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Task‐sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire
Author(s) -
McNairy Margaret L.,
Bashi Jules B.,
Chung Hannah,
Wemin Louise,
Lorng MarieNicole Akpro,
Brou Hermann,
Nioble Cyprien,
Lokossue A.,
Abo Kouame,
Achi Delphine,
Ouattara Kiyali,
Sess Daniel,
Sanogo Pongathie Adama,
Ekra Alexandre,
EttiegneTraore Virginie,
Diabate Conombo J.,
Abrams Elaine J.,
ElSadr Wafaa M.
Publication year - 2017
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12839
Subject(s) - medicine , cote d ivoire , human immunodeficiency virus (hiv) , family medicine , nursing , antiretroviral therapy , viral load , humanities , philosophy
Objective 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. Methods 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. Results 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. Conclusion 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.