SynthesisJournal of the International AIDS Society2013
Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis.
Synthesis in Journal of the International AIDS Society, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The effects of decentralising antiretroviral therapy care delivery on health outcomes for adolescents and young adults in low- and middle-income countries: a systematic review.Global health action · 2019Pooled it
- Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.AIDS care · 2017Pooled it
- Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.The Cochrane database of systematic reviews · 2014Pooled it
- Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department.European journal of pediatrics · 2017Trial
- Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda.BMC public health · 2016Trial
- [Expanding team-based care for hypertension and cardiovascular risk management with HEARTS in the AmericasAmpliação da atenção baseada em equipe para a gestão do risco de hipertensão arterial e doenças cardiovasculares com a iniciativa HEARTS nas Américas].Revista panamericana de salud publica = Pan American journal of public health · 2026Article
- 'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.BMJ open respiratory research · 2025Article
- Empowerment through knowledge: Qualitative perceptions of 'undetectable equals Untransmittable' among people living with HIV and tuberculosis in South Africa.International journal of nursing studies · 2025Article
- Expanding team-based care for hypertension and cardiovascular risk management with HEARTS in the Americas.Revista panamericana de salud publica = Pan American journal of public health · 2025Article
- Nurse prescribing and dispensing in South Africa: Gaps in the current legislative framework.Health SA = SA Gesondheid · 2024Review
- Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: inter-professional training and task-sharing considerations.Human resources for health · 2021Article
- Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers.Southern African journal of HIV medicine · 2021Article
- Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up.Human resources for health · 2020Article
- Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study.BMC pregnancy and childbirth · 2019Article
- Review: A workforce in jeopardy: identifying the challenges of ensuring a sustainable advanced HIV nursing workforce.Journal of research in nursing : JRN · 2018Review
- Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d'Ivoire, Kenya, and Mozambique.International journal of STD & AIDS · 2017Article
- Overcoming Health System Challenges for Women and Children Living With HIV Through the Global Plan.Journal of acquired immune deficiency syndromes (1999) · 2017Review
- Non-physician Clinicians - A Gain for Physicians' Working in Sub-Saharan Africa Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".International journal of health policy and management · 2017Article
- Impediments and catalysts to task-shifting psychotherapeutic interventions for adolescents with PTSD: perspectives of multi-stakeholders.Child and adolescent psychiatry and mental health · 2017Article
- Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study.BMJ global health · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionA severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed.
methodsOnline databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively.
resultsMortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88-1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: -12.7-17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65-1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56-0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care.
conclusionsNon-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.