@article{fdi:010060386,
  title = {{T}ask shifting {HIV} care in rural district hospitals in {C}ameroon : evidence of comparable antiretroviral treatment-related outcomes between nurses and physicians in the stratall {ANRS}/{ESTHER} trial},
  author = {{B}oulle, {C}. and {K}ouanfack, {C}. and {L}aborde-{B}alen, {G}. and {C}arrieri, {M}. {P}. and {D}ontsop, {M}. and {B}oyer, {S}. and {A}ghokeng {F}obang, {A}velin and {S}pire, {B}. and {K}oulla-{S}hiro, {S}. and {D}elaporte, {E}ric and {L}aurent, {C}hristian},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {T}ask shifting to nurses for antiretroviral therapy ({ART}) is promoted by the {W}orld {H}ealth {O}rganization to compensate for the severe shortage of physicians in {A}frica. {W}e assessed the effectiveness of task shifting from physicians to nurses in rural district hospitals in {C}ameroon. {M}ethods: {W}e performed a cohort study using data from the {S}tratall trial, designed to assess monitoring strategies in 2006-2010. {ART}-naive patients were followed up for 24 months after treatment initiation. {C}linical visits were performed by nurses or physicians. {W}e assessed the associations between the consultant ratio (ie, the ratio of the number of nurse-led visits to the number of physician-led visits) and {HIV} virological success, {CD}4 recovery, mortality, and disease progression to death or to the {W}orld {H}ealth {O}rganization clinical stage 4 in multivariate analyses. {R}esults: {O}f the 4141 clinical visits performed in 459 patients (70.6% female, median age 37 years), a quarter was task shifted to nurses. {T}he consultant ratio was not significantly associated with virological success [odds ratio 1.00, 95% confidence interval ({CI}): 0.59 to 1.72, {P} = 0.990], {CD}4 recovery (coefficient 23.6, 95% {CI}: 235.6; 28.5, {P} = 0.827), mortality (time ratio 1.39, 95% {CI}: 0.27 to 7.06, {P} = 0.693), or disease progression (time ratio 1.60, 95% {CI}: 0.35 to 7.37, {P} = 0.543). {C}onclusions: {T}his study brings important evidence about the comparability of {ART}-related outcomes between {HIV} models of care based on physicians or nurses in resource-limited settings. {I}nvesting in nursing resources for the management of noncomplex patients should help reduce costs and patient waiting lists while freeing up physician time for the management of complex cases, for mentoring and supervision activities, and for other health interventions.},
  keywords = {{A}frica ; antiretroviral ; effectiveness ; {HIV} ; nurse ; task shifting ; {CAMEROUN}},
  booktitle = {},
  journal = {{J}aids.{J}ournal of {A}cquired {I}mmune {D}eficiency {S}yndromes},
  volume = {62},
  numero = {5},
  pages = {569--576},
  ISSN = {1525-4135},
  year = {2013},
  DOI = {10.1097/{QAI}.0b013e318285f7b6},
  URL = {https://www.documentation.ird.fr/hor/fdi:010060386},
}