Examining the Impact of Changes in Practice Patterns of Nurses and Physicians on Patient Experiences and Outcomes in an ARV Clinic at a Nigerian Teaching Hospital

Background: HIV/ AIDS is the leading cause of death from infectious diseases worldwide. Sub-Saharan African countries bear 2/3 of the disease burden. In Nigeria, 2.86 million (4.4%) persons were living with HIV/ AIDS in 2005. About 500,000 PLWHA (persons living with HIV/ AIDS) in Nigeria are in need of treatment, however only 166,000 receive appropriate care. The demand for HIV care services has markedly surpassed its supply. Additional 2.4 million physicians, nurses and nurse-midwives are needed to meet the increasing demands in African. As a result, Task-shifting evolved as a means to serve PLWHA. Task-shifting is defined by WHO as a strategy to make “better use of the human resources that are currently available by moving appropriate tasks to less specialized workers”. This was piloted in Nigeria in 2008 by Institute of Human Virology Nigeria to expand nurses' roles to include follow-up and prescription refill for stable HIV positive patients within an “interdisciplinary team” model. Methods: 200 patients at an anti-retroviral (ART) clinic in Nigeria were surveyed. (100 attended to by physicians and 100 by nurses) to evaluate patient satisfaction associated with changes in care provider roles at the clinic. Chi-square was used to determine differences between provider groups. Results: No significant differences were seen between nurses and physicians in relation to patients' perception of care and interaction. 93% indicated clinicians spent enough time with them and 87% indicated minimal interruptions during care. 86%indicated clinicians portray non-judgmental attitudes towards PLWHA. Medication side-effects explanations were provided to only 47% of cases.