ArticlePloS one2013
Task-sharing of HIV care and ART initiation: evaluation of a mixed-care non-physician provider model for ART delivery in rural Malawi.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review.Implementation science : IS · 2017Pooled it
- Pooled it
- Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.The Cochrane database of systematic reviews · 2014Pooled it
- 'Empowerment' as a proximal implementation outcome for task shifting with informal cadres: findings from a qualitative study with traditional healers in rural Uganda.Implementation science communications · 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
- The development of task sharing policy and guidelines in Kenya.Human resources for health · 2022Article
- Advancing a cascading train-the-trainer model of frontline HIV service providers in South Africa: protocol of an implementation trial.Addiction science & clinical practice · 2021Article
- 'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda.BMJ global health · 2019Article
- Understanding the relationship between couple dynamics and engagement with HIV care services: insights from a qualitative study in Eastern and Southern Africa.Sexually transmitted infections · 2017Article
- Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations.Lancet (London, England) · 2017Review
- Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.PloS one · 2017Article
- Human resource constraints and the prospect of task-sharing among community health workers for the detection of early signs of pre-eclampsia in Ogun State, Nigeria.Reproductive health · 2016Article
- Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study.Journal of the International AIDS Society · 2016Article
- Editorial commentary: immunodeficiency at start of antiretroviral therapy: the persistent problem of late presentation to care.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Article
- Reversing a global health workforce crisis.Bulletin of the World Health Organization · 2015Article
- The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa.Open forum infectious diseases · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundExpanding access to antiretroviral therapy (ART) in sub-Saharan Africa requires implementation of alternative care delivery models to traditional physician-centered approaches. This longitudinal analysis compares outcomes of patients initiated on antiretroviral therapy (ART) by non-physician and physician providers.
methodsAdults (≥15 years) initiating ART between September 2007 and March 2010, and with >1 follow-up visit were included and classified according to the proportion of clinical visits performed by nurses or by clinical officers (≥ 80% of visits). Multivariable Poisson models were used to compare 2-year program attrition (mortality and lost to follow-up) and mortality by type of provider. In sensitivity analyses only patients with less severe disease were included.
resultsA total of 10,112 patients contributed 14,012 person-years to the analysis: 3386 (33.5%) in the clinical officer group, 1901 (18.8%) in the nurse care group and 4825 (47.7%) in the mixed care group. Overall 2-year program retention was 81.8%. Attrition was lower in the mixed care and higher in the clinical officer group, compared to the nurse group (adjusted incidence rate ratio [aIRR]=0.54, 95%CI 0.45-0.65; and aIRR=3.03, 95%CI 2.56-3.59, respectively). While patients initiated on ART by clinical officers in the mixed care group had lower attrition (aIRR=0.36, 95%CI 0.29-0.44) than those in the overall nurse care group; no differences in attrition were found between patients initiated on ART by nurses in the mixed care group and those included in the nurse group (aIRR=1.18, 95%CI 0.95-1.47). Two-year mortality estimates were aIRR=0.72, 95%CI 0.49-1.09 and aIRR=5.04, 95%CI 3.56-7.15, respectively. Slightly higher estimates were observed when analyses were restricted to patients with less severe disease.
conclusionThe findings of this study support the use of a mixed care model with well trained and regularly supervised nurses and medical assistants to provide HIV care in countries with high HIV prevalence.
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