title: Clinical staging of HIV-related illness in Mozambique: performance of nonphysician clinicians based on direct observation of clinical care and implications for health worker training.
abstract: BACKGROUND
  In Mozambique, clinical staging may be the primary determinant of HIV/AIDS treatment decisions, and the task of staging commonly falls to nonphysician clinicians (técnicos de medicina). Two years after the first Mozambican técnicos were trained in HIV/AIDS care, the quality of their performance in clinical staging was unknown.
  
  
  METHODS
  Expert clinicians observed 127 clinical encounters conducted by a randomly selected national sample of 44 técnicos and compared observed clinical staging decisions to World Health Organization and Mozambican national norms. They also reviewed relevant Mozambican in-service training curricula in HIV/AIDS care.
  
  
  RESULTS
  Observers agreed with fewer than half (44.1%) of the técnicos' stage-defining diagnoses. Misclassification or misdiagnosis of 3 complaints (weight loss, fever, and diarrhea) accounted for the majority of the observed errors. Review of health worker curricula determined that observed staging errors reflected content errors and omissions in the técnicos' in-service HIV/AIDS training and constraints in local laboratory and imaging capacity.
  
  
  CONCLUSIONS
  In response to these findings, the Mozambican Ministry of Health has revised the técnicos' scope of work and has developed new guidelines, curriculum materials, and training strategies to improve the quality of clinical staging and opportunistic infection diagnosis in Mozambique.
authors.affiliation: University of Washington, Seattle, WA, USA. brentp2@u.washington.edu
authors.forename: Paula E
authors.initials: PE
authors.lastname: Brentlinger
authors.forename: José Vallejo
authors.initials: JV
authors.lastname: Torres
authors.forename: Pilar Martínez
authors.initials: PM
authors.lastname: Martínez
authors.forename: Annette
authors.initials: A
authors.lastname: Ghee
authors.forename: Johnny
authors.initials: J
authors.lastname: Lujan
authors.forename: Rui
authors.initials: R
authors.lastname: Bastos
authors.forename: Rolanda
authors.initials: R
authors.lastname: Manuel
authors.forename: Florindo M
authors.initials: FM
authors.lastname: Mudender
authors.forename: Américo
authors.initials: A
authors.lastname: Assan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D004501:Education, Medical / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D006302:Health Services Research; D006801:Humans; D009073:Mozambique; D009726:Nurses; D012720:Severity of Illness Index
chemical_list: D019380:Anti-HIV Agents