title: HIV management by nurse prescribers compared with doctors at a paediatric centre in Gaborone, Botswana.
abstract: OBJECTIVE
  To compare compliance with national paediatric HIV treatment guidelines between nurse prescribers and doctors at a paediatric referral centre in Gaborone, Botswana.
  
  
  METHODS
  A cross-sectional study was conducted in 2009 at the Botswana-Baylor Children's Clinical Centre of Excellence (COE), Gaborone, Botswana, comparing the performance of nurse prescribers and physicians caring for HIV-infected paediatric patients. Selected by stratified random sampling, 100 physician and 97 nurse prescriber encounters were retrospectively reviewed for successful documentation of eight separate clinically relevant variables: pill count charted; chief complaint listed; social history updated; disclosure reviewed; physical exam; laboratory testing; World Health Organization (WHO) staging documented; paediatric dosing.
  
  
  RESULTS
  Nurse prescribers and physicians correctly documented 96.0% and 94.9% of the time, respectively. There was a trend towards a higher proportion of social history documentation by the nurses, but no significant difference in any other documentation items.
  
  
  CONCLUSIONS
  Our findings support the continued investment in programmes employing properly trained nurses in southern Africa to provide quality care and ART services to HIV-infected children who are stable on therapy. Task shifting remains a promising strategy to scale up and sustain adult and paediatric ART more effectively, particularly where provider shortages threaten ART rollout. Policies guiding ART services in southern Africa should avoid restricting the delivery of crucial services to doctors, especially where their numbers are limited.
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Gadzikanani
authors.initials: G
authors.lastname: Monyatsi
authors.forename: Paul C
authors.initials: PC
authors.lastname: Mullan
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Phelps
authors.forename: Michael A
authors.initials: MA
authors.lastname: Tolle
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Machine
authors.forename: Floriza F
authors.initials: FF
authors.lastname: Gennari
authors.forename: Jenny
authors.initials: J
authors.lastname: Makosky
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Anabwani
mesh_terms: D001902:Botswana; D002648:Child; D002662:Child Health Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005568:Forms and Records Control / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards*; D015658:HIV Infections / Q000451:nursing / Q000628:therapy; D006801:Humans; D008297:Male; D009732:Nursing Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011996:Records