Author: Mark Mascolini
04 February 2010
HIV care from nonphysician clinicians (NPCs) at two public clinics in central Mozambique proved as effective as—or more effective than—physician care for adults starting antiretroviral therapy (ART), according to results of a retrospective cohort study.
Nonphysician health workers play an increasingly important role in low- and middle-income countries striving to expand HIV care. They can relieve clinicians of some responsibilities, freeing their time for more difficult aspects of care.
This retrospective study used computerized records to compare certain aspects of care in 5892 nonpregnant adults starting ART from July 2004 through October 2007 at two public HIV clinics. The study included 5892 people, 4093 of them (69.5%) initially cared for by an NPC and 1799 (30.5%) initially cared for by a physician.
People initially cared for by an NPC were more likely to have their CD4 count measured in the 90 to 210 days after starting ART (risk ratio [RR] 1.13, 1.04 < RR < 1.23) and 330 to 390 days after starting (RR 1.12, a nonsignificant difference, 0.96 < RR < 1.31).
Patients treated first by an NPC had more clinic visits in the first year of ART than did those initially treated by a physician (RR 1.02, 1.00< RR <1.05). Adherence to ART in the first 6 months of treatment proved significantly better in the NPC group than in the physician group (RR 1.05, 1.02 < RR 1.09). And NPC patients were less likely to stop returning for clinic visits (RR 0.86, 0.73 < RR <1.02).
The authors believe their results “highlight the important role of NPCs 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.”
Source: K.H. Sherr, M.A. Micek, S.O. Gimbel, S.S. Gloyd, J.P. Hughes, G.C. John-Stewart, R.M. Manjate, J. Pfeiffer, N.S. Weiss. Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study. AIDS. 2010;24 Suppl 1:S59-S66.
For the study abstract
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