Farahani Mansoor, Price Natalie, El-Halabi Shenaaz, Mlaudzi Naledi, Keapoletswe Koona, Lebelonyane Refeletswe, Fetogang Ernest Benny, Chebani Tony, Kebaabetswe Poloko, Masupe Tiny, Gabaake Keba, Auld Andrew F, Nkomazana Oathokwa, Marlink Richard
Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
Ministry of Health, Gaborone, Botswana.
PLoS One. 2016 Aug 4;11(8):e0160206. doi: 10.1371/journal.pone.0160206. eCollection 2016.
To measure the association between the number of doctors, nurses and hospital beds per 10,000 people and individual HIV-infected patient outcomes in Botswana.
Analysis of routinely collected longitudinal data from 97,627 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. Doctors, nurses, and hospital bed density data at district-level were collected from various sources.
A multilevel, longitudinal analysis method was used to analyze the data at both patient- and district-level simultaneously to measure the impact of the health system input at district-level on probability of death or loss-to-follow-up (LTFU) at the individual level. A marginal structural model was used to account for LTFU over time.
Increasing doctor density from one doctor to two doctors per 10,000 population decreased the predicted probability of death for each patient by 27%. Nurse density changes from 20 nurses to 25 nurses decreased the predicted probability of death by 28%. Nine percent decrease was noted in predicted mortality of an individual in the Masa program for every five hospital bed density increase.
Considerable variation was observed in doctors, nurses, and hospital bed density across health districts. Predictive margins of mortality and LTFU were inversely correlated with doctor, nurse and hospital bed density. The doctor density had much greater impact than nurse or bed density on mortality or LTFU of individual patients. While long-term investment in training more healthcare professionals should be made, redistribution of available doctors and nurses can be a feasible solution in the short term.
衡量博茨瓦纳每万人中医生、护士数量及医院病床数与个体艾滋病毒感染患者治疗结果之间的关联。
对2002年至2013年期间通过博茨瓦纳国家艾滋病毒/艾滋病治疗项目在所有24个卫生区接受抗逆转录病毒治疗的97627名患者的常规收集的纵向数据进行分析。从不同来源收集了各地区的医生、护士和医院病床密度数据。
采用多层次纵向分析方法，同时在患者和地区层面分析数据，以衡量地区层面卫生系统投入对个体层面死亡或失访概率的影响。使用边际结构模型来考虑随时间的失访情况。
每万人口中医生密度从1名增加到2名，每位患者的预测死亡概率降低27%。护士密度从20名增加到25名，预测死亡概率降低28%。每增加五张医院病床密度，马萨项目中个体的预测死亡率下降9%。
各卫生区的医生、护士和医院病床密度存在很大差异。死亡率和失访的预测边际与医生、护士和医院病床密度呈负相关。医生密度对个体患者的死亡率或失访率的影响远大于护士或病床密度。虽然应长期投资培训更多医疗专业人员，但短期内重新分配现有医生和护士可能是一个可行的解决方案。
