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The effectiveness and cost implications of task-shifting in the delivery of antiretroviral therapy to HIV-infected patients: a systematic review

Health policy and planning, 2013-05, Vol.28 (3), p.223-236 [Peer Reviewed Journal]

2013 Oxford University Press ;Copyright Oxford Publishing Limited(England) May 2013 ;ISSN: 0268-1080 ;EISSN: 1460-2237 ;DOI: 10.1093/heapol/czs058 ;PMID: 22738755 ;CODEN: HPOPEV

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Title:
The effectiveness and cost implications of task-shifting in the delivery of antiretroviral therapy to HIV-infected patients: a systematic review
Author: Mdege, Noreen Dadirai ; Chindove, Stanley ; Ali, Shehzad
Subjects: Admission ; Africa ; Anti-HIV Agents - economics ; Anti-HIV Agents - therapeutic use ; Antiretroviral drugs ; Antiretroviral therapy ; CD4 antigen ; CD4 Lymphocyte Count ; Clinical trials ; Clinics ; Cost ; Cost effectiveness ; Cost reduction ; Cost-Benefit Analysis ; Delivery of Health Care - economics ; Delivery of Health Care - methods ; Delivery of Health Care - organization & administration ; Doctors ; Effectiveness studies ; Health administration ; Health care ; Health Care Costs ; Health care delivery ; Health policy ; HIV ; HIV Infections - drug therapy ; HIV Infections - economics ; Hospitals ; Human immunodeficiency virus ; Human resources ; Humans ; Medical personnel ; Medical service ; Medication Adherence ; Medicine ; Mortality ; Nurse's Role ; Nurses ; Patients ; Physician's Role ; Physicians ; Planning ; Quality of life ; REVIEW ; Saving ; Shortages ; Sub-Saharan Africa ; Systematic review ; Treatment Outcome
Is Part Of: Health policy and planning, 2013-05, Vol.28 (3), p.223-236
Description: Introduction Human resource shortages are a challenge to the rollout of antiretroviral therapy (ART) for HIV-infected patients, particularly in sub-Saharan Africa. Taskshifting has been recommended as an approach to reduce the impact of human resource shortages. We conducted a systematic review of randomized controlled trials and quasi-experimental studies to assess the effectiveness of task-shifting, and its impact on costs of ART provision. Methods We searched MEDLINE, EMBASE, PSYCINFO, Cochrane Library, Web of Knowledge and the Current Controlled Trials Register for articles published up to January 2011. We included studies evaluating any task-shifting model against any other intervention using any of the following outcomes: mortality (all causes); occurrence of new AIDS-defining illness; virological outcomes; CD4 cell count; adherence to ART medicines (e.g. self-report and pill counts); hospital admissions; clinic visits; toxicity or adverse events; quality of life indicators; costs and cost-effectiveness. We did not pool the results because of high levels of clinical heterogeneity. Results We identified six effectiveness studies including a total of 19767 patients. Non-inferior patient outcomes were achieved with task-shifting from doctors to nurses, or from health care professionals to mid-level workers or lay health workers. However, most of the identified studies were underpowered to detect any difference. Three studies were identified on the cost implications of task-shifting. Task-shifting resulted in substantial cost and physician time savings. Conclusions The reviewed evidence suggests that task-shifting from doctors to nurses, or from health care professionals to lay health workers can potentially reduce costs of ART provision without compromising health outcomes for patients. Task-shifting is therefore a potentially effective and cost-effective approach to addressing the human resource limitations to ART rollout. However, most of the studies conducted were relatively small and more evidence is needed for each task-shifting model as it is currently limited.
Publisher: England: Oxford University Press
Language: English
Identifier: ISSN: 0268-1080
EISSN: 1460-2237
DOI: 10.1093/heapol/czs058
PMID: 22738755
CODEN: HPOPEV
Source: GFMER Free Medical Journals
MEDLINE
PubMed Central

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The effectiveness and cost implications of task-shifting in the delivery of antiretroviral therapy to HIV-infected patients: a systematic review

2013 Oxford University Press ;Copyright Oxford Publishing Limited(England) May 2013 ;ISSN: 0268-1080 ;EISSN: 1460-2237 ;DOI: 10.1093/heapol/czs058 ;PMID: 22738755 ;CODEN: HPOPEV

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