Introduction:
Shifting the task of HIV care to primary care providers is
an important strategy to sustain expanding access to antiretroviral therapy
(ART) in high HIV burden countries like Thailand. In a pilot project, the task
of following up ART-receiving patients was shifted from a physician-led HIV
clinic team based at district level community hospital, to a nurse-led primary
healthcare team of seven primary care centers, based at sub-district level in a
district of Chiang Mai in northern Thailand. This study aimed to evaluate the
task-shifted ART service in a patient-centered approach.
Methodology:
Patients’ satisfaction level was assessed cross-sectionally
in a sample of 198 patients, which included 66 people living with HIV (PLHIV)
receiving task-shifted ART service and matched controls in a ratio of 1:2. HIV
immunological outcome was compared in a retrospective cohort of a year
follow-up. Transculturally translated patient satisfaction questionnaire short
form (PSQ-18) was used. Multivariate analysis of variance compared seven
domains of patients’ satisfaction levels.
Results:
Community hospital patients expressed significantly higher
levels of satisfaction with the technical quality, communication, and time
spent by the service provider, whereas the task-shifted model patients
experienced significantly better accessibility and convenience of the service.
At the one-year follow up, CD4 counts of the two groups were not significantly
different.
Conclusion:
Future research and training programs should aim to improve
the technical quality and communication skills of nurse-led ART service teams
to shift the task of HIV care and sustain expansion of ART access in primary
care settings.
Full article at: http://goo.gl/qf9p9O
By:
Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand
doi:10.3855/jidc.7661
More at: https://twitter.com/hiv
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