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

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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 (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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ASJC Scopus subject areas

  • Public Administration
  • Public Health, Environmental and Occupational Health

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Brentlinger, P. E., Assan, A., Mudender, F., Ghee, A. E., Torres, J. V., Martínez Martínez, P., Bacon, O., Bastos, R., Manuel, R., Ramirez Li, L., McKinney, C., & Nelson, L. J. (2010). Task shifting in Mozambique: Cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care. Human Resources for Health, 8, [23]. https://doi.org/10.1186/1478-4491-8-23