STRETCHing HIV treatment: A replication study of task shifting in South Africa
The Streamlining Tasks & Roles to Expand Treatment and Care for HIV (STRETCH) program was developed to increase the reach of antiretroviral therapy (ART) for HIV/AIDS patients in Sub-Saharan Africa by training nurses to prescribe, initiate, and maintain ART. Fairall and colleagues conducted a cl...
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| description | The Streamlining Tasks & Roles to Expand Treatment and Care for HIV (STRETCH) program was developed to increase the reach of antiretroviral therapy (ART) for HIV/AIDS patients in Sub-Saharan Africa by training nurses to prescribe, initiate, and maintain ART. Fairall and colleagues conducted a cluster-randomized trial to determine the effects/impact of STRETCH on patient health outcomes in South Africa between 2008 and 2010. The purpose of our replication study is to evaluate Fairall and colleagues' findings. We conducted push button and pure replication studies and measurement and estimation analyses (MEA). Our MEA validates the original findings: (1) overall, time to death did not differ between intervention (STRETCH) and control (ART) patients; (2) in a subgroup analysis of patients with CD4 counts of 201-350 cells per μL, the intervention group patients had a 30% lower risk of death than those in the control group, when controlling for baseline characteristics; (3) in a subgroup analysis of patients with CD4 counts of ≤200 cells per μL, time to death did not differ between the two groups; and (4) rates of viral suppression one year after enrollment did not differ between the intervention and control groups. This set of results have more caveats in the MEA. Although the intervention did not lead to improvements in the main outcomes, the effectiveness of STRETCH was proven to be similar to standard care while increasing the pool of prescribers, expanding their geographical range, and improving the quality of care for patients. Therefore, our analyses support the implementation of task shifting of antiretroviral therapy from doctors to trained nurses, which enhances confidence in the implementation of the intervention program and policymaking not only in South Africa but also in other developing countries that have similar circumstances. |
| doi_str_mv | 10.1371/journal.pone.0206677 |
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Fairall and colleagues conducted a cluster-randomized trial to determine the effects/impact of STRETCH on patient health outcomes in South Africa between 2008 and 2010. The purpose of our replication study is to evaluate Fairall and colleagues' findings. We conducted push button and pure replication studies and measurement and estimation analyses (MEA). Our MEA validates the original findings: (1) overall, time to death did not differ between intervention (STRETCH) and control (ART) patients; (2) in a subgroup analysis of patients with CD4 counts of 201-350 cells per μL, the intervention group patients had a 30% lower risk of death than those in the control group, when controlling for baseline characteristics; (3) in a subgroup analysis of patients with CD4 counts of ≤200 cells per μL, time to death did not differ between the two groups; and (4) rates of viral suppression one year after enrollment did not differ between the intervention and control groups. This set of results have more caveats in the MEA. Although the intervention did not lead to improvements in the main outcomes, the effectiveness of STRETCH was proven to be similar to standard care while increasing the pool of prescribers, expanding their geographical range, and improving the quality of care for patients. Therefore, our analyses support the implementation of task shifting of antiretroviral therapy from doctors to trained nurses, which enhances confidence in the implementation of the intervention program and policymaking not only in South Africa but also in other developing countries that have similar circumstances.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0206677</identifier><identifier>PMID: 30958829</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Acquired Immunodeficiency Syndrome - blood ; Acquired Immunodeficiency Syndrome - drug therapy ; Acquired Immunodeficiency Syndrome - epidemiology ; Adult ; AIDS ; AIDS treatment ; Anti-HIV Agents - administration & dosage ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Care and treatment ; CD4 antigen ; CD4 Lymphocyte Count ; Datasets ; Death ; Developing countries ; Dosage and administration ; Drug therapy ; Female ; Generalized linear models ; Health ; Highly active antiretroviral therapy ; HIV ; Human immunodeficiency virus ; Humans ; Intervention ; LDCs ; Male ; Medical care quality ; Medical personnel ; Medicine and Health Sciences ; Mortality ; Nurses ; Patients ; People and Places ; Physicians ; Primary care ; Quality ; Quality of care ; Replication ; Research and Analysis Methods ; South Africa - epidemiology ; Statistical methods ; Streamlining ; Studies ; Subgroups ; Therapy ; Tuberculosis ; Variables ; Virus replication</subject><ispartof>PloS one, 2019-04, Vol.14 (4), p.e0206677-e0206677</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Chen, Alam. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Chen, Alam 2019 Chen, Alam</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-15743f18189c15004a64715b954f05f3fc8b32460ab0d8696c8ba974da5c3f9c3</citedby><orcidid>0000-0002-9683-9390</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453457/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453457/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23853,27911,27912,53778,53780,79355,79356</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30958829$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ojikutu, Bisola O.</contributor><creatorcontrib>Chen, Baojiang</creatorcontrib><creatorcontrib>Alam, Morshed</creatorcontrib><title>STRETCHing HIV treatment: A replication study of task shifting in South Africa</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The Streamlining Tasks & Roles to Expand Treatment and Care for HIV (STRETCH) program was developed to increase the reach of antiretroviral therapy (ART) for HIV/AIDS patients in Sub-Saharan Africa by training nurses to prescribe, initiate, and maintain ART. Fairall and colleagues conducted a cluster-randomized trial to determine the effects/impact of STRETCH on patient health outcomes in South Africa between 2008 and 2010. The purpose of our replication study is to evaluate Fairall and colleagues' findings. We conducted push button and pure replication studies and measurement and estimation analyses (MEA). Our MEA validates the original findings: (1) overall, time to death did not differ between intervention (STRETCH) and control (ART) patients; (2) in a subgroup analysis of patients with CD4 counts of 201-350 cells per μL, the intervention group patients had a 30% lower risk of death than those in the control group, when controlling for baseline characteristics; (3) in a subgroup analysis of patients with CD4 counts of ≤200 cells per μL, time to death did not differ between the two groups; and (4) rates of viral suppression one year after enrollment did not differ between the intervention and control groups. This set of results have more caveats in the MEA. Although the intervention did not lead to improvements in the main outcomes, the effectiveness of STRETCH was proven to be similar to standard care while increasing the pool of prescribers, expanding their geographical range, and improving the quality of care for patients. Therefore, our analyses support the implementation of task shifting of antiretroviral therapy from doctors to trained nurses, which enhances confidence in the implementation of the intervention program and policymaking not only in South Africa but also in other developing countries that have similar circumstances.</description><subject>Acquired immune deficiency syndrome</subject><subject>Acquired Immunodeficiency Syndrome - blood</subject><subject>Acquired Immunodeficiency Syndrome - drug therapy</subject><subject>Acquired Immunodeficiency Syndrome - epidemiology</subject><subject>Adult</subject><subject>AIDS</subject><subject>AIDS treatment</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Datasets</subject><subject>Death</subject><subject>Developing countries</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Generalized linear models</subject><subject>Health</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Intervention</subject><subject>LDCs</subject><subject>Male</subject><subject>Medical care quality</subject><subject>Medical personnel</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Primary care</subject><subject>Quality</subject><subject>Quality of care</subject><subject>Replication</subject><subject>Research and Analysis Methods</subject><subject>South Africa - epidemiology</subject><subject>Statistical methods</subject><subject>Streamlining</subject><subject>Studies</subject><subject>Subgroups</subject><subject>Therapy</subject><subject>Tuberculosis</subject><subject>Variables</subject><subject>Virus replication</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl1v0zAYhSMEYlvhHyCIhITgosWOP2JzgVRNwCpNTFrHbi3HsVuXNO5sZ2L_HmfNpgbtAuUiifOcY78nJ8veQDCDqISfN67zrWxmO9fqGSgApWX5LDuGHBVTWgD0_OD5KDsJYQMAQYzSl9kRApwwVvDj7Ofy6vLb1emZbVf52eI6j17LuNVt_JLPc693jVUyWtfmIXb1Xe5MHmX4nYe1NbHX2DZfui6u87nxCX2VvTCyCfr1cJ9kv7739tPzix-L0_n5VFFexCkkJUYGMsi4ggQALCkuIak4wQYQg4xiFSowBbICNaOcpnfJS1xLopDhCk2yd3vfXeOCGKIIoijSiDxNiROx2BO1kxux83Yr_Z1w0or7BedXQvpoVaNFysQwxAFihmIAcYVArRiqMC9NyRhKXl-H3bpqq2uV4vGyGZmOv7R2LVbuVlBMECZlMvg4GHh30-kQxdYGpZtGttp19-emBYJlOsMke_8P-vR0A7WSaQDbGpf2Vb2pmBMGKUeE9NTsCSpdtd5alXpjbFofCT6NBImJ-k9cyS4EsVhe_j97cT1mPxyway2buA6u6fpmhTGI96DyLgSvzWPIEIi-9g9piL72Yqh9kr09_EGPooeeo78BK_lr</recordid><startdate>20190408</startdate><enddate>20190408</enddate><creator>Chen, Baojiang</creator><creator>Alam, Morshed</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9683-9390</orcidid></search><sort><creationdate>20190408</creationdate><title>STRETCHing HIV treatment: A replication study of task shifting in South Africa</title><author>Chen, Baojiang ; Alam, Morshed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-15743f18189c15004a64715b954f05f3fc8b32460ab0d8696c8ba974da5c3f9c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Acquired Immunodeficiency Syndrome - blood</topic><topic>Acquired Immunodeficiency Syndrome - drug therapy</topic><topic>Acquired Immunodeficiency Syndrome - epidemiology</topic><topic>Adult</topic><topic>AIDS</topic><topic>AIDS treatment</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Datasets</topic><topic>Death</topic><topic>Developing countries</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Generalized linear models</topic><topic>Health</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Intervention</topic><topic>LDCs</topic><topic>Male</topic><topic>Medical care quality</topic><topic>Medical personnel</topic><topic>Medicine and Health Sciences</topic><topic>Mortality</topic><topic>Nurses</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physicians</topic><topic>Primary care</topic><topic>Quality</topic><topic>Quality of care</topic><topic>Replication</topic><topic>Research and Analysis Methods</topic><topic>South Africa - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Baojiang</au><au>Alam, Morshed</au><au>Ojikutu, Bisola O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>STRETCHing HIV treatment: A replication study of task shifting in South Africa</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-04-08</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>e0206677</spage><epage>e0206677</epage><pages>e0206677-e0206677</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The Streamlining Tasks & Roles to Expand Treatment and Care for HIV (STRETCH) program was developed to increase the reach of antiretroviral therapy (ART) for HIV/AIDS patients in Sub-Saharan Africa by training nurses to prescribe, initiate, and maintain ART. Fairall and colleagues conducted a cluster-randomized trial to determine the effects/impact of STRETCH on patient health outcomes in South Africa between 2008 and 2010. The purpose of our replication study is to evaluate Fairall and colleagues' findings. We conducted push button and pure replication studies and measurement and estimation analyses (MEA). Our MEA validates the original findings: (1) overall, time to death did not differ between intervention (STRETCH) and control (ART) patients; (2) in a subgroup analysis of patients with CD4 counts of 201-350 cells per μL, the intervention group patients had a 30% lower risk of death than those in the control group, when controlling for baseline characteristics; (3) in a subgroup analysis of patients with CD4 counts of ≤200 cells per μL, time to death did not differ between the two groups; and (4) rates of viral suppression one year after enrollment did not differ between the intervention and control groups. This set of results have more caveats in the MEA. Although the intervention did not lead to improvements in the main outcomes, the effectiveness of STRETCH was proven to be similar to standard care while increasing the pool of prescribers, expanding their geographical range, and improving the quality of care for patients. Therefore, our analyses support the implementation of task shifting of antiretroviral therapy from doctors to trained nurses, which enhances confidence in the implementation of the intervention program and policymaking not only in South Africa but also in other developing countries that have similar circumstances.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30958829</pmid><doi>10.1371/journal.pone.0206677</doi><tpages>e0206677</tpages><orcidid>https://orcid.org/0000-0002-9683-9390</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acquired immune deficiency syndrome Acquired Immunodeficiency Syndrome - blood Acquired Immunodeficiency Syndrome - drug therapy Acquired Immunodeficiency Syndrome - epidemiology Adult AIDS AIDS treatment Anti-HIV Agents - administration & dosage Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Care and treatment CD4 antigen CD4 Lymphocyte Count Datasets Death Developing countries Dosage and administration Drug therapy Female Generalized linear models Health Highly active antiretroviral therapy HIV Human immunodeficiency virus Humans Intervention LDCs Male Medical care quality Medical personnel Medicine and Health Sciences Mortality Nurses Patients People and Places Physicians Primary care Quality Quality of care Replication Research and Analysis Methods South Africa - epidemiology Statistical methods Streamlining Studies Subgroups Therapy Tuberculosis Variables Virus replication |
| title | STRETCHing HIV treatment: A replication study of task shifting in South Africa |
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