title: Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand.
abstract: BACKGROUND
  Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand. In a pilot project, the task of following up ART-receiving patients was shifted from a physician-led HIV clinic team based at district level community hospital, to a nurse-led primary healthcare team of seven primary care centers, based at sub-district level in a district of Chiang Mai in northern Thailand. This study aimed to evaluate the task-shifted ART service in a patient-centered approach.
  
  
  METHODS
  Patients' satisfaction level was assessed cross-sectionally in a sample of 198 patients, which included 66 people living with HIV (PLHIV) receiving task-shifted ART service and matched controls in a ratio of 1:2. HIV immunological outcome was compared in a retrospective cohort of a year follow-up. Transculturally translated patient satisfaction questionnaire short form (PSQ-18) was used. Multivariate analysis of variance compared seven domains of patients' satisfaction levels.
  
  
  RESULTS
  Community hospital patients expressed significantly higher levels of satisfaction with the technical quality, communication, and time spent by the service provider, whereas the task-shifted model patients experienced significantly better accessibility and convenience of the service. At the one-year follow up, CD4 counts of the two groups were not significantly different.
  
  
  CONCLUSIONS
  Future research and training programs should aim to improve the technical quality and communication skills of nurse-led ART service teams to shift the task of HIV care and sustain expansion of ART access in primary care settings.
authors.affiliation: Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. dr.myonyeinaung@gmail.com.
authors.forename: Myo Nyein
authors.initials: MN
authors.lastname: Aung
authors.forename: Saiyud
authors.initials: S
authors.lastname: Moolphate
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kitajima
authors.forename: Yaowaluk
authors.initials: Y
authors.lastname: Siriwarothai
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Takamtha
authors.forename: Chitima
authors.initials: C
authors.lastname: Katanyoo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamura
authors.forename: Malcom
authors.initials: M
authors.lastname: Field
authors.forename: Osamu
authors.initials: O
authors.lastname: Noyama
authors.forename: Pongsak
authors.initials: P
authors.lastname: Wannakrairot
authors.forename: Virat
authors.initials: V
authors.lastname: Klinbuayaem
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006298:Health Services Administration; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013785:Thailand
chemical_list: D044966:Anti-Retroviral Agents