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Table 1 Characteristics and outcomes of studies on the impact of task-shfting in HIV/AIDS care

From: A systematic review of task- shifting for HIV treatment and care in Africa

Study Setting Study design Study size Intervention Outcomes
Apondi et al, 2007 [65]; Tugume et al 2009 [66]. Uganda (rural) Cohort 2522 'Field officers' provide home-based ART Cumulative outcomes at 4 years showed excellent adherence (96.8% were > 95% adherent) and < 1% defaulting. Social improvements: reduced stigma, stronger family and community relationships
Arem et al, 2009 [69]. Uganda (rural) Qualitative Survey --- Peer adherence supporters Peer health workers successfully understood ART regimens and physical danger signs; 97% of clinic staff reported that peer health workers improved patient outcomes.
Bedelu et al, 2007 [40]. South Africa (rural) Cohort 1025 Decentralized, nurse-initiated ART Task-shifted, decentralised care increases access and is more acceptable to patients loss-to-follow-up was clinics 2% at clinics compared to 19% at hospital for comparable virological and immunological outcomes.
Bolton-Moore et al, 2007 [50] Zambia (urban) Cohort (paediatric) 2938 Nurse- and clinical officer-initiated paediatric ART Decentralization allows for dramatically scaled-up rollout; cumulative 3-year mortality (8.3%) and defaulting (5.4%) comparable to other programmes.
Chang et al, 2008 [74] Uganda (rural) Cohort 360 Patients trained as 'peer health workers' to monitor ART adherence by mobile phone Extremely cost effective. 72% retention and 86% virological suppression at 2 years
Chiambe et al, 2009 [42]. Kenya
(urban and rural)
Cohort 39,900 Lay health care workers supporting basic clinic tasks and adherence counselling Enrollment increased from 1,176 to 39,900 patients within 3 years
Chung et al, 2008 [25] Rwanda (rural) Modelling 3194 Nurse-initiated ART Substantial time savings: nurse-initiated ART reduces physician HIV-related workload by 78%, saving up to 56 hours physician time/month.
Cohen et al, 2009 [55]. Lesotho (rural) Cohort 4,347 Nurse-initiated ART Favourable outcomes at 12 months among adults (9.3% mortality, 2.5% defaulting) and children (5% mortality, 2% defaulting)
Gimbel-Sherr et al 2008 [48]. Mozambique Cohort 6,006 ART initiated by mid-level workers (2.5 years training) vs doctors Patients seen by NPCs (69.4% of cohort) were 44% less likely to be lost to follow up; no difference in mortality
Jaffar et al, 2009 [59]. Uganda (rural) RCT 859 Home vs clinic-based ART delivery Similar outcomes of mortality and viral suppression in home-based and faculty-based ART
Koenig et al 2004 [35]. Haiti (rural) Cohort 2300 Decentralized, CHW-monitored ART Approach increases access, reduces defaulting, and delays resistance to first-line medication
McGuire et al, 2008 [29]. Malawi (rural) Cohort 1676 Nurses/medical assistants initiating and managing ART More rapid time to initiation (21.5 days for nurses/medical assistants vs 35 days for clinical officers); no difference in outcomes and retention rates
Sanjana et al, 2009 [73]. Zambia Cross-sectional survey --- Assessment of record-keeping errors among lay vs health care workers Error rate for lay counsellors was less (6.44/1,000 field) than health care workers (16.81/1,000 fields)
Shulman et al, 2009 [50]. Malawi (rural) Cohort --- Lay workers trained as pharmacist assistants Expanded pharmacy capacity (500 prescriptions per day) and reduced errors (30% to 5%)
Shumbusho et al, 2008 [47]. Rwanda (rural) Concordance study --- Nurses trained in ART initiation Discordance between eligibility and initiation < 1% (n = 343)
Shumbusho 2008 [47]. Rwanda (rural) Cohort 3194 Nurse-initiated ART Mortality at defaulting < 5% at 12 months.
Tweya et al, 2008 [64]. Malawi (rural) Cohort 1,617 Lay-workers to pre-screen for adult ART eligibility Symptom screening checklist had high sensitivity (91.8%) but low specificity (28%)
Tootla et al 2007 [53]. South Africa (urban) Cohort 2,084 Nurse/pharmacist managed ART 75% of clients had undetectable viral load at 12 months
Torpey et al 2008 [27]. Zambia Cohort (quantitative and qualitative analysis) 500 Lay-workers used as 'adherence supporters' Lay adherence supporters reduced loss-to-follow-up from 15% to 0%; reduced wait times
Udegboka et al, 2009 [28]. Nigeria Cohort --- Nurse ART treatment and peer support Task shifting reduced waiting times by 4 hours
Van Rie et al 2009 [46]. DRC (urban) Blinded concordance study 339 Nurse vs doctor decisions to initiate ART 95% agreement
Van Griensven et al, 2008 [57]. Rwanda (urban) Cohort 315 Nurse-initiated and monitored paediatric ART 84% retention and 83% virological suppression at 2 years
Van Griensven et al, 2009
[58].
Rwanda (urban) Cohort 435 Nurse-initiated and monitored Adult ART 0.3% attrition and 8.5% mortality at 1 year
Wood et al, 2009 [45]. South Africa (urban) RCT 812 Doctor vs nurse-initiated ART Non-inferiority according to virological failure, toxicity, adherence, and mortality.
Zachariah et al, 2007 [62]. Malawi (rural) Cohort 1634 Community support vs no support 26% increase in survival; 98% reduction in loss to follow up.