) and mortality by type of provider. In sensitivity analyses only patients with less severe disease were included. Results: A total of 10,112 patients contributed 14,012 person-years to the analysis: 3386 (33.5%) in the clinical officer group, 1901 (18.8%) in the nurse care group and 4825 (47.7%) in the mixed care group. Overall 2-year program retention was 81.8%. Attrition was lower in the mixed care and higher in the clinical officer group, compared to the nurse group (adjusted incidence rate ratio [aIRR]=0.54, 95%CI 0.45-0.65; and aIRR=3.03, 95%CI 2.56-3.59,respectively). While patients initiated on ART by clinical officers in the mixed care group had lower attrition(aIRR=0.36, 95%CI 0.29-0.44) than those in the overall nurse care group; no differences in attrition were found between patients initiated on ART by nurses in the mixed care group and those included in the nurse group (aIRR=1.18, 95%CI 0.95-1.47). Two-year mortality estimates were aIRR=0.72, 95%CI 0.49-1.09 and aIRR=5.04,95%CI 3.56-7.15, respectively. Slightly higher estimates were observed when analyses were restricted to patients with less severe disease. Conclusion: The findings of this study support the use of a mixed care model with well trained and regularly supervised nurses and medical assistants to provide HIV care in countries with high HIV prevalence.
Issue Date:
16-Sep-2013
URI:
http://hdl.handle.net/10144/302214
DOI:
10.1371/journal.pone.0074090
Additional Links:
http://dx.plos.org/10.1371/journal.pone.0074090
Submitted date:
2013-09-23
Language:
en
ISSN:
1932-6203
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorMcGuire, Meganen_GB
dc.contributor.authorBen Farhat, Jihaneen_GB
dc.contributor.authorPedrono, Gaelleen_GB
dc.contributor.authorSzumilin, Elisabethen_GB
dc.contributor.authorHeinzelmann, Annetteen_GB
dc.contributor.authorChinyumba, Yamikani Ntakwileen_GB
dc.contributor.authorGoossens, Sylvieen_GB
dc.contributor.authorMakombe, Simonen_GB
dc.contributor.authorPujades-Rodríguez, Maren_GB
dc.date.accessioned2013-09-24T20:50:40Z-
dc.date.available2013-09-24T20:50:40Z-
dc.date.issued2013-09-16-
dc.date.submitted2013-09-23-
dc.identifier.citationTask-Sharing of HIV Care and ART Initiation: Evaluation of a Mixed-Care Non-Physician Provider Model for ART Delivery in Rural Malawi 2013, 8 (9):e74090 PLoS ONEen_GB
dc.identifier.issn1932-6203-
dc.identifier.doi10.1371/journal.pone.0074090-
dc.identifier.urihttp://hdl.handle.net/10144/302214-
dc.description.abstractBackground: Expanding access to antiretroviral therapy (ART) in sub-Saharan Africa requires implementation of alternative care delivery models to traditional physician-centered approaches. This longitudinal analysis compares outcomes of patients initiated on antiretroviral therapy (ART) by non-physician and physician providers. Methods: Adults (≥15 years) initiating ART between September 2007 and March 2010, and with >1 follow-up visit were included and classified according to the proportion of clinical visits performed by nurses or by clinical officers(≥80% of visits). Multivariable Poisson models were used to compare 2-year program attrition (mortality and lost to follow-up) and mortality by type of provider. In sensitivity analyses only patients with less severe disease were included. Results: A total of 10,112 patients contributed 14,012 person-years to the analysis: 3386 (33.5%) in the clinical officer group, 1901 (18.8%) in the nurse care group and 4825 (47.7%) in the mixed care group. Overall 2-year program retention was 81.8%. Attrition was lower in the mixed care and higher in the clinical officer group, compared to the nurse group (adjusted incidence rate ratio [aIRR]=0.54, 95%CI 0.45-0.65; and aIRR=3.03, 95%CI 2.56-3.59,respectively). While patients initiated on ART by clinical officers in the mixed care group had lower attrition(aIRR=0.36, 95%CI 0.29-0.44) than those in the overall nurse care group; no differences in attrition were found between patients initiated on ART by nurses in the mixed care group and those included in the nurse group (aIRR=1.18, 95%CI 0.95-1.47). Two-year mortality estimates were aIRR=0.72, 95%CI 0.49-1.09 and aIRR=5.04,95%CI 3.56-7.15, respectively. Slightly higher estimates were observed when analyses were restricted to patients with less severe disease. Conclusion: The findings of this study support the use of a mixed care model with well trained and regularly supervised nurses and medical assistants to provide HIV care in countries with high HIV prevalence.en_GB
dc.language.isoenen
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0074090en_GB
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen_GB
dc.subjectHIV/AIDSen_GB
dc.subjectModels of Careen_GB
dc.titleTask-Sharing of HIV Care and ART Initiation: Evaluation of a Mixed-Care Non-Physician Provider Model for ART Delivery in Rural Malawien
dc.identifier.journalPLoS ONEen_GB
All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.