Managing ART: Nurses are as good as Doctors

[Guest guest]

Dear MEMBERS of AIDS INDIA,

The finding of th study -Nurse versus doctor management of HIV-infected patients

receiving antiretroviral therapy- is significant. Nurses are as good as Doctors

in managing ART.

AIDS INDIA request NACO to initiate a pilot project to test the efficacy of a

Nurse managed ART centres.

Editor,

AIDS INDIA e FORUM.

/

Ps/ Your editor is happy to send a full text of this article, if you any

difficulty to access this research report.

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Nurse versus doctor management of HIV-infected patients receiving antiretroviral

therapy (CIPRA-SA): a randomised non-inferiority trial

Ian Sanne FCP a, Dr Orrell MMed b , P Fox DSc c, Francesca

Conradie MD a, Prudence Ive FCP a, Zeinecker MPH b, Morna Cornell MPH

b, Christie Heiberg MTech b, Charlotte Ingram MBA a, Ravindre Panchia MBBCh a,

Mohammed Rassool MBChB a, René Gonin PhD d, s FCPath a, Handré

Truter NDip a, Marjorie Dehlinger DNSc e, Prof van der Horst MD f,

McIntyre FRCOG g, Prof Robin Wood FCP b, for the CIPRA-SA Study Team‡

The Lancet, Volume 376, Issue 9734, Pages 33 - 40, 3 July 2010

Summary

Background

Expanded access to combination antiretroviral therapy (ART) in resource-poor

settings is dependent on task shifting from doctors to other health-care

providers. We compared outcomes of nurse versus doctor management of ART care

for HIV-infected patients.

Methods

This randomised non-inferiority trial was undertaken at two South African

primary-care clinics. HIV-positive individuals with a CD4 cell count of less

than 350 cells per & #956;L or WHO stage 3 or 4 disease were randomly assigned to

nurse-monitored or doctor-monitored ART care.

Patients were randomly assigned by stratified permuted block randomisation, and

neither the patients nor those analysing the data were masked to assignment.

The primary objective was a composite endpoint of treatment-limiting events,

incorporating mortality, viral failure, treatment-limiting toxic effects, and

adherence to visit schedule.

Analysis was by intention to treat. Non-inferiority of the nurse versus doctor

group for cumulative treatment failure was prespecified as an upper 95% CI for

the hazard ratio that was less than 1•40.

This study is registered with ClinicalTrials.gov, number NCT00255840.

Findings

408 patients were assigned to doctor-monitored ART care and 404 to

nurse-monitored ART care; all participants were analysed.

371 (46%) patients reached an endpoint of treatment failure: 192 (48%) in the

nurse group and 179 (44%) in the doctor group.

The hazard ratio for composite failure was 1•09 (95% CI 0•89—1•33), which was

within the limits for non-inferiority.

After a median follow-up of 120 weeks (IQR 60—144), deaths (ten vs 11),

virological failures (44 vs 39), toxicity failures (68 vs 66), and programme

losses (70 vs 63) were similar in nurse and doctor groups, respectively.

Interpretation

Nurse-monitored ART is non-inferior to doctor-monitored therapy.

Findings from this study lend support to task shifting to appropriately trained

nurses for monitoring of ART.

Funding

National Institutes of Health; United States Agency for International

Development; National Institute of Allergy and Infectious Diseases.