Table 1 Characteristic of included studies
First author, year | Study design | Study participant | Study location/country | Study objective | Model of ART services | Additional resources provided | Study duration/period | Number of patient enrolled | Outcomes of interest | |
|---|---|---|---|---|---|---|---|---|---|---|
Primary | Secondary | |||||||||
Assefa, 2011 [30] | Mix method: retrospective cohort and qualitative study | HIV patient started ART at health facilities providing ART services | 55 health facilities 25 health centers and 30 hospitals representing different regions of Ethiopia | To evaluate outcomes of ART services at health centers vs hospital | ART services led by health officer, nurses and CHWs at health center | Community health workers: adherence counseling, defaulter tracking referral and linkage between facilities | Sep 2006–Mar 2009 | 6206 at health centers; 31,929 at hospitals | Proportion of patient with CD4 count documented Stakeholder’s perspectives on new decentralized model of care |  |
Bedelu, 2007 [17] | Retrospective cohort | Adult HIV patient | Primary care clinics and hospitals/Lusikisiki, South Africa (SA) | To assess the effect of decentralization and task-shifting on treatment outcomes | ART service led by nurses at health clinic | MSF supported through mobile team visit, training/mentoring of nurse; engage community through support groups | Apr 2004–Apr 2006 | 1025 (595 at clinic; 430 at hospital) | Proportion of patient with CD4 count and VR data documented |  |
Boulle, 2010 [19] | Retrospective cohort | Adult treatment naïve HIV patient ≥14 years old | HIV treatment program at three public primary care clinics (PHC) Khayelitsha, SA | To describe outcomes of ART program for adult up to 5 years | Nurse based care with stable patients seen by a nurse 2–3 monthly | Program established/supported by MSF | 2001–2007 | 7323 | Proportion of patient with CD4 count and viral load data available | Proportion of patient reported treatment failure; % patient switch to 2nd line ART |
Brennan, 2011 [16] | Retrospective cohort | ART naive patient >18 years old | Urban HIV clinic and local PHC in Johannesburg SA | To compare one year outcomes between patient down-referred and maintained at central clinic | ART initiated at hospital and then follow-up at PHC by nurse | Nurse received down-reference training; supervise by doctor, plus advice by electronic treatment algorithm | Apr 2004–Sep 2008 | 2772 | Proportion of patient with 12 month CD4 and VL available |  |
Fatti, 2010 [41] | Retrospective cohort | ART naïve adult patient >16 years | 59 public facilities: 47 PHCs, nine district and three regional hospitals in four provinces of SA | To compare treatment outcomes at different levels of health system (primary health care, district and regional hospital) | ART services led by doctor at different levels | Community-based adherence counselor; all sites supported by NGO (absolute return to kids) with free services to HIV patients | Dec 2004–Dec 2007 | 29,203 | Proportion of patient with viral load results |  |
Fairall, 2012 [13] | Randomized control trial | Adult patient who had received ART for at least 6 months and were on ART at time of enrollment | 31 clinics (16 intervention and 15 control) in free state of SA | To assess effects of task-shifting program on treatment outcomes | ART service led by nurse at primary care clinics (intervention) vs doctor at hospital OPC (control) | Outreach training for nurses with doctor support | Jan 2008–Jun 2010 | 3029 (intervention) 3202 (control) | Proportion of patient with VR data available |  |
Humphreys, 2010 [27] | Prospective cohort | Adult patient on ART at least 4 weeks CD4 >100 | Primary care clinics and district hospital in rural Swaziland | To assess effect of nurse led primary care based ART program | ART service led by nurse at primary care clinics vs doctor at hospital | Training for primary care nurses by hospital followed by monthly outreach support visits | Jan–Nov 2007 | 474 | Patient experience with primary based ART program |  |
Hansudewe-chakul, 2012 [15] | Retrospective cohort | HIV infected children | Tertiary hospital and community hospital in rural Thailand | To assess effects of decentralization of pediatric HIV care model | ART initiated at tertiary hospital, monitored at community hospital | Training and mentoring for CH staffs; trained PLHIV: adherence, psychological support | Feb 2002–Mar 2008 | 410 | Proportion of patient with VL data recorded |  |
Janssen, 2010 [21] | Prospective cohort | HIV patient <15 years on ART | Primary care clinics, KwaZulu-Natal, SA | To assess clinical outcomes of children in a decentralized model | Nurse/counselor led ART program | Home-based care program with nurse/community volunteer providing first aids, nutrition, adherence support at home | Jun 2004–Jun 2008 | 477 | Proportion of patients receiving CD4 and VL monitoring |  |
Jobanputra, 2014 [26] | Retrospective cohort | HIV patient on ART | Primary health care clinics in rural poor Shiselweni region of Swaziland | To assess program quality, cost and outcomes of routine VL monitoring | Nurse led ART program | MSF support (laboratory equipment, reagent, training of staff) | Oct 2012–Mar 2013 | 5563 | Proportion of patients receiving routine VL monitoring | Reported treatment failure rate; % patient switch to 2nd line ART |
Labhardt, 2012 [29] | Retrospective cohort | HIV patient >16 years old on ART with at least three drugs | Two hospital and 12 health centers of Botha-Bothe ad Thaba-Tseka districts of Lesotho | To assess the effectiveness of decentralized ART program | Nurse led ART program | ART program supported by a Swiss NGO through the SolidarMed ART project | Jan 2008–Apr 2011 | 3747 | Availability of treatment monitoring tools at decentralized settings |  |
Mutevedzi, 2010 [20] | Retrospective cohort | Adult patient >16 years old | 16 primary care clinic in rural SA | To describe and assess scale-up of decentralized HIV treatment program | ART initiated by doctor and monitored by nurse | Support for program provided by PEPFAR | Oct 2004–Sep 2008 | 3010 | Proportion of patient with VL data recorded |  |
Rich, 2012 [22] | Retrospective cohort | HIV patient on ART | ART clinics at health centers in rural Rwanda | To assess clinical outcomes of HIV treatment program | Community-based ART program with directly observed ART and psychosocial supported provided by CHWs | Ongoing HIV education, nutritional assistance, travel allowance for clinic visits, diagnosis and treatment of TB; additional doctor/provider support | Jun 2005–Apr 2006 | 1041 | Proportion of patient with CD4 and VL monitoring data available | Proportion of patient change treatment regimen due to toxicity; % patient switch to 2nd line ART |
Selke, 2010 [14] | Randomized control trial | HIV patient, 18 years stable on ART at least 3 months | HIV clinic in rural health center of Kenya | To assess impact of task shifting | Nurse led ART service with home based visit by community care coordinator (CCCs) vs standard of care (no CCCs) | Electronic device support tool (PDA) for patient monitoring; program supported by USAID | Mar 2006–Apr 2008 | 208 (96 intervention; 112 control) | Proportion of patient monitored with clinical, immunological, virological data |  |
Shumbusho, 2009 [24] | Retrospective cohort | HIV treatment-naïve adult patients | Three rural primary health centers in Rwanda | To evaluate results of pilot task-shifting model for ART service provision | Nurse centered ART services (initiation management and referral of complex cases | Additional personnel provided for intervention (specific number not reported) | Sep 2005–Mar 2008 | 1076 (641 pre-ART and 435 on ART) | Proportion of patient with CD4 count documented | Proportion of patient change treatment regimen due to toxicity; % patient switch to 2nd line ART |
Sanne, 2010 [25] | Randomized control trial | Adult HIV-1patient (>16 year old, CD4 <350 or previous AIDS defining illness; not pregnant) | Two primary health care sites in Cape town and Johannesbur, SA | To compare outcomes of nurse vs doctor management of ART | ART services led by nurses (vs doctor led): full decentralization | Not reported | Feb 2005–Jan 2009 | 812 | Proportion of patient reported drug toxicity |  |
Uzodike, 2015 [18] | Cross-sectional | Adult HIV patient on ART | Primary healthcare (PHC) clinics in Kwazulu-Natal, SA | To assess monitoring and referral of patient on ART managed at PHC clinics | ART services led by nurses | Not reported | Jun 2011–Jun 2012 | 488 | Proportion of patients with CD4 VL monitoring data available | % patient reported virological failure |
Vogt, 2015 [23] | Retrospective cohort | HIV patient >18 years old initiated on ART at district hospital and rural health clinics (RHCs) | Beitbridge district hospital and six RHCs in Matabeleland South province, Zimbabwe | To compare coverage of CD4 testing between rural and urban HIV patient during 1st year of treatment | HIV care services provided by nurses at RHCs through weekly outreach visits | Services provision supported by MSF (MSF nurse and phlebotomy equipment) | Jan 2011–Dec 2012 | 2145 | Proportion of patients receiving CD4 testing |  |
Walter, 2014 [12] | Before–after (decentralization) comparison | HIV adult patients initiated on ART at primary health centers |  | To compare treatment outcomes before and after decentralization | ART service led by nurses at primary health care center | Not reported | 2003–2006 (before) 2009–2011 (after) | 3936 (before); 13,505 (after) | Proportion of patient with CD4 count documented |  |
Georgeu, 2012 [28] | Qualitative | HIV patient, service providers (physician, nurse) | Primary health care clinics in free state of SA | To explore experience, perceptions of various stakeholders on implementation process of decentralization of ART services | ART service led by nurses | Not reported | Oct 2007–Jun 2008 | 16 FGDs, 26 in-depth and key informant interview | Implementing issues related to decentralization Stakeholder’s perspective on decentralization |  |