Abstract
Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand. In a pilot project, the task of following up ART-receiving patients was shifted from a physician-led HIV clinic team based at district level community hospital, to a nurse-led primary healthcare team of seven primary care centers, based at sub-district level in a district of Chiang Mai in northern Thailand. This study aimed to evaluate the task-shifted ART service in a patient-centered approach. Patients' satisfaction level was assessed cross-sectionally in a sample of 198 patients, which included 66 people living with HIV (PLHIV) receiving task-shifted ART service and matched controls in a ratio of 1:2. HIV immunological outcome was compared in a retrospective cohort of a year follow-up. Transculturally translated patient satisfaction questionnaire short form (PSQ-18) was used. Multivariate analysis of variance compared seven domains of patients' satisfaction levels. Community hospital patients expressed significantly higher levels of satisfaction with the technical quality, communication, and time spent by the service provider, whereas the task-shifted model patients experienced significantly better accessibility and convenience of the service. At the one-year follow up, CD4 counts of the two groups were not significantly different. Future research and training programs should aim to improve the technical quality and communication skills of nurse-led ART service teams to shift the task of HIV care and sustain expansion of ART access in primary care settings.
Highlights
Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand
Results showed that the highest PSQ score within the routine ART service group was for communication, whilst the lowest score was for time spent by healthcare service provider
In the taskshifted ART service group, the highest PSQ score was for the financial aspect of the care, whereas the lowest score was for time spent by healthcare service provider
Summary
Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand. In countries where a critical shortage of healthcare workers coexists with a huge HIV burden, task shifting is a way to expand and sustain ART services at the community level [2]. One such country with a critical shortage of healthcare workers, given that it is home to more than 400,000 people living with HIV (PLHIV), is Thailand [3,4,5]. Producing health professionals is the hardest and most time-consuming part of health system
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