Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study
Identifieur interne : 001D40 ( Pmc/Corpus ); précédent : 001D39; suivant : 001D41Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study
Auteurs : Kenneth H. Sherr ; Mark A. Micek ; Sarah O. Gimbel ; Stephen S. Gloyd ; James P. Hughes ; Grace C. John-Stewart ; Rosa M. Manjate ; James Pfeiffer ; Noel S. WeissSource :
- AIDS (London, England) [ 0269-9370 ] ; 2010.
Abstract
To compare HIV care quality provided by non-physician clinicians (NPC) and physicians.
Retrospective cohort study assessing the relationship between provider cadre and HIV care quality among non-pregnant adult patients initiating antiretroviral therapy (ART) in the national HIV care programme.
Computerized medical records from patients initiating ART between July 2004 and October 2007 at two HIV public HIV clinics in central Mozambique were used to develop multivariate analyses evaluating differences in process and care continuity measures for patients whose initial provider was a NPC or physician.
A total of 5892 patients was included in the study, including 4093 (69.5%) with NPC and 1799 (30.5%) with physicians as initial providers. Those whose initial provider was a NPC were more likely to have a CD4 cell count 90–210 days [risk ratio (RR) 1.13, 1.04
NPC performance was similar to or better than that of physicians for the HIV care quality study measures. Our results highlight the important role of NPC in scaling up ART in Mozambique, and argue for using all relevant clinical resources to meet the large demands for care in countries with high HIV burdens.
Url:
DOI: 10.1097/01.aids.0000366083.75945.07
PubMed: 20023441
PubMed Central: 3372417
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PMC:3372417Le document en format XML
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<author><name sortKey="Sherr, Kenneth H" sort="Sherr, Kenneth H" uniqKey="Sherr K" first="Kenneth H." last="Sherr">Kenneth H. Sherr</name>
<affiliation><nlm:aff id="A1">Department of Global Health, University of Washington, Seattle, Washington, USA</nlm:aff>
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<affiliation><nlm:aff id="A5">Health Alliance International, Seattle, Washington, USA</nlm:aff>
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<author><name sortKey="Micek, Mark A" sort="Micek, Mark A" uniqKey="Micek M" first="Mark A." last="Micek">Mark A. Micek</name>
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<author><name sortKey="Gimbel, Sarah O" sort="Gimbel, Sarah O" uniqKey="Gimbel S" first="Sarah O." last="Gimbel">Sarah O. Gimbel</name>
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<author><name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
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<author><name sortKey="Sherr, Kenneth H" sort="Sherr, Kenneth H" uniqKey="Sherr K" first="Kenneth H." last="Sherr">Kenneth H. Sherr</name>
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<author><name sortKey="Micek, Mark A" sort="Micek, Mark A" uniqKey="Micek M" first="Mark A." last="Micek">Mark A. Micek</name>
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<author><name sortKey="Gimbel, Sarah O" sort="Gimbel, Sarah O" uniqKey="Gimbel S" first="Sarah O." last="Gimbel">Sarah O. Gimbel</name>
<affiliation><nlm:aff id="A1">Department of Global Health, University of Washington, Seattle, Washington, USA</nlm:aff>
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<affiliation><nlm:aff id="A5">Health Alliance International, Seattle, Washington, USA</nlm:aff>
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<author><name sortKey="Gloyd, Stephen S" sort="Gloyd, Stephen S" uniqKey="Gloyd S" first="Stephen S." last="Gloyd">Stephen S. Gloyd</name>
<affiliation><nlm:aff id="A1">Department of Global Health, University of Washington, Seattle, Washington, USA</nlm:aff>
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<affiliation><nlm:aff id="A5">Health Alliance International, Seattle, Washington, USA</nlm:aff>
</affiliation>
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<author><name sortKey="Hughes, James P" sort="Hughes, James P" uniqKey="Hughes J" first="James P." last="Hughes">James P. Hughes</name>
<affiliation><nlm:aff id="A2">Department of Biostatistics, University of Washington, Seattle, Washington, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
<affiliation><nlm:aff id="A3">Department of Medicine, Global Health and Epidemiology, University of Washington, Seattle, Washington, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Manjate, Rosa M" sort="Manjate, Rosa M" uniqKey="Manjate R" first="Rosa M." last="Manjate">Rosa M. Manjate</name>
<affiliation><nlm:aff id="A6">Medical Care Department, Mozambique Ministry of Health, Maputo, Mozambique</nlm:aff>
</affiliation>
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<author><name sortKey="Pfeiffer, James" sort="Pfeiffer, James" uniqKey="Pfeiffer J" first="James" last="Pfeiffer">James Pfeiffer</name>
<affiliation><nlm:aff id="A1">Department of Global Health, University of Washington, Seattle, Washington, USA</nlm:aff>
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<affiliation><nlm:aff id="A5">Health Alliance International, Seattle, Washington, USA</nlm:aff>
</affiliation>
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<author><name sortKey="Weiss, Noel S" sort="Weiss, Noel S" uniqKey="Weiss N" first="Noel S." last="Weiss">Noel S. Weiss</name>
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<series><title level="j">AIDS (London, England)</title>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title>
<p id="P1">To compare HIV care quality provided by non-physician clinicians (NPC) and physicians.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">Retrospective cohort study assessing the relationship between provider cadre and HIV care quality among non-pregnant adult patients initiating antiretroviral therapy (ART) in the national HIV care programme.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">Computerized medical records from patients initiating ART between July 2004 and October 2007 at two HIV public HIV clinics in central Mozambique were used to develop multivariate analyses evaluating differences in process and care continuity measures for patients whose initial provider was a NPC or physician.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">A total of 5892 patients was included in the study, including 4093 (69.5%) with NPC and 1799 (30.5%) with physicians as initial providers. Those whose initial provider was a NPC were more likely to have a CD4 cell count 90–210 days [risk ratio (RR) 1.13, 1.04</p>
</sec>
<sec id="S5"><title>Conclusion</title>
<p id="P5">NPC performance was similar to or better than that of physicians for the HIV care quality study measures. Our results highlight the important role of NPC in scaling up ART in Mozambique, and argue for using all relevant clinical resources to meet the large demands for care in countries with high HIV burdens.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1493</journal-id>
<journal-id journal-id-type="nlm-ta">AIDS</journal-id>
<journal-id journal-id-type="iso-abbrev">AIDS</journal-id>
<journal-title-group><journal-title>AIDS (London, England)</journal-title>
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<issn pub-type="ppub">0269-9370</issn>
<issn pub-type="epub">1473-5571</issn>
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<article-meta><article-id pub-id-type="pmid">20023441</article-id>
<article-id pub-id-type="pmc">3372417</article-id>
<article-id pub-id-type="doi">10.1097/01.aids.0000366083.75945.07</article-id>
<article-id pub-id-type="manuscript">NIHMS359022</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Sherr</surname>
<given-names>Kenneth H.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Micek</surname>
<given-names>Mark A.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gimbel</surname>
<given-names>Sarah O.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gloyd</surname>
<given-names>Stephen S.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hughes</surname>
<given-names>James P.</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>John-Stewart</surname>
<given-names>Grace C.</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Manjate</surname>
<given-names>Rosa M.</given-names>
</name>
<xref ref-type="aff" rid="A6">f</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pfeiffer</surname>
<given-names>James</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Weiss</surname>
<given-names>Noel S.</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
Department of Global Health, University of Washington, Seattle, Washington, USA</aff>
<aff id="A2"><label>b</label>
Department of Biostatistics, University of Washington, Seattle, Washington, USA</aff>
<aff id="A3"><label>c</label>
Department of Medicine, Global Health and Epidemiology, University of Washington, Seattle, Washington, USA</aff>
<aff id="A4"><label>d</label>
Department of Epidemiology, University of Washington, Seattle, Washington, USA</aff>
<aff id="A5"><label>e</label>
Health Alliance International, Seattle, Washington, USA</aff>
<aff id="A6"><label>f</label>
Medical Care Department, Mozambique Ministry of Health, Maputo, Mozambique</aff>
<author-notes><corresp id="FN1">Correspondence to Kenneth H. Sherr, Department of Global Health, University of Washington, Seattle, Washington, USA. Tel: +1 206 543 8382; <email>ksherr@u.washington.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>23</day>
<month>3</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="ppub"><month>1</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>11</day>
<month>6</month>
<year>2012</year>
</pub-date>
<volume>24</volume>
<issue>Suppl 1</issue>
<fpage>S59</fpage>
<lpage>S66</lpage>
<permissions><copyright-statement>© 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins</copyright-statement>
<copyright-year>2010</copyright-year>
</permissions>
<abstract><sec id="S1"><title>Objectives</title>
<p id="P1">To compare HIV care quality provided by non-physician clinicians (NPC) and physicians.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">Retrospective cohort study assessing the relationship between provider cadre and HIV care quality among non-pregnant adult patients initiating antiretroviral therapy (ART) in the national HIV care programme.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">Computerized medical records from patients initiating ART between July 2004 and October 2007 at two HIV public HIV clinics in central Mozambique were used to develop multivariate analyses evaluating differences in process and care continuity measures for patients whose initial provider was a NPC or physician.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">A total of 5892 patients was included in the study, including 4093 (69.5%) with NPC and 1799 (30.5%) with physicians as initial providers. Those whose initial provider was a NPC were more likely to have a CD4 cell count 90–210 days [risk ratio (RR) 1.13, 1.04</p>
</sec>
<sec id="S5"><title>Conclusion</title>
<p id="P5">NPC performance was similar to or better than that of physicians for the HIV care quality study measures. Our results highlight the important role of NPC in scaling up ART in Mozambique, and argue for using all relevant clinical resources to meet the large demands for care in countries with high HIV burdens.</p>
</sec>
</abstract>
<kwd-group><kwd>antiretroviral therapy</kwd>
<kwd>Mozambique</kwd>
<kwd>non-physician clinicians</kwd>
<kwd>scale-up</kwd>
<kwd>task shifting</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source>
<award-id>P30 AI027757-13 || AI</award-id>
</award-group>
<award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source>
<award-id>P30 AI027757 || AI</award-id>
</award-group>
<award-group><funding-source country="United States">National Institute of Child Health & Human Development : NICHD</funding-source>
<award-id>K24 HD054314-02 || HD</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
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