Open AccessNon‐physician clinician provided HIV treatment results in equivalent outcomes as physician‐provided care: a meta‐analysis
Author(s) -
Emdin Connor A,
Chong Nicholas J,
Millson Peggy E
Publication year - 2013
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.16.1.18445
Subject(s) - medicine , family medicine , hazard ratio , health care , economic shortage , primary care physician , human immunodeficiency virus (hiv) , medline , antiretroviral therapy , viral load , primary care , confidence interval , political science , law , linguistics , philosophy , government (linguistics) , economics , economic growth
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.