Table 1 |
|||||
|
Characteristics and outcomes of studies on the impact of task-shfting in HIV/AIDS care |
|||||
|
Study |
Setting |
Study design |
Study size |
Intervention |
Outcomes |
|
|
|||||
|
Uganda (rural) |
Cohort |
2522 |
'Field officers' provide home-based ART |
Cumulative outcomes at 4 years showed excellent adherence (96.8% were > 95% adherent) and < 1% defaulting. Social improvements: reduced stigma, stronger family and community relationships |
|
|
|
|||||
|
Arem et al, 2009 [69]. |
Uganda (rural) |
Qualitative Survey |
--- |
Peer adherence supporters |
Peer health workers successfully understood ART regimens and physical danger signs; 97% of clinic staff reported that peer health workers improved patient outcomes. |
|
|
|||||
|
Bedelu et al, 2007 [40]. |
South Africa (rural) |
Cohort |
1025 |
Decentralized, nurse-initiated ART |
Task-shifted, decentralised care increases access and is more acceptable to patients loss-to-follow-up was clinics 2% at clinics compared to 19% at hospital for comparable virological and immunological outcomes. |
|
|
|||||
|
Bolton-Moore et al, 2007 [50] |
Zambia (urban) |
Cohort (paediatric) |
2938 |
Nurse- and clinical officer-initiated paediatric ART |
Decentralization allows for dramatically scaled-up rollout; cumulative 3-year mortality (8.3%) and defaulting (5.4%) comparable to other programmes. |
|
|
|||||
|
Chang et al, 2008 [74] |
Uganda (rural) |
Cohort |
360 |
Patients trained as 'peer health workers' to monitor ART adherence by mobile phone |
Extremely cost effective. 72% retention and 86% virological suppression at 2 years |
|
|
|||||
|
Chiambe et al, 2009 [42]. |
Kenya (urban and rural) |
Cohort |
39,900 |
Lay health care workers supporting basic clinic tasks and adherence counselling |
Enrollment increased from 1,176 to 39,900 patients within 3 years |
|
|
|||||
|
Chung et al, 2008 [25] |
Rwanda (rural) |
Modelling |
3194 |
Nurse-initiated ART |
Substantial time savings: nurse-initiated ART reduces physician HIV-related workload by 78%, saving up to 56 hours physician time/month. |
|
|
|||||
|
Cohen et al, 2009 [55]. |
Lesotho (rural) |
Cohort |
4,347 |
Nurse-initiated ART |
Favourable outcomes at 12 months among adults (9.3% mortality, 2.5% defaulting) and children (5% mortality, 2% defaulting) |
|
|
|||||
|
Gimbel-Sherr et al 2008 [48]. |
Mozambique |
Cohort |
6,006 |
ART initiated by mid-level workers (2.5 years training) vs doctors |
Patients seen by NPCs (69.4% of cohort) were 44% less likely to be lost to follow up; no difference in mortality |
|
|
|||||
|
Jaffar et al, 2009 [59]. |
Uganda (rural) |
RCT |
859 |
Home vs clinic-based ART delivery |
Similar outcomes of mortality and viral suppression in home-based and faculty-based ART |
|
|
|||||
|
Koenig et al 2004 [35]. |
Haiti (rural) |
Cohort |
2300 |
Decentralized, CHW-monitored ART |
Approach increases access, reduces defaulting, and delays resistance to first-line medication |
|
|
|||||
|
McGuire et al, 2008 [29]. |
Malawi (rural) |
Cohort |
1676 |
Nurses/medical assistants initiating and managing ART |
More rapid time to initiation (21.5 days for nurses/medical assistants vs 35 days for clinical officers); no difference in outcomes and retention rates |
|
|
|||||
|
Sanjana et al, 2009 [73]. |
Zambia |
Cross-sectional survey |
--- |
Assessment of record-keeping errors among lay vs health care workers |
Error rate for lay counsellors was less (6.44/1,000 field) than health care workers (16.81/1,000 fields) |
|
|
|||||
|
Shulman et al, 2009 [50]. |
Malawi (rural) |
Cohort |
--- |
Lay workers trained as pharmacist assistants |
Expanded pharmacy capacity (500 prescriptions per day) and reduced errors (30% to 5%) |
|
|
|||||
|
Shumbusho et al, 2008 [47]. |
Rwanda (rural) |
Concordance study |
--- |
Nurses trained in ART initiation |
Discordance between eligibility and initiation < 1% (n = 343) |
|
|
|||||
|
Shumbusho 2008 [47]. |
Rwanda (rural) |
Cohort |
3194 |
Nurse-initiated ART |
Mortality at defaulting < 5% at 12 months. |
|
|
|||||
|
Tweya et al, 2008 [64]. |
Malawi (rural) |
Cohort |
1,617 |
Lay-workers to pre-screen for adult ART eligibility |
Symptom screening checklist had high sensitivity (91.8%) but low specificity (28%) |
|
|
|||||
|
Tootla et al 2007 [53]. |
South Africa (urban) |
Cohort |
2,084 |
Nurse/pharmacist managed ART |
75% of clients had undetectable viral load at 12 months |
|
|
|||||
|
Torpey et al 2008 [27]. |
Zambia |
Cohort (quantitative and qualitative analysis) |
500 |
Lay-workers used as 'adherence supporters' |
Lay adherence supporters reduced loss-to-follow-up from 15% to 0%; reduced wait times |
|
|
|||||
|
Udegboka et al, 2009 [28]. |
Nigeria |
Cohort |
--- |
Nurse ART treatment and peer support |
Task shifting reduced waiting times by 4 hours |
|
|
|||||
|
Van Rie et al 2009 [46]. |
DRC (urban) |
Blinded concordance study |
339 |
Nurse vs doctor decisions to initiate ART |
95% agreement |
|
|
|||||
|
Van Griensven et al, 2008 [57]. |
Rwanda (urban) |
Cohort |
315 |
Nurse-initiated and monitored paediatric ART |
84% retention and 83% virological suppression at 2 years |
|
|
|||||
|
Van Griensven et al, 2009 [58]. |
Rwanda (urban) |
Cohort |
435 |
Nurse-initiated and monitored Adult ART |
0.3% attrition and 8.5% mortality at 1 year |
|
|
|||||
|
Wood et al, 2009 [45]. |
South Africa (urban) |
RCT |
812 |
Doctor vs nurse-initiated ART |
Non-inferiority according to virological failure, toxicity, adherence, and mortality. |
|
|
|||||
|
Zachariah et al, 2007 [62]. |
Malawi (rural) |
Cohort |
1634 |
Community support vs no support |
26% increase in survival; 98% reduction in loss to follow up. |
|
|
|||||
|
Callaghan et al. Human Resources for Health 2010 8:8 doi:10.1186/1478-4491-8-8 |
|||||
