A systematic review of task- shifting for HIV treatment and care in Africa.
A systematic review of task- shifting for HIV treatment and care in Africa.
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DOI：
10.1186/1478-4491-8-8
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发表时间：
2010-03-31
影响因子：
4.5
通讯作者：
Schneider H
中科院分区：
文献类型：
--
作者：
Callaghan M;Ford N;Schneider H
卫生人力资源的短缺严重阻碍了抗逆转录病毒疗法(ART)在撒哈拉以南非洲的推广。目前推出的模式是医院和医生密集型的。任务转移，或将医生执行的任务委托给资历较低的工作人员，被认为是在资源匮乏或人力资源有限的环境中扩大推广的一种手段。我们进行了系统的文献综述。用以下术语搜索Medline、Cochrane图书馆、社会科学引文索引和南非国家卫生研究数据库：任务转移*、护理平衡、非医生临床医生、替代卫生保健工作者、社区护理人员、初级卫生保健团队、干部和护士*艾滋病毒。我们挖掘了书目，并与作者通信，以获得进一步的结果。灰色文献在网上被搜索，会议记录被搜索摘要。共检索到2960篇文献，其中84篇纳入核心综述。报告了51项成果，包括来自撒哈拉以南非洲10个国家的研究。所研究的最常见的干预措施是将任务(特别是启动和监测HAART)从医生委派给护士和其他非内科临床医生。5项研究表明，通过扩大临床能力增加了获得HAART的机会；2项得出结论，任务转移是具有成本效益的；9项研究表明，工作人员的护理质量相同或更好；关于非医生临床医生与医生决定的一致性的研究喜忧参半，大多数研究表明一致性很好。任务转移是解决艾滋病毒治疗和护理中人力资源短缺的有效战略。与以医生为中心的模式相比，任务切换为更多的患者提供了高质量、高成本效益的护理。实施方面的主要挑战包括为担任新角色的工作人员提供充分和可持续的培训、支持和支付薪酬、将新成员纳入医疗团队以及监管机构的合规。在人力资源短缺威胁到推广计划的情况下，应考虑谨慎执行任务转移。
Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. We conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts. We found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement. Task shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes.
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影响因子：
2.1
作者：
Doherty, TM;Coetzee, M
通讯作者：
Coetzee, M
DOI：
10.1097/qai.0b013e3181988375
发表时间：
2009-03-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Chang LW;Alamo S;Guma S;Christopher J;Suntoke T;Omasete R;Montis JP;Quinn TC;Juncker M;Reynolds SJ
通讯作者：
Reynolds SJ
影响因子：
6.4
作者：
Bedelu, Martha;Ford, Nathan;Reuter, Hermann
通讯作者：
Reuter, Hermann
影响因子：
3.8
作者：
Koenig, SP;Léandre, F;Farmer, PE
通讯作者：
Farmer, PE
影响因子：
6
作者：
Cohen, Rachel;Lynch, Sharonann;Ford, Nathan
通讯作者：
Ford, Nathan