Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study.

OBJECTIVES: To compare HIV care quality provided by non-physician clinicians (NPC) and physicians.
DESIGN: Retrospective cohort study assessing the relationship between provider cadre and HIV care quality among non-pregnant adult patients initiating antiretroviral therapy (ART) in the national HIV care programme.
METHODS: Computerized medical records from patients initiating ART between July 2004 and October 2007 at two HIV public HIV clinics in central Mozambique were used to develop multivariate analyses evaluating differences in process and care continuity measures for patients whose initial provider was a NPC or physician.
RESULTS: A total of 5892 patients was included in the study, including 4093 (69.5%) with NPC and 1799 (30.5%) with physicians as initial providers. Those whose initial provider was a NPC were more likely to have a CD4 cell count 90-210 days [risk ratio (RR) 1.13, 1.04<RR<1.23] and 330-390 days (RR 1.12, 0.96<RR<1.31) after initiating ART. A large majority of patients adhered well to care, although patients whose initial provider was a NPC had more frequent clinical visits in the first year post-ART initiation (RR 1.02, 1.00<RR<1.05) and higher levels of adherence to antiretroviral medicines in the first 6 months after initiating ART (RR1.05, 1.02<RR<1.09). Patients of NPC were less likely to be lost to follow-up than those seen by physicians (RR 0.86, 0.73<RR<1.02).
CONCLUSION: NPC performance was similar to or better than that of physicians for the HIV care quality study measures. Our results highlight the important role of NPC in scaling up ART in Mozambique, and argue for using all relevant clinical resources to meet the large demands for care in countries with high HIV burdens.