title: Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy].
abstract: The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon.
  
  
  
  Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes.
  
  
  
  Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02).
  
  
  
  Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation for task-shifting.
authors.affiliation: INSERM, UMR912 Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 13006, Marseille, France; Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Suzan-Monti
authors.forename: J
authors.initials: J
authors.lastname: Blanche
authors.forename: S
authors.initials: S
authors.lastname: Boyer
authors.forename: C
authors.initials: C
authors.lastname: Kouanfack
authors.forename: E
authors.initials: E
authors.lastname: Delaporte
authors.forename: R-C
authors.initials: RC
authors.lastname: Bonono
authors.forename: P M
authors.initials: PM
authors.lastname: Carrieri
authors.forename: C
authors.initials: C
authors.lastname: Protopopescu
authors.forename: C
authors.initials: C
authors.lastname: Laurent
authors.forename: B
authors.initials: B
authors.lastname: Spire
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count / Q000191:economics; D002163:Cameroon / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000451:nursing*; D006304:Health Status; D006767:Hospitals, District / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008991:Monitoring, Physiologic / Q000191:economics / Q000451:nursing*; D009726:Nurses; D017060:Patient Satisfaction; D010820:Physicians; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data; D019562:Viral Load; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-1; antiretroviral therapy; comprehensive care; health-related quality of life; task-shifting