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Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis.

Abstract：

INTRODUCTION:A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed. METHODS:Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. RESULTS:Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88-1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: -12.7-17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65-1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56-0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. CONCLUSIONS:Non-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.

journal_name

J Int AIDS Soc

journal_title

Journal of the International AIDS Society

authors

Emdin CA,Chong NJ,Millson PE

doi

10.7448/IAS.16.1.18445

subject

Has Abstract

pub_date

2013-07-03 00:00:00

pages

18445

issn

1758-2652

pii

18445

journal_volume

pub_type

杂志文章,meta分析,评审

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Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis.