title: Task shifting HIV care in rural district hospitals in Cameroon: evidence of comparable antiretroviral treatment-related outcomes between nurses and physicians in the Stratall ANRS/ESTHER trial.
abstract: Task shifting to nurses for antiretroviral therapy (ART) is promoted by the World Health Organization to compensate for the severe shortage of physicians in Africa. We assessed the effectiveness of task shifting from physicians to nurses in rural district hospitals in Cameroon.
  
  
  
  We performed a cohort study using data from the Stratall trial, designed to assess monitoring strategies in 2006-2010. ART-naive patients were followed up for 24 months after treatment initiation. Clinical visits were performed by nurses or physicians. We assessed the associations between the consultant ratio (ie, the ratio of the number of nurse-led visits to the number of physician-led visits) and HIV virological success, CD4 recovery, mortality, and disease progression to death or to the World Health Organization clinical stage 4 in multivariate analyses.
  
  
  
  Of the 4141 clinical visits performed in 459 patients (70.6% female, median age 37 years), a quarter was task shifted to nurses. The consultant ratio was not significantly associated with virological success [odds ratio 1.00, 95% confidence interval (CI): 0.59 to 1.72, P = 0.990], CD4 recovery (coefficient -3.6, 95% CI: -35.6; 28.5, P = 0.827), mortality (time ratio 1.39, 95% CI: 0.27 to 7.06, P = 0.693), or disease progression (time ratio 1.60, 95% CI: 0.35 to 7.37, P = 0.543).
  
  
  
  This study brings important evidence about the comparability of ART-related outcomes between HIV models of care based on physicians or nurses in resource-limited settings. Investing in nursing resources for the management of noncomplex patients should help reduce costs and patient waiting lists while freeing up physician time for the management of complex cases, for mentoring and supervision activities, and for other health interventions.
authors: UMI 233, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France.
authors: Charlotte
authors: C
authors: Boullé
authors: Charles
authors: C
authors: Kouanfack
authors: Gabrièle
authors: G
authors: Laborde-Balen
authors: Maria Patrizia
authors: MP
authors: Carrieri
authors: Marlise
authors: M
authors: Dontsop
authors: Sylvie
authors: S
authors: Boyer
authors: Avelin Fobang
authors: AF
authors: Aghokeng
authors: Bruno
authors: B
authors: Spire
authors: Sinata
authors: S
authors: Koulla-Shiro
authors: Eric
authors: E
authors: Delaporte
authors: Christian
authors: C
authors: Laurent
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D002163:Cameroon / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D009726:Nurses; D010820:Physicians; D012044:Regression Analysis; D012424:Rural Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents