Pathways of care for HIV infected children in Beira, Mozambique: a pre-post intervention study on the impact of task shifting

In 2013, Mozambique adopted the Option B+ strategy proposed by WHO to improve the coverage of care of HIV infected children. A task-shifting (TS) from clinical officers to nurses was implemented to provide the continuum of care of newly HIV positive children <5 years old. Aim of the study was to evaluate in a sample of Local Health Facilities (LHFs) of the Beira District the impact of TS on the effectiveness of the new pathway of care on the taking charge of HIV infected children and on the administering of ART.

A retrospective pre-post intervention study was conducted on 5 (33.3%) of the 15 LHFs of the Beira District by accessing ARCC registries and HIV Health Service (HHS) patient’s files. Two time periods, the pre-intervention and the post-intervention, lasting 365 days each, were compared using a set of endpoints. The variables distribution was explored by descriptive statistics. T-student, Mann Whitney and Chi-square tests were used to compare the two groups.
A sample of 588 HIV infected children (F= 51.4%) was recruited in the study, 330 belonging to the post intervention group. The mean time from referral to ARCC until ART start up decreased from 2.3 (+ 4.4) to 1.1 (+ 5.0) months after the implementation of intervention (p-value: 0.000). A significant association was documented also with an increase of Isoniazid (INH) prophylaxis (O.R.: 2,69; 95%CI: 1.7 – 4.15) as well as with a decreasing of both regular nutritional surveillance (O.R.= 0.45; 95%CI: 0.31-0.64) and CD4 count at beginning of ART (O.R.= 0.46; 95%CI: 0.32-0.65).
Our data suggest that TS alone could not be enough to improve effectiveness of HIV infected children taking charge and should be implemented in a wilder range of public health measures.

Francesco Di Gennaro
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