Using nurses to identify HAART eligible patients in the Republic of Mozambique: results of a time series analysis

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Using nurses to identify HAART eligible patients in the Republic of Mozambique: results of a time series analysis

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dc.contributor.author Gimbel-Sherr, Sarah O. en_US
dc.contributor.author Micek, Mark A. en_US
dc.contributor.author Gimbel-Sherr, Kenneth H. en_US
dc.contributor.author Koepsell, Thomas en_US
dc.contributor.author Hughes, James P. en_US
dc.contributor.author Thomas, Katherine K. en_US
dc.contributor.author Pfeiffer, James en_US
dc.contributor.author Gloyd, Stephen S. en_US
dc.date.accessioned 2010-04-21T15:58:10Z
dc.date.available 2010-04-21T15:58:10Z
dc.date.issued 2007 en_US
dc.identifier.citation Gimbel-Sherr S, Micek M, Gimbel-Sherr K, et al. Using nurses to identify HAART eligible patients in the Republic of Mozambique: results of a time series analysis. Human Resources for Health. 2007;5(1):7. en_US
dc.identifier.other 10.1186/1478-4491-5-7 en_US
dc.identifier.uri http://www.human-resources-health.com/content/5/1/7 en_US
dc.identifier.uri http://hdl.handle.net/1773/15791
dc.description.abstract Background: The most pressing challenge to achieving universal access to highly active anti-retroviral therapy (HAART) in sub-Saharan Africa is the shortage of trained personnel to handle the increased service requirements of rapid roll-out. Overcoming the human resource challenge requires developing innovative models of care provision that improve efficiency of service delivery and rationalize use of limited resources. Methods: We conducted a time-series intervention trial in two HIV clinics in central Mozambique to discern whether expanding the role of basic-level nurses to stage HIV-positive patients using CD4 counts and WHO-defined criteria would lead to more rapid information on patient status (including identification of HAART eligible patients), increased efficiency in the use of higher-level clinical staff, and increased capacity to start HAART-eligible patients on treatment. Results: Overall, 1,880 of the HAART-eligible patients were considered in the study of whom 48.5% started HAART, with a median time of 71 days from their initial blood draw. After adjusting for time, expanding the role of nurses to stage patients was associated with more rational use of higher-level clinical staff at one site (Beira OR 1.9, 95% CI 1.1-3.3; Chimoio OR 0.2, 95% CI 0.1-0.5). In multivariate analyses, the rate of starting HAART in patients with CD4 counts of less than 200/mm3 increased over time (HR = 1.07, 95% CI 1.02-1.13), as did the total number of new patients initiating HAART ([Beta] = 7.3, 95% CI 1.3-13.3). However, the intervention was not independently associated with either of these outcomes in multivariate analyses (HR = 0.9, 95% CI 0.7-1.2) for starting HAART in patients with CD4 counts of less than 200/mm3; ([Beta] = -5.2, p = 0.75) for the total number of new patients initiating HAART per month. No effect of the intervention was found in these outcomes when stratifying by site. Conclusion: The CD4 nurse intervention, when implemented correctly, was associated with a more rational use of higherlevel clinical providers, which may improve overall clinic flow and efficient use of the limited supply of human resources. However, this intervention did not lead to an increase in the number of patients starting HAART or a reduction in the time to HAART initiation. Study month appears to play an important role in all outcomes, suggesting that general improvements in clinic efficiency may have overshadowed the effect of the intervention. The lack of observed effect in these outcomes may be due to additional health systems bottlenecks that delay the initiation of treatment in HAART-eligible patients. en_US
dc.description.sponsorship MAM was supported in part through an STD/AIDS Research Training Grant at the time that this study was completed (NIH T32 AI 07140). KHGS is a Doris Duke Charitable Foundation (ORACTA) grant recipient. en_US
dc.language.iso en_US en_US
dc.title Using nurses to identify HAART eligible patients in the Republic of Mozambique: results of a time series analysis en_US
dc.type Article en_US


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