Rustagi Alison S, Manjate Rosa Marlene, Gloyd Stephen, John-Stewart Grace, Micek Mark, Gimbel Sarah, Sherr Kenneth
Department of Global Health, Schools of Public Health and Medicine, University of Washington, Harris Hydraulics Building, 1510 NE San Juan Road, Box 357965, Seattle, WA, 98195-7765, USA.
Ministry of Health, Maputo, Mozambique.
Hum Resour Health. 2015 Apr 1;13:18. doi: 10.1186/s12960-015-0009-3.
Task shifting is a common strategy to deliver antiretroviral therapy (ART) in resource-limited settings and is safe and effective if implemented appropriately. Consensus among stakeholders is necessary to formulate clear national policies that maintain high-quality care. We sought to understand key stakeholders' opinions regarding task shifting of HIV care in Mozambique and to characterize which specific tasks stakeholders considered appropriate for specific cadres of health workers.
National and provincial Ministry of Health leaders, representatives from donor and non-governmental organizations (NGOs), and clinicians providing HIV care were intentionally selected to represent diverse viewpoints. Using open- and closed-ended questions, interviewees were asked about their general support of task shifting, its potential advantages and disadvantages, and whether each of seven cadres of non-physician health workers should perform each of eight tasks related to ART provision. Responses were tallied overall and stratified by current job category. Interviews were conducted between November 2007 and June 2008.
Of 62 stakeholders interviewed, 44% held leadership positions in the Ministry of Health, 44% were clinicians providing HIV care, and 13% were donors or employed by NGOs; 89% held a medical degree. Stakeholders were highly supportive of physician assistants performing simple ART-related tasks and unanimous in opposing community health workers providing any ART-related services. The most commonly cited motives to implement task shifting were to increase ART access, decrease physician workload, and decrease patient wait time, whereas chief concerns included reduced quality of care and poor training and supervision. Support for task shifting was higher among clinicians than policy and programme leaders for three specific task/cadre combinations: general mid-level nurses to initiate ART in adults (supported by 75% of clinicians vs. 41% of non-clinicians) and in pregnant women (75% vs. 34%, respectively) and physician assistants to change ART regimens in adults (43% vs. 24%, respectively).
Stakeholders agreed on some ART-related task delegation to lower health worker cadres. Clinicians were more likely to support task shifting than policy and programme leaders, perhaps motivated by their front-line experiences. Harmonizing policy and programme managers' views with those of clinicians will be important to formulate and implement clear policy.
任务转移是在资源有限地区提供抗逆转录病毒治疗（ART）的常用策略，若实施得当则安全有效。利益相关者之间达成共识对于制定维持高质量医疗服务的明确国家政策至关重要。我们旨在了解莫桑比克关键利益相关者对艾滋病护理任务转移的看法，并确定利益相关者认为哪些具体任务适合哪些特定类别的卫生工作者。
特意挑选了国家和省级卫生部领导、捐助方和非政府组织（NGO）代表以及提供艾滋病护理的临床医生，以代表不同观点。通过开放式和封闭式问题，询问受访者对任务转移的总体支持情况、其潜在优缺点，以及七类非医师卫生工作者中的每一类是否应执行八项与提供抗逆转录病毒治疗相关的任务。对回答进行总体统计，并按当前工作类别分层。访谈于2007年11月至2008年6月期间进行。
在接受访谈的62名利益相关者中，44%在卫生部担任领导职务，44%是提供艾滋病护理的临床医生，13%是捐助方或受雇于非政府组织；89%拥有医学学位。利益相关者高度支持医师助理执行与抗逆转录病毒治疗相关的简单任务，并且一致反对社区卫生工作者提供任何与抗逆转录病毒治疗相关的服务。实施任务转移最常被提及的动机是增加抗逆转录病毒治疗的可及性、减轻医生工作量以及减少患者等待时间，而主要担忧包括医疗服务质量下降以及培训和监督不足。对于三种特定的任务/人员组合，临床医生对任务转移的支持高于政策和项目负责人：普通中级护士为成人启动抗逆转录病毒治疗（75%的临床医生支持，而非临床医生为41%）以及为孕妇启动治疗（分别为75%和34%），以及医师助理为成人更改抗逆转录病毒治疗方案（分别为43%和24%）。
利益相关者就一些与抗逆转录病毒治疗相关的任务委托给较低级别的卫生工作者达成了一致。临床医生比政策和项目负责人更有可能支持任务转移，这可能是受他们的一线经验所驱使。使政策和项目管理人员的观点与临床医生的观点协调一致对于制定和实施明确的政策很重要。
