Health Alliance International, Abidjan, Côte d'Ivoire.
Department of Global Health, University of Washington, Seattle, USA.
Hum Resour Health. 2022 Feb 19;20(1):18. doi: 10.1186/s12960-022-00715-2.
The purpose of this study was to assess the distribution of HIV-program staff and the extent to which their availability influences HIV programmatic and patient outcomes.
The study was a facility level cross-sectional survey. Data from October 2018 to September 2019 were abstracted from HIV program reports conducted in 18 districts of Côte d'Ivoire. The distribution of staff in clinical, laboratory, pharmacy, management, lay, and support cadres were described across high and low antiretroviral therapy (ART) volume facilities. Non-parametric regression was used to estimate the effects of cadre categories on the number of new HIV cases identified, the number of cases initiated on ART, and the proportion of patients achieving viral load suppression.
Data from 49,871 patients treated at 216 health facilities were included. Low ART volume facilities had a median of 8.1 staff-per-100 ART patients, significantly higher than the 4.4 staff-per-100 ART patients at high-ART volume facilities. One additional laboratory staff member was associated with 4.30 (IQR: 2.00-7.48, p < 0.001) more HIV cases identified and 3.81 (interquartile range [IQR]: 1.44-6.94, p < 0.001) additional cases initiated on ART. Similarly, one additional lay worker was associated with 2.33 (IQR: 1.00-3.43, p < 0.001) new cases identified and 2.24 (IQR: 1.00-3.31, p < 0.001) new cases initiated on ART. No cadres were associated with viral suppression.
HCWs in the laboratory and lay cadre categories were associated with an increase in HIV-positive case identification and initiation on ART. Our findings suggest that allocation of HCWs across health facilities should take into consideration the ART patient volume. Overall, increasing investment in health workforce is critical to achieve national HIV goals and reaching HIV epidemic control.
本研究旨在评估 HIV 规划工作人员的分布情况，以及其可及性对 HIV 规划和患者结局的影响程度。
本研究为设施层面的横断面调查。2018 年 10 月至 2019 年 9 月期间，从科特迪瓦 18 个区的 HIV 规划报告中提取数据。描述了临床、实验室、药房、管理、非专业人员和支持人员在高和低抗逆转录病毒治疗（ART）量设施中的分布情况。采用非参数回归估计干部类别对新发现的 HIV 病例数、开始接受 ART 的病例数以及病毒载量抑制的患者比例的影响。
共纳入了 216 家卫生机构的 49871 名治疗患者的数据。低 ART 量设施的每 100 名 ART 患者中有 8.1 名工作人员，显著高于高 ART 量设施的每 100 名 ART 患者中有 4.4 名工作人员。每增加一名实验室工作人员，与发现的 HIV 病例数增加 4.30（IQR：2.00-7.48，p<0.001）和开始接受 ART 的病例数增加 3.81（IQR：1.44-6.94，p<0.001）相关。同样，每增加一名非专业人员与发现的 2.33 例（IQR：1.00-3.43，p<0.001）新病例和开始接受 ART 的 2.24 例（IQR：1.00-3.31，p<0.001）新病例相关。没有干部与病毒抑制相关。
实验室和非专业人员干部类别的卫生工作者与 HIV 阳性病例的发现和开始接受 ART 治疗的增加有关。我们的研究结果表明，卫生设施内卫生工作者的分配应考虑 ART 患者量。总体而言，增加卫生人力投资对于实现国家艾滋病毒目标和达到艾滋病毒流行控制至关重要。
