Satisfaction of HIV Patients with Task-Shifted Primary Care Service vs Routine Hospital Service in Northern Thailand

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:  Myo Nyein Aung, Saiyud Moolphate, Tsutomu Kitajima, Yaowaluk Siriwarothai, Piyaporn Takamtha, Chitima Katanyoo　, Hiroshi Okamura, Malcom Field, Osamu Noyama, Pongsak Wannakrairot, Virat Klinbuayaem

Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

doi:10.3855/jidc.7661

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Task-Shifting and Quality of HIV Testing Services: Experiences from a National Reference Hospital in Zambia

Background

With new testing technologies, task-shifting and rapid scale-up of HIV testing services in high HIV prevalence countries, assuring quality of HIV testing is paramount. This study aimed to explore various cadres of providers’ experiences in providing HIV testing services and their understanding of elements that impact on quality of service in Zambia.

Methods

Sixteen in-depth interviews and two focus group discussions were conducted with HIV testing service providers including lay counselors, nurses and laboratory personnel at purposively selected HIV testing sites at a national reference hospital in Lusaka. Qualitative content analysis was adopted for data analysis.

Results

Lay counselors and nurses reported confidentiality and privacy to be greatly compromised due to limited space in both in- and out-patient settings. Difficulties in upholding consent were reported in provider-initiated testing in in-patient settings. The providers identified non-adherence to testing procedures, high workload and inadequate training and supervision as key elements impacting on quality of testing. Difficulties related to testing varied by sub-groups of providers: lay counselors, in finger pricking and obtaining adequate volumes of specimen; non-laboratory providers in general, in interpreting invalid, false-negative and false-positive results. The providers had been participating in a recently established national HIV quality assurance program, i.e. proficiency testing, but rarely received site supervisory visits.

Conclusion

Task-shifting coupled with policy shifts in service provision has seriously challenged HIV testing quality, protection of confidentiality and the process of informed consent. Ways to better protect confidentiality and informed consent need careful attention. Training, supervision and quality assurance need strengthening tailored to the needs of the different cadres of providers.

Below:  Providers’ experiences in HIV testing service provision and their understanding of elements impacting on quality

Full article at:   http://goo.gl/M2Iz6F

By:

Sheila Mwangala, Hope C. Nkamba, Kunda G. Musonda, Mwaka Monze, Katoba K. Musukwa

Virology Laboratory, Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia

Sheila Mwangala, Karen M. Moland, Knut Fylkesnes

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

Kunda G. Musonda

Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom

Knut Fylkesnes

Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia

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