Task shifting in Mozambique: Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care

Paula E. Brentlinger, Américo Assan, Florindo Mudender, Annette E. Ghee, Jose V Torres, Pilar Martínez Martínez, Oliver Bacon, Rui Bastos, Rolanda Manuel, Lucy Ramirez Li, Catherine McKinney, Lisa J. Nelson

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART).Methods: Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course.Results: In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters.The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated.Conclusions: In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.

Original languageEnglish (US)
Article number23
JournalHuman Resources for Health
Volume8
DOIs
StatePublished - Oct 12 2010
Externally publishedYes

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Mozambique
Acquired Immunodeficiency Syndrome
AIDS
HIV
Sulfamethoxazole Drug Combination Trimethoprim
evaluation
performance
Health
ministry
health
Therapeutics
Training Support
prophylaxis
cadre
Quality of Health Care
staging
Opportunistic Infections
Drug-Related Side Effects and Adverse Reactions
mentoring
WHO

ASJC Scopus subject areas

  • Public Administration
  • Public Health, Environmental and Occupational Health

Cite this

Task shifting in Mozambique : Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care. / Brentlinger, Paula E.; Assan, Américo; Mudender, Florindo; Ghee, Annette E.; Torres, Jose V; Martínez Martínez, Pilar; Bacon, Oliver; Bastos, Rui; Manuel, Rolanda; Ramirez Li, Lucy; McKinney, Catherine; Nelson, Lisa J.

In: Human Resources for Health, Vol. 8, 23, 12.10.2010.

Research output: Contribution to journalArticle

Brentlinger, PE, Assan, A, Mudender, F, Ghee, AE, Torres, JV, Martínez Martínez, P, Bacon, O, Bastos, R, Manuel, R, Ramirez Li, L, McKinney, C & Nelson, LJ 2010, 'Task shifting in Mozambique: Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care', Human Resources for Health, vol. 8, 23. https://doi.org/10.1186/1478-4491-8-23
Brentlinger, Paula E. ; Assan, Américo ; Mudender, Florindo ; Ghee, Annette E. ; Torres, Jose V ; Martínez Martínez, Pilar ; Bacon, Oliver ; Bastos, Rui ; Manuel, Rolanda ; Ramirez Li, Lucy ; McKinney, Catherine ; Nelson, Lisa J. / Task shifting in Mozambique : Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care. In: Human Resources for Health. 2010 ; Vol. 8.
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abstract = "Background: Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (t{\'e}cnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART).Methods: Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course.Results: In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6{\%}, and correctly managed co-trimoxazole prophylaxis in 71.6{\%} and ART in 75.5{\%} (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6{\%} of encounters.The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated.Conclusions: In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.",
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T2 - Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care

AU - Brentlinger, Paula E.

AU - Assan, Américo

AU - Mudender, Florindo

AU - Ghee, Annette E.

AU - Torres, Jose V

AU - Martínez Martínez, Pilar

AU - Bacon, Oliver

AU - Bastos, Rui

AU - Manuel, Rolanda

AU - Ramirez Li, Lucy

AU - McKinney, Catherine

AU - Nelson, Lisa J.

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N2 - Background: Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART).Methods: Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course.Results: In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters.The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated.Conclusions: In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.

AB - Background: Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART).Methods: Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course.Results: In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters.The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated.Conclusions: In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.

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