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 language | English (US) |
|---|---|
| Article number | 23 |
| Journal | Human Resources for Health |
| Volume | 8 |
| DOIs | |
| State | Published - Oct 12 2010 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Task shifting in Mozambique
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.
PY - 2010/10/12
Y1 - 2010/10/12
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.
UR - http://www.scopus.com/inward/record.url?scp=77957740267&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957740267&partnerID=8YFLogxK
U2 - 10.1186/1478-4491-8-23
DO - 10.1186/1478-4491-8-23
M3 - Article
C2 - 20939909
AN - SCOPUS:77957740267
VL - 8
JO - Human Resources for Health
JF - Human Resources for Health
SN - 1478-4491
M1 - 23
ER -