Task-sharing with nurses to enhance access to HIV treatment in Côte d’Ivoire.

Abstract

OBJECTIVE: We report the first national programme in Côte d’Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services.

METHODS: Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics.

RESULTS: A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care.

CONCLUSION: Task-sharing of HIV care and ART initiation with nurses in Côte d’Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d’Ivoire.

 

Citation: McNairy ML, Bashi JB, Chung H, Wemin L, Lorng MA, Brou H, Nioble C, Lokossué A, Abo K, Achi D, Ouattara K, Sess D, Sanogo PA, Ekra A, Ettiegne-Traore V,Diabate CJ, Abrams EJ, El-Sadr WM. Task-sharing with nurses to enhance access to HIV treatment in Côte d’Ivoire. Trop Med Int Health. 2017 Jan 18. (Epub ahead of print). Link to PubMed >>

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