Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia.
J Health Serv Res Policy. 2012 Jan;17(1):24-9. doi: 10.1258/jhsrp.2011.010135. Epub 2011 Nov 17.
The World Health Organization (WHO) recommends shifting tasks from physicians to lower cadres for the delivery of antiretroviral treatment (ART) for countries short of physicians. Our objective was to evaluate the effectiveness and acceptability of ART delivery by health officers and nurses in Ethiopia.
A retrospective cohort study to evaluate outcomes of ART services in 25 health centres staffed with health officers and/or nurses and 30 hospitals staffed with physicians in 2009. Median CD4-cell counts, mortality, loss to follow-up and retention were the primary outcomes. Interviews and focus group discussions were conducted with people living with HIV/AIDS, AIDS programme managers and health care providers to identify the types and acceptability of the tasks conducted by the health officers, nurses and community health workers.
Health officers and nurses were providing ART, including ART prescription, for non-severe cases. The management of severe cases was exclusively the task of physicians. Community health workers were involved in adherence counselling and defaulter tracing. The baseline median CD4-cell counts per micro-liter of blood were 117 (interquartiles [IQ] 64,188) and 119 (IQ 67,190) at health centres and hospitals respectively. After 24 months on ART, the median CD4-cell counts per micro-liter of blood increased to 321 (IQ 242, 414) and 301 (IQ 217, 411) at health centres and hospitals respectively. Retention in care was higher in health centres (76%, 95% confidence interval [CI] [73%-79%]) than hospitals (67%, 95% CI [66%-68%]). This difference is mainly due to the higher loss to follow-up rate in hospitals (25% versus 13%). Mortality was higher in health centres than hospitals (11% versus 8%), but the difference is not statistically significant. Service delivery by non-physicians was accepted by patients, health care providers and programme managers. However, the absence of a regulatory framework for task shifting, the lack of extra remuneration for the additional roles assumed by nurses and health officers, and the high cost for training and mentorship were identified as weaknesses.
ART delivery in health centres, based on health officers and nurses is feasible, effective and acceptable in Ethiopia. However, issues related to regulation, remuneration and cost need to be addressed for the sustainable implementation of these delivery models.
世界卫生组织（WHO）建议在医师短缺的国家将部分工作从医师转移到基层卫生工作者手中，以提供抗逆转录病毒治疗（ART）。我们的目的是评估在埃塞俄比亚由卫生官员和护士提供 ART 服务的效果和可接受性。
这是一项回顾性队列研究，评估了 2009 年由卫生官员和/或护士在 25 个卫生中心和由医师在 30 个医院提供的 ART 服务的结果。主要结局为 CD4 细胞计数中位数、死亡率、失访率和保留率。对艾滋病毒/艾滋病感染者、艾滋病规划管理人员和卫生保健提供者进行了访谈和焦点小组讨论，以确定卫生官员、护士和社区卫生工作者所执行任务的类型和可接受性。
卫生官员和护士正在为非重症病例提供 ART，包括 ART 处方。重症病例的管理则完全是医师的任务。社区卫生工作者参与了依从性咨询和失访者追踪。基线时，每个微升血液的 CD4 细胞中位数分别为卫生中心 117（四分位距 [IQR] 64、188）和医院 119（IQR 67、190）。接受 ART 治疗 24 个月后，每个微升血液的 CD4 细胞中位数分别增加至卫生中心 321（IQR 242、414）和医院 301（IQR 217、411）。卫生中心的治疗保留率高于医院（76%，95%置信区间 [CI] [73%-79%]）。这种差异主要是由于医院的失访率较高（25%比 13%）。卫生中心的死亡率高于医院（11%比 8%），但差异无统计学意义。非医师提供的服务得到了患者、卫生保健提供者和规划管理人员的认可。然而，任务转换缺乏监管框架、护士和卫生官员承担额外角色缺乏额外报酬、培训和指导的成本高，这些都是需要解决的问题。
在埃塞俄比亚，基于卫生官员和护士的卫生中心提供 ART 是可行、有效和可接受的。然而，为了可持续实施这些交付模式，需要解决与监管、薪酬和成本相关的问题。
