Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis

J Int AIDS Soc. 2013 Jul 3;16(1):18445. doi: 10.7448/IAS.16.1.18445.


Introduction: A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed.

Methods: Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively.

Results: Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88-1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: -12.7-17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65-1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56-0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care.

Conclusions: Non-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.

Keywords: ART; HIV treatment; antiretroviral therapy; non-physician; substitution of physicians; task shifting.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Africa South of the Sahara
  • Anti-HIV Agents / therapeutic use*
  • Body Weight
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / pathology
  • Humans
  • Medication Adherence / statistics & numerical data
  • Nurses*
  • Patient Satisfaction / statistics & numerical data
  • Physicians*
  • Survival Analysis
  • Treatment Outcome
  • Tuberculosis / diagnosis


  • Anti-HIV Agents