Task shifting for the delivery of pediatric antiretroviral treatment: a systematic review

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Martina Penazzato1, Mary-Ann Davies, Tsitsi Apollo

  • 1*HIV/AIDS Department, World Health Organization, Geneva, Switzerland; †Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; and ‡HIV and AIDS Department, Ministry of Health and Social Welfare, Harare, Zimbabwe.

Journal of Acquired Immune Deficiency Syndromes (1999)
|March 4, 2014
PubMed

Insights

Task shifting for pediatric antiretroviral therapy (ART) in resource-limited settings is effective. Outcomes in children receiving ART from nonphysician providers were comparable to specialist care, supporting task shifting to improve treatment access.

Area of Science:

  • Public Health
  • Pediatrics
  • Infectious Diseases

Background:

  • Pediatric antiretroviral treatment (ART) coverage lags in resource-limited settings.
  • Task shifting, while effective for adults, faces implementation challenges in pediatric care due to staff confidence and skills.
  • Limited access to specialist care impacts children requiring ART.

Purpose of the Study:

  • To evaluate the effectiveness and outcomes of task shifting for pediatric antiretroviral therapy (ART) in resource-limited settings.
  • To compare outcomes of pediatric ART managed by nonphysician providers versus specialist care.
  • To inform strategies for scaling up pediatric ART coverage.

Main Methods:

  • Systematic review of observational studies on task shifting and pediatric ART.
  • Searched five databases and two conferences from inception to August 2013.
  • Included studies with outcome data for children receiving ART from nonphysician providers.

Main Results:

  • Eight observational studies analyzed data for 11,828 children across 10 sub-Saharan African countries.
  • Pooled mortality rates at 6, 12, 24, and 36 months were 3.2%, 4.6%, 6.2%, and 5.9%, respectively.
  • Mortality and loss to follow-up were comparable to physician-led care programs.

Conclusions:

  • Task shifting for pediatric ART yields outcomes comparable to routine physician care.
  • This approach should be integrated into strategies to scale-up pediatric treatment access.
  • Specialist care remains crucial for complex pediatric cases; further research on implementation is needed.
Abstract

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