TY - JOUR
T1 - Task shifting routine inpatient pediatric HIV testing improves program outcomes in urban Malawi
T2 - A retrospective observational study
AU - McCollum, Eric D.
AU - Preidis, Geoffrey A.
AU - Kabue, Mark M.
AU - Singogo, Emmanuel B.M.
AU - Mwansambo, Charles
AU - Kazembe, Peter N.
AU - Kline, Mark W.
N1 - Funding Information:
A program algorithm divided PITC into eight steps [], and the confidential patient register facilitated referrals and monitoring []. All PITC staff worked from 7:30am to 4:00pm Monday through Friday. HIV testing was not available on weekends. Government approval was obtained, and funding was acquired from the Baylor International Pediatric AIDS Initiative. Baylor International Pediatric AIDS Initiative receives primary funding from Bristol Myers Squibb, the Abbott Fund, Texas Children's Hospital, The United Nations Children's Fund, and the Malawi Ministry of Health.
PY - 2010/3/10
Y1 - 2010/3/10
N2 - Background: This study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated "task shifting," or the allocation of tasks to the least-costly, capable health worker. Methods and Findings: Two models were piloted for three months each within the pediatric department of a referral hospital in Lilongwe, Malawi between January 1 and June 30, 2008. Model 1 utilized lay counselors for HIV testing instead of nurses and clinicians. Model 2 further shifted program flow and advocacy responsibilities from counselors to volunteer parents of HIV-infected children, called "patient escorts." A retrospective review of data from 6318 hospitalized children offered HIV testing between January-December 2008 was conducted. The pilot quarters of Model 1 and Model 2 were compared, with Model 2 selected to continue after the pilot period. There was a 2-fold increase in patients offered HIV testing with Model 2 compared with Model 1 (43.1% vs 19.9%, p<0.001). Furthermore, patients in Model 2 were younger (17.3 vs 26.7 months, p<0.001) and tested sooner after admission (1.77 vs 2.44 days, p<0.001). There were no differences in test acceptance or enrollment rates into HIV care, and the program trends continued 6 months after the pilot period. Overall, 10244 HIV antibody tests (4779 maternal; 5465 child) and 453 DNA-PCR tests were completed, with 97.8% accepting testing. 19.6% of all mothers (n = 1112) and 8.5% of all children (n = 525) were HIV-infected. Furthermore, 6.5% of children were HIV-exposed (n = 405). Cumulatively, 72.9% (n = 678) of eligible children were evaluated in the hospital by a HIVtrained clinician, and 68.3% (n = 387) successfully enrolled into outpatient HIV care. Conclusions/Significance:The strategy presented here, task shifting from lay counselors alone to lay counselors and patient escorts, greatly improved program outcomes while only marginally increasing operational costs. The wider implementation of this strategy could accelerate pediatric HIV care access in high-prevalence settings.
AB - Background: This study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated "task shifting," or the allocation of tasks to the least-costly, capable health worker. Methods and Findings: Two models were piloted for three months each within the pediatric department of a referral hospital in Lilongwe, Malawi between January 1 and June 30, 2008. Model 1 utilized lay counselors for HIV testing instead of nurses and clinicians. Model 2 further shifted program flow and advocacy responsibilities from counselors to volunteer parents of HIV-infected children, called "patient escorts." A retrospective review of data from 6318 hospitalized children offered HIV testing between January-December 2008 was conducted. The pilot quarters of Model 1 and Model 2 were compared, with Model 2 selected to continue after the pilot period. There was a 2-fold increase in patients offered HIV testing with Model 2 compared with Model 1 (43.1% vs 19.9%, p<0.001). Furthermore, patients in Model 2 were younger (17.3 vs 26.7 months, p<0.001) and tested sooner after admission (1.77 vs 2.44 days, p<0.001). There were no differences in test acceptance or enrollment rates into HIV care, and the program trends continued 6 months after the pilot period. Overall, 10244 HIV antibody tests (4779 maternal; 5465 child) and 453 DNA-PCR tests were completed, with 97.8% accepting testing. 19.6% of all mothers (n = 1112) and 8.5% of all children (n = 525) were HIV-infected. Furthermore, 6.5% of children were HIV-exposed (n = 405). Cumulatively, 72.9% (n = 678) of eligible children were evaluated in the hospital by a HIVtrained clinician, and 68.3% (n = 387) successfully enrolled into outpatient HIV care. Conclusions/Significance:The strategy presented here, task shifting from lay counselors alone to lay counselors and patient escorts, greatly improved program outcomes while only marginally increasing operational costs. The wider implementation of this strategy could accelerate pediatric HIV care access in high-prevalence settings.
UR - http://www.scopus.com/inward/record.url?scp=77949673929&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77949673929&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0009626
DO - 10.1371/journal.pone.0009626
M3 - Article
C2 - 20224782
AN - SCOPUS:77949673929
SN - 1932-6203
VL - 5
JO - PloS one
JF - PloS one
IS - 3
M1 - e9626
ER -