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Benefits of task‐shifting HIV care to nurses in terms of health‐related quality of life in patients initiating antiretroviral therapy in rural district hospitals in C ameroon [Stratall Agence Nationale de Recherche sur le SIDA ( ANRS ) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau ( ESTHER ) substudy]
Author(s) -
SuzanMonti M,
Blanche J,
Boyer S,
Kouanfack C,
Delaporte E,
Boo RC,
Carrieri PM,
Protopopescu C,
Laurent C,
Spire B
Publication year - 2015
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12213
Subject(s) - medicine , quality of life (healthcare) , confidence interval , human immunodeficiency virus (hiv) , antiretroviral therapy , gerontology , family medicine , viral load , nursing
Objectives The World Health Organization ( WHO ) recommends task‐shifting HIV care to nurses in low‐resource settings with limited numbers of physicians. However, the effect of such task‐shifting on the health‐related quality of life ( HRQL ) of people living with HIV ( PLHIV ) has seldom been evaluated. We aimed to investigate the effect of task‐shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy ( ART ) in rural district hospitals in C ameroon. Methods Outcomes in PLHIV were longitudinally collected in the 2006−2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face‐to‐face interviews using the WHO Quality of Life ( WHOQOL )‐ HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task‐shifting was estimated using a consultant ratio (i.e. the ratio of nurse‐led to physician‐led visits). The effect of task‐shifting and other potential correlates on HRQL dimensions was explored using a Heckman two‐stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Results Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task‐shifted to nurses. After multiple adjustment, task‐shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval ( CI ) 0.1–1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0–1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1–1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1–1.0; P = 0.02).Conclusions Task‐shifting HIV care to nurses benefits the HRQL of PLHIV . Together with the previously demonstrated comparable clinical effectiveness of physician‐based and nurse‐based models of HIV care, our results support the WHO recommendation for task‐shifting.