CROI: Nurses Can Manage HIV Therapy

According to preliminary study results presented at the 18th Conference on Retroviruses and Opportunistic Infections in Boston, South African HIV patients whose antiretroviral (ARV) therapy was managed by nurses in regional clinics fared as well as those whose care was overseen by doctors at large hospitals.

The study compared the outcomes of patients who remained in care at the central clinic where treatment was initiated versus those who were assigned to a "down-referral clinic" where nurses managed their care. All the patients had been on stable ARV therapy for 11 months or more, had an undetectable viral load in the previous 10 months, had CD4+ counts of more than 200 cells/mm3, had no opportunistic infections, and had weight loss of less than 5 percent in the past three visits. Patients' mean age was 38.8; more than 90 percent were on regimens containing efavirenz (Sustiva).

The down-referred patients (n=540) were matched - based on age, CD4+ count, time on ARVs, and regimen-using propensity scores - with a group of patients who were eligible for down-referral but remained at the initiation site (n=1,620).

After one year, 98 percent of patients in the nurse-managed down-referral programs were still in treatment and responding, versus 93 percent of central clinic patients.

"The costs were about 9 percent to 10 percent lower at the down-referral site, so the cost per patient was $505 at the down-referral site versus $553 at the initiation site," said Sydney Rosen, MPA, of Boston University's School of Public Health. If this outcome is generalizable to all of South Africa, the resulting savings of $12 million to $20 million a year would enable "probably 20,000 to 40,000 additional patients [to] be treated with the same budget," Rosen said.

"Our results suggest a down-referral strategy may increase treatment capacity and conserve resources without compromising patient outcomes," Rosen said. "The reduction in costs and improvement in outcomes indicate that this is a cost-effective strategy for the maintenance of stable patients."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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