Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy
Suzan-Monti, M.; Blanche, J.; Boyer, S.; Kouanfack, C.; Delaporte, E.; Bonono, R-C.; Carrieri, P.M.; Protopopescu, C.; Laurent, C.; Spire, B.; Biwolé-Sida, M.; Kouanfack, C.; Koulla-Shiro, S.; Bourgeois, A.; Delaporte, E.; Laurent, C.; Peeters, M.; Laborde-Balen, G.; Dontsop, M.; Kazé, S.; Mben, J-M.; Aghokeng, A.; Edoul, M..G.; Mpoudi-Ngolé, E.; Tongo, M.; Boyer, S.; Carrieri, M..P.; Marcellin, F.; Moatti, J-P.; Spire, B.; Abé, C.; Abega, S-C.; Bonono, C-R.; Mimcheu, H.; Yebga, S..Ngo.; Bil
HIV Medicine 16(5): 307-318
2015
ISSN/ISBN: 1464-2662 PMID: 25721267 DOI: 10.1111/hiv.12213Document Number: 637320
The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon. Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation for task-shifting.
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