Task Shifting Routine Inpatient Pediatric HIV Testing Improves Program Outcomes in Urban Malawi: A Retrospective Observational Study
Task Shifting Routine Inpatient Pediatric HIV Testing Improves Program Outcomes in Urban Malawi: A Retrospective Observational Study
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DOI：
10.1371/journal.pone.0009626
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发表时间：
2010-03-10
期刊：
影响因子：
3.7
通讯作者：
Kline, Mark W.
中科院分区：
文献类型：
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作者：
McCollum, Eric D.;Preidis, Geoffrey A.;Kline, Mark W.
背景：本研究评估了艾滋病毒高流行且资源有限的非洲地区住院儿童的两种常规艾滋病毒检测模型。两种模型都纳入了“任务转移”，即把任务分配给成本最低、有能力的卫生工作者。方法和结果：2008 年 1 月 1 日至 6 月 30 日期间，两种模型在马拉维利隆圭一家转诊医院的儿科部门试行了三个月。模型 1 利用非专业咨询师而不是护士和临床医生进行艾滋病毒检测。模型 2 进一步将项目流程和宣传责任从咨询师转移到艾滋病毒感染儿童的志愿者父母身上，我们对 2008 年 1 月至 12 月期间接受 HIV 检测的 6318 名住院儿童的数据进行了回顾性审查。对模型1和模型2的试点进行了比较，模型2选择在试点期结束后继续进行。与模型 1 相比，使用模型 2 进行 HIV 检测的患者数量增加了 2 倍（43.1% vs 19.9%，p < 0.001）。此外，模型 2 中的患者更年轻（17.3 个月 vs 26.7 个月，p < 0.001）并且入院后更早进行测试（1.77 天 vs 2.44 天，p < 0.001）。 HIV 护理的测试接受率或登记率没有差异，并且该计划趋势在试点期后 6 个月内持续存在。总体而言，已完成 10244 项 HIV 抗体检测（4779 名孕产妇；5465 名儿童）和 453 项 DNA-PCR 检测，其中 97.8% 接受检测。 19.6% 的母亲 (n = 1112) 和 8.5% 的儿童 (n = 525) 感染艾滋病毒。此外，6.5% 的儿童感染了艾滋病毒（n = 405）。累计，72.9% (n = 678) 的合格儿童在医院接受了经过 HIV 培训的临床医生的评估，68.3% (n = 387) 成功加入门诊 HIV 护理。 结论/意义：本文提出的策略，将任务从非专业咨询师单独转移到非专业咨询师和患者陪同，极大地改善了项目成果，同时仅略微增加了运营成本。更广泛地实施这一战略可以加速高流行地区儿童艾滋病毒护理的获得。
Background: This study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated "task shifting,'' or the allocation of tasks to the least-costly, capable health worker.Methods and Findings: Two models were piloted for three months each within the pediatric department of a referral hospital in Lilongwe, Malawi between January 1 and June 30, 2008. Model 1 utilized lay counselors for HIV testing instead of nurses and clinicians. Model 2 further shifted program flow and advocacy responsibilities from counselors to volunteer parents of HIV-infected children, called "patient escorts.'' A retrospective review of data from 6318 hospitalized children offered HIV testing between January-December 2008 was conducted. The pilot quarters of Model 1 and Model 2 were compared, with Model 2 selected to continue after the pilot period. There was a 2-fold increase in patients offered HIV testing with Model 2 compared with Model 1 (43.1% vs 19.9%, p < 0.001). Furthermore, patients in Model 2 were younger (17.3 vs 26.7 months, p < 0.001) and tested sooner after admission (1.77 vs 2.44 days, p < 0.001). There were no differences in test acceptance or enrollment rates into HIV care, and the program trends continued 6 months after the pilot period. Overall, 10244 HIV antibody tests (4779 maternal; 5465 child) and 453 DNA-PCR tests were completed, with 97.8% accepting testing. 19.6% of all mothers (n = 1112) and 8.5% of all children (n = 525) were HIV-infected. Furthermore, 6.5% of children were HIV-exposed (n = 405). Cumulatively, 72.9% (n = 678) of eligible children were evaluated in the hospital by a HIV-trained clinician, and 68.3% (n = 387) successfully enrolled into outpatient HIV care.Conclusions/Significance: The strategy presented here, task shifting from lay counselors alone to lay counselors and patient escorts, greatly improved program outcomes while only marginally increasing operational costs. The wider implementation of this strategy could accelerate pediatric HIV care access in high-prevalence settings.