Abstract
BackgroundIn 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services.MethodsThe study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services. Two time periods, pre- and post-intervention, were compared using a set of endpoints. Variables distribution was explored using descriptive statistics. T-student, Mann Whitney and Chi-square tests were used for comparisons.ResultsOverall, 588 HIV infected children (F = 51.4%) were recruited, 330 belonging to the post intervention period. The mean time from referral to ARCC until initiation of ART decreased from 2.3 (± 4.4) to 1.1 (± 5.0) months after the intervention implementation (p-value: 0.000). A significant increase of Isoniazid prophylaxis (O.R.: 2.69; 95%CI: 1.7–4.15) and a decrease of both regular nutritional assessment (O.R. = 0.45; 95%CI: 0.31–0.64) and CD4 count at the beginning of ART (O.R. = 0.46; 95%CI: 0.32–0.65) were documented after the intervention.ConclusionsDespite several limitations and controversial results on nutrition assessment and CD4 count at the initiation of ART reported after the intervention, it could be assumed that TS alone may play a role in the improvement of the global effectiveness of care for HIV infected children only if integrated into a wider range of public health measures.
Highlights
In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for Human Immunodeficiency Virus (HIV) positive children < 5 years old
Two different pathways of taking charge of HIV infected children and their mothers were compared after the implementation of a second level of TS in 5 Local health facilities (LHF) of the Beira district, according to an one stop model (OSM) approach consisting in patients’ care delivered by the same provider in the same consultation in order to guarantee a continuum of care
According to our findings, the proposed new pathway of taking charge of HIV infected children under 5 years old supports the provision of the continuum of care
Summary
In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. Since 2001, according to the Prevention of Mother to Child Transmission (PMCT) Programs promoted by the World Health Organization (WHO) [2], the proportion of HIV infected pregnant women with access to the antiretroviral drugs has constantly increased, achieving 77% (69–86%) coverage worldwide in 2016 [3]. This improvement resulted in an indirect reduction of the number of HIV infected children (0–14), estimated at 150,000 (110,000–190,000) new infections in 2016, globally [3]. Notwithstanding the documented advances, only 38% (25–48%) of the HIV positive children eligible for ART were estimated to receive the treatment in 2016 [4]
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