@article{fdi:010064118,
  title = {{B}enefits 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 {C}ameroon [{S}tratall {A}gence {N}ationale de {R}echerche sur le {SIDA} ({ANRS}) 12110/{E}nsemble pour une {S}olidarit{\'e} {T}h{\'e}rapeutique {H}ospitali{\`e}re en {R}{\'e}seau ({ESTHER}) substudy]},
  author = {{S}uzan-{M}onti, {M}. and {B}lanche, {J}. and {B}oyer, {S}. and {K}ouanfack, {C}. and {D}elaporte, {E}ric and {B}onono, {R}. {C}. and {C}arrieri, {P}. {M}. and {P}rotopopescu, {C}. and {L}aurent, {C}hristian and {S}pire, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives{T}he {W}orld {H}ealth {O}rganization ({WHO}) recommends task-shifting {HIV} care to nurses in low-resource settings with limited numbers of physicians. {H}owever, the effect of such task-shifting on the health-related quality of life ({HRQL}) of people living with {HIV} ({PLHIV}) has seldom been evaluated. {W}e 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 {C}ameroon. {M}ethods{O}utcomes in {PLHIV} were longitudinally collected in the 2006-2010 {S}tratall trial. {PLHIV} were followed up for 24 months by nurses and/or physicians. {S}ix {HRQL} dimensions were assessed during face-to-face interviews using the {WHO} {Q}uality of {L}ife ({WHOQOL})-{HIV} {BREF} scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. {T}he degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). {T}he effect of task-shifting and other potential correlates on {HRQL} dimensions was explored using a {H}eckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. {R}esults{O}f 1424 visits in 440 {PLHIV} (70.5% female; median age 36 years; median {CD}4 count 188 cells/{L} at enrolment), 423 (29.7%) were task-shifted to nurses. {A}fter 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). {C}onclusions{T}ask-shifting {HIV} care to nurses benefits the {HRQL} of {PLHIV}. {T}ogether 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.},
  keywords = {antiretroviral therapy ; comprehensive care ; health-related quality of life ; {HIV}-1 ; task-shifting ; {CAMEROUN}},
  booktitle = {},
  journal = {{H}iv {M}edicine},
  volume = {16},
  numero = {5},
  pages = {307--318},
  ISSN = {1464-2662},
  year = {2015},
  DOI = {10.1111/hiv.12213},
  URL = {https://www.documentation.ird.fr/hor/fdi:010064118},
}