Identifying models of HIV care and treatment service delivery in Tanzania, Uganda, and Zambia using cluster analysis and Delphi survey

Post Date: 
2017-12-06
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Countries: 
Publication: 
BMC Health Services Research
Summary: 

BACKGROUND:
Organization of HIV care and treatment services, including clinic staffing and services, may shape clinical and financial outcomes, yet there has been little attempt to describe different models of HIV care in sub-Saharan Africa (SSA). Information about the relative benefits and drawbacks of different models could inform the scale-up of antiretroviral therapy (ART) and associated services in resource-limited settings (RLS), especially in light of expanded client populations with country adoption of WHO's test and treat recommendation.

METHODS:
We characterized task-shifting/task-sharing practices in 19 diverse ART clinics in Tanzania, Uganda, and Zambia and used cluster analysis to identify unique models of service provision. We ran descriptive statistics to explore how the clusters varied by environmental factors and programmatic characteristics. Finally, we employed the Delphi Method to make systematic use of expert opinions to ensure that the cluster variables were meaningful in the context of actual task-shifting of ART services in SSA.

RESULTS:
The cluster analysis identified three task-shifting/task-sharing models. The main differences across models were the availability of medical doctors, the scope of clinical responsibility assigned to nurses, and the use of lay health care workers. Patterns of healthcare staffing in HIV service delivery were associated with different environmental factors (e.g., health facility levels, urban vs. rural settings) and programme characteristics (e.g., community ART distribution or integrated tuberculosis treatment on-site).

CONCLUSIONS:
Understanding the relative advantages and disadvantages of different models of care can help national programmes adapt to increased client load, select optimal adherence strategies within decentralized models of care, and identify differentiated models of care for clients to meet the growing needs of long-term ART patients who require more complicated treatment management.

Citation: 
Tsui S, Denison JA, Kennedy CE, Chang LW, Koole O, Torpey K, Van Praag E, Farley J, Ford N, Stuart L, Wabwire-Mangen F. Identifying models of HIV care and treatment service delivery in Tanzania, Uganda, and Zambia using cluster analysis and Delphi survey. BMC Health Serv Res. 2017 Dec 6;17(1):811. doi: 10.1186/s12913-017-2772-4.
Collaborators: 
  • Department of International Health, Johns Hopkins Bloomberg School of Public Health,  Baltimore, MD 
  • Department of International Health, Johns Hopkins Bloomberg School of Public Health,  Baltimore, MD 
  • Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium.
  • Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  • School of Public Health, University of Ghana College of Health Sciences, Accra, Ghana
  • Technical Support Division, Global Health Population and Nutrition, FHI 360, Dar es Salaam, Tanzania
  • Department of Community - Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
  • University of KwaZulu Natal, Durban, South Africa
  • Association of Nurses in AIDS Care,  Akron, OH 
  • Dept HIV, World Health Organization, Genève, Switzerland
  • FHI 360, Washington, DC
  • Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda