Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Rodriguez EM[original query] |
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Task shifting for initiation and monitoring of antiretroviral therapy for HIV-infected adults in Uganda: The SHARE Trial
Sekiziyivu AB , Bancroft E , Rodriguez EM , Sendagala S , Muniina PN , Sserunga MN , Kiragga NA , Musaazi J , Musinguzi J , Sande E , Bartholow B , Dalal S , Tusiime JB , Kambugu A . J Acquir Immune Defic Syndr 2020 86 (3) e71-e79 BACKGROUND: With countries moving towards the World Health Organization's "Treat All" recommendation, there is need to initiate more HIV-infected persons on antiretroviral therapy (ART). In resource-limited settings, task shifting is one approach that can address clinician shortages. SETTING: Uganda METHODS:: We conducted a randomized controlled trial to test if nurse-initiated and monitored antiretroviral therapy (NIMART) is non-inferior to clinician-initiated and monitored ART (CIMART) in HIV-infected adults in Uganda. Study participants were HIV-infected, ART-naïve, and clinically stable adults. The primary outcome was a composite endpoint of any of the following: all-cause mortality, virological failure, toxicity, and loss to follow up at 12 months post-ART initiation. RESULTS: Over half of the study cohort (1,760) was female (54.9%). The mean age was 35.1 years (standard deviation 9.51). Five hundred and thirty-three (31.6%) participants experienced the composite endpoint. At 12 months post-ART initiation, NIMART was non-inferior to CIMART. The intention-to-treat site-adjusted risk differences for the composite endpoint were -4.1 (97.5% CI = -9.8 to 0.2) with complete case analysis (CCA) and -3.4 (97.5% CI = -9.1 to 2.5) with multiple imputation analysis (MIA). Per-protocol site-adjusted risk differences were -3.6 (97.5% CI = -10.5 to 0.6) for CCA and -3.1 (-8.8 to 2.8) for MIA. This difference was within hypothesized margins (6%) for non-inferiority. CONCLUSIONS: Nurses were non-inferior to clinicians for initiation and monitoring of ART. Task shifting to trained nurses is a viable means to increase access to ART. Future studies should evaluate NIMART for other groups (e.g., children, adolescents, and unstable patients). |
Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce
Bikinesi L , O'Bryan G , Roscoe C , Mekonen T , Shoopala N , Mengistu AT , Sawadogo S , Agolory S , Mutandi G , Garises V , Pati R , Tison L , Igboh L , Johnson C , Rodriguez EM , Ellerbrock T , Menzies H , Baughman AL , Brandt L , Forster N , Scott J , Wood B , Unruh KT , Arora S , Iandiorio M , Kalishman S , Zalud-Cerrato S , Lehmer J , Lee S , Mahdi MA , Spedoske S , Zuber A , Reilley B , Ramers CB , Hamunime N , O'Malley G , Struminger B . Hum Resour Health 2020 18 (1) 61 BACKGROUND: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. METHODS: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. RESULTS: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. CONCLUSIONS: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation. |
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