title: Task-sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire.
abstract: We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services.
  
  
  
  Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics.
  
  
  
  A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care.
  
  
  
  Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire.
authors.affiliation: ICAP at Columbia University, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNairy
authors.affiliation: ICAP at Columbia University, New York, NY, USA.
authors.forename: Jules B
authors.initials: JB
authors.lastname: Bashi
authors.affiliation: ICAP at Columbia University, New York, NY, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Chung
authors.affiliation: ICAP at Columbia University, New York, NY, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Wemin
authors.affiliation: Ministère de la Santé et de la Lutteontre le Sida, Programme National de Prise en Charge Médicale des Personnes Vivant Avec le VIH, Abidjan, Cote d'Ivoire.
authors.forename: Marie-Nicole Akpro
authors.initials: MA
authors.lastname: Lorng
authors.affiliation: ICAP at Columbia University, New York, NY, USA.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brou
authors.affiliation: Jhpiego, Abidjan, Cote d'Ivoire.
authors.forename: Cyprien
authors.initials: C
authors.lastname: Nioble
authors.affiliation: CDC/PEPFAR, Abidjan, Cote d'Ivoire.
authors.forename: A
authors.initials: A
authors.lastname: Lokossue
authors.affiliation: Ministère de la Santé et de la Lutteontre le Sida, Programme National de Prise en Charge Médicale des Personnes Vivant Avec le VIH, Abidjan, Cote d'Ivoire.
authors.forename: Kouame
authors.initials: K
authors.lastname: Abo
authors.affiliation: CDC/PEPFAR, Abidjan, Cote d'Ivoire.
authors.forename: Delphine
authors.initials: D
authors.lastname: Achi
authors.affiliation: Jhpiego, Abidjan, Cote d'Ivoire.
authors.forename: Kiyali
authors.initials: K
authors.lastname: Ouattara
authors.affiliation: Ministère de la Santé et de la Lutte Contre le Sida, Institut National de la Formation des Agents de Sante, Abidjan, Cote d'Ivoire.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sess
authors.affiliation: Ministère de la Santé et de la Lutte Contre le Sida, Direction de la Formation et de la Recherche, Abidjan, Cote d'Ivoire.
authors.forename: Pongathie Adama
authors.initials: PA
authors.lastname: Sanogo
authors.affiliation: CDC/PEPFAR, Abidjan, Cote d'Ivoire.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ekra
authors.affiliation: Ministère de la Santé et de la Lutteontre le Sida, Programme National de Prise en Charge Médicale des Personnes Vivant Avec le VIH, Abidjan, Cote d'Ivoire.
authors.forename: Virginie
authors.initials: V
authors.lastname: Ettiegne-Traore
authors.affiliation: Ministère de la Santé et de la Lutte Contre le Sida, Direction Générale de la Lutte Contre le Sida, Abidjan, Cote d'Ivoire.
authors.forename: Conombo J
authors.initials: CJ
authors.lastname: Diabate
authors.affiliation: ICAP at Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.affiliation: ICAP at Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D007560:Cote d'Ivoire; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D009726:Nurses; D010360:Patient Transfer; D010820:Physicians; D010865:Pilot Projects; D057184:Practice Patterns, Nurses'
chemical_list: D019380:Anti-HIV Agents
keywords:  AIDS ;  HIV ;  SIDA ;  VIH ; Reparto de tareas; Retención; partage des tâches; retention; rétention; task-sharing