title: Task shifting for the delivery of pediatric antiretroviral treatment: a systematic review.
abstract: BACKGROUND
  Pediatric antiretroviral treatment coverage in resource-limited settings continues to lag behind adults. Task shifting is an effective approach broadly used for adults, which some countries have also adopted for children, but implementation is limited by lack of confidence and skills among nonspecialist staff.
  
  
  METHODS
  A systematic review was conducted by combining key terms for task shifting, antiretroviral therapy (ART), and children. Five databases and two conferences were searched from inception till August 01, 2013.
  
  
  RESULTS
  Eight observational studies provided outcome data for 11,828 children who received ART from nonphysician providers across 10 countries in sub-Saharan Africa. The cumulative pooled proportion of deaths was 3.2% [95% confidence interval (CI): 2.0 to 4.5] at 6 months, 4.6% (95% CI: 2.1 to 7.1) at 12 months, 6.2% (95% CI: 3.7 to 8.8) at 24 months, and 5.9% (95% CI: 3.5 to 8.3) at 36 months. Mortality and loss to follow-up in task-shifting programs were comparable to those reported by programs providing doctor- or specialist-led care.
  
  
  CONCLUSIONS
  Our review suggests that task shifting of ART care can result in outcomes comparable to routine physician care, and this approach should be considered as part of a strategy to scale-up pediatric treatment. Specialist care will remain important for management of sick patients and complicated cases. Further qualitative research is needed to inform optimal implementation of task shifting for pediatric patients.
authors.affiliation: *HIV/AIDS Department, World Health Organization, Geneva, Switzerland; †Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; and ‡HIV and AIDS Department, Ministry of Health and Social Welfare, Harare, Zimbabwe.
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Apollo
authors.forename: Eyerusalem
authors.initials: E
authors.lastname: Negussie
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy*; D006298:Health Services Administration; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents