title: Implementation and Operational Research: A Comparison of Two Task-Shifting Models of Pharmaceutical Care in Antiretroviral Treatment Programs in South Africa.
abstract: BACKGROUND
  The severe shortage of pharmacists is an important limitation to providing antiretroviral treatment (ART) in resource-limited countries. Two task-shifting pharmaceutical care models have been developed to address this in South Africa, namely indirectly supervised pharmacist assistant (ISPA) and nurse-managed models. This study compared pharmaceutical care quality, patient clinical outcomes, and provider staff costs between these models.
  
  
  METHODS
  An analysis of pharmaceutical quality audits, patient clinical data, and staff costing data collected at 7 ISPA and 8 nurse-managed facilities was undertaken. Pharmaceutical audits were conducted by pharmacists using a standardized tool. Routine clinical data were collected prospectively at patient visits, and staff human resources costs were analyzed.
  
  
  RESULTS
  Overall pharmaceutical care quality scores were higher at ISPA sites than nurse-managed sites; 88.8% vs. 79.9%, respectively; risk ratio (ISPA vs. nurse) = 1.11 (95% confidence interval: 1.09 to 1.13; P < 0.0001). Mean provider pharmaceutical-related human resources costs per patient visit and per item dispensed were 29% and 49% lower, respectively, at ISPA facilities. At ISPA facilities, patient attrition was observed to be lower and viral suppression higher than at nurse-managed sites.
  
  
  CONCLUSIONS
  The ISPA model had a higher quality of pharmaceutical care and was less costly to implement. Further expansion of this model or integrating it with nurse-managed ART may enhance the cost-efficient scale-up of ART programs in Sub-Saharan Africa.
authors.affiliation: *Kheth'Impilo, Cape Town, South Africa;†School of Pharmacy, University of the Western Cape, Cape Town, South Africa; and‡Health Economics Unit, School of Public Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Fatti
authors.forename: Lizette
authors.initials: L
authors.lastname: Monteith
authors.forename: Najma
authors.initials: N
authors.lastname: Shaikh
authors.forename: Erika
authors.initials: E
authors.lastname: Kapp
authors.forename: Nicola
authors.initials: N
authors.lastname: Foster
authors.forename: Ashraf
authors.initials: A
authors.lastname: Grimwood
mesh_terms: D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D032022:Delegation, Professional / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D009726:Nurses / Q000191:economics / Q000592:standards* / Q000600:supply & distribution; D010595:Pharmacists / Q000191:economics / Q000592:standards / Q000600:supply & distribution*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents