Task shifting in HIV clinics, Western Kenya

Area of Science:

• Public Health
• Infectious Disease Management
• Healthcare Delivery Models

Background:

• The United States Agency for International Development-Academic Model for Providing Accesses to Healthcare (USAID-AMPATH) supports over 80,000 HIV-infected patients.
• The Express Care (EC) model was developed to manage challenges in caring for clinically stable patients on combined antiretroviral therapy (cART) and high-risk patients newly initiated on cART with low CD4 counts.

Purpose of the Study:

• To enhance patient outcomes within existing clinic resources.
• To evaluate the feasibility of the EC model in managing HIV-infected patients.

Main Methods:

• A descriptive study was conducted utilizing a clinician-supervised shared nurse model.
• The study took place at USAID-AMPATH clinics in Western Kenya.

Main Results:

• Out of 4,824 patients, 90.4% were eligible for EC, with 34.6% enrolled.
• Nurses managed the majority of visits for both stable (two-thirds) and high-risk (three-quarters) patients.
• Clinicians managed remaining visits for stable and high-risk patients, along with all visits ineligible for EC.

Conclusions:

• The EC model is a feasible strategy for HIV patient management.
• Task shifting to nurses enables efficient care for stable patients.
• This model allows clinicians more time for newly diagnosed and critically ill patients.