HIV management by nurse prescribers compared with doctors at a paediatric centre in Gaborone, Botswana

  • Gadzikanani Monyatsi
  • Paul C Mullan
  • Benjamin R Phelps
  • Michael A Tolle
  • Edwin M Machine
  • Floriza F Gennari
  • Jenny Makosky
  • Gabriel M Anabwani

Abstract

Objectives. To compare compliance with national paediatric HIV treatment guidelines between nurse prescribers and doctors at a paediatric referral centre in Gaborone, Botswana. Methods. A cross-sectional study was conducted in 2009 at the Botswana-Baylor Children’s Clinical Centre of Excellence (COE), Gaborone, Botswana, comparing the performance of nurse prescribers and physicians caring for HIV-infected paediatric patients. Selected by stratified random sampling, 100 physician and 97 nurse prescriber encounters were retrospectively reviewed for successful documentation of eight separate clinically relevant variables: pill count charted; chief complaint listed; social history updated; disclosure reviewed; physical exam; laboratory testing; World Health Organization (WHO) staging documented; paediatric dosing. Results. Nurse prescribers and physicians correctly documented 96.0% and 94.9% of the time, respectively. There was a trend towards a higher proportion of social history documentation by the nurses, but no significant difference in any other documentation items. Conclusions. Our findings support the continued investment in programmes employing properly trained nurses in southern Africa to provide quality care and ART services to HIV-infected children who are stable on therapy. Task shifting remains a promising strategy to scale up and sustain adult and paediatric ART more effectively, particularly where provider shortages threaten ART rollout. Policies guiding ART services in southern Africa should avoid restricting the delivery of crucial services to doctors, especially where their numbers are limited.

S Afr Med J, 2012;102:34-37

Author Biographies

Gadzikanani Monyatsi
Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
Paul C Mullan
Botswana-Baylor Children’s Clinical Centre of Excellence, Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas, USA, and Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine
Benjamin R Phelps
Botswana-Baylor Children’s Clinical Centre of Excellence and Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital
Michael A Tolle
Botswana-Baylor Children’s Clinical Centre of Excellence and Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital
Edwin M Machine
Botswana-Baylor Children’s Clinical Centre of Excellence and Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital
Floriza F Gennari
Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
Jenny Makosky
University of Utah School of Medicine, Salt Lake City, Utah, USA
Gabriel M Anabwani
Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
Section
Articles

Journal Identifiers


eISSN: 0256-95749
print ISSN: 2078-5135