Density of healthcare providers and patient outcomes: evidence from a nationally representative multi-site HIV treatment program in Uganda.
OBJECTIVE
We examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda.


METHODS
We obtained data from The AIDS Support Organization (TASO) in Uganda. Patients 18 years of age and older who initiated cART at TASO between 2004 and 2008 contributed to this analysis. The number of healthcare providers per 100 patients, the number of patients lost to follow-up per 100 person years and number of deaths per 100 person years were calculated. Spearman correlation was used to identify associations between patient loss to follow-up and mortality with the healthcare provider-patient ratios.


RESULTS
We found no significant associations between the number of patients lost to follow-up and physicians (p = 0.45), nurses (p = 0.93), clinical officers (p = 0.80), field officers (p = 0.56), and healthcare providers overall (p = 0.83). Similarly, no significant associations were observed between mortality and physicians (p = 0.65), nurses (p = 0.49), clinical officers (p = 0.73), field officers (p = 0.78), and healthcare providers overall (p = 0.73).


CONCLUSIONS
Patient outcomes, as measured by loss to follow-up and mortality, were not significantly associated with the number of doctors, nurses, clinical officers, field officers, or healthcare providers overall. This may suggest that that other factors, such as the presence of volunteer patient supporters or broader political or socioeconomic influences, may be more closely associated with outcomes of care among patients on cART in Uganda.
The AIDS Support Organization, Headquarters, Kampala, Uganda.
Celestin
C
Bakanda
Josephine
J
Birungi
Robert
R
Mwesigwa
Wendy
W
Zhang
Amy
A
Hagopian
Nathan
N
Ford
Edward J
EJ
Mills
D000293:Adolescent; D000328:Adult; D000368:Aged; D003625:Data Collection; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D009026:Mortality; D009313:National Health Programs / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
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