Pathways of care for HIV infected children in Beira, Mozambique: pre-post intervention study to assess impact of task shifting

Background: In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services. Methods: The study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services. Two time periods, pre- and post-intervention, were compared using a set of endpoints. Variables distribution was explored using descriptive statistics. T-student, Mann Whitney and Chi-square tests were used for comparisons. Results: Overall, 588 HIV infected children (F = 51.4%) were recruited, 330 belonging to the post intervention period. The mean time from referral to ARCC until initiation of ART decreased from 23 (+/- 4.4) to 1.1 (+/- 5.0) months after the intervention implementation (p-value: 0.000). A significant increase of Isoniazid prophylaxis (0.R.: 2.69; 95%Cl: 1.7-4.15) and a decrease of both regular nutritional assessment (O.R. = 0.45; 95%Cl: 0.31-0.64) and CD4 count at the beginning of ART (O.R. = 0.46; 95%Cl: 032-0.65) were documented after the intervention. Conclusions: Despite several limitations and controversial results on nutrition assessment and CD4 count at the initiation of ART reported after the intervention, it could be assumed that TS alone may play a role in the improvement of the global effectiveness of care for HIV infected children only if integrated into a wider range of public health measures.