Shifting tasks from pharmacy to nonpharmacy personnel for providing antiretroviral therapy to people living with HIV : a systematic review and metaanalysis
Date
2017-8
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Abstract
Objectives Lay people or non-pharmacy health workers
with training could dispense antiretroviral therapy (ART)
in resource-constrained countries, freeing up time
for pharmacists to focus on more technical tasks. We
assessed the effectiveness of such task-shifting in lowincome
and middle-income countries.
Method We conducted comprehensive searches of peerreviewed
and grey literature. Two authors independently
screened search outputs, selected controlled trials, extracted
data and resolved discrepancies by consensus. We performed
random-effects meta-analysis and assessed certainty of
evidence using the Grading of Recommendations, Assessment,
Development and Evaluation (GRADE) approach.
Results Three studies with 1993 participants met the
inclusion criteria, including two cluster trials conducted in
Kenya and Uganda and an individually randomised trial
conducted in Brazil. We found very low certainty evidence
regarding mortality due to the low number of events.
Therefore, we are uncertain whether there is a true increase
in mortality as the effect size suggests, or a reduction in
mortality between pharmacy and non-pharmacy models of
dispensing ART (risk ratio (RR) 1.86, 95% CI 0.44 to 7.95,
n=1993, three trials, very low certainty evidence). There may
be no differences between pharmacy and non-pharmacy
models of dispensing ART on virological failure (risk ratio (RR)
0.92, 95% CI 0.73 to 1.15, n=1993, three trials, low certainty
evidence) and loss to follow-up (RR 1.13, 95% CI 0.68 to
1.91, n=1993. three trials, low certainty evidence). We found
some evidence that costs may be reduced for the patient and
health system when task-shifting is undertaken.
Conclusions The low certainty regarding the evidence
implies a high likelihood that further research may find
the effects of the intervention to be substantially different
from our findings. If resource-constrained countries decide
to shift ART dispensing and distribution from pharmacy to
non-pharmacy personnel, this should be accompanied by
robust monitoring and impact evaluation.
Description
CITATION: Mbeye, N. M. et al. 2017. Shifting tasks from pharmacy to non-pharmacy personnel for providing antiretroviral therapy to people living with HIV: a systematic review and meta-analysis. BMJ Open, 7(8):e015072. doi:10.1136/bmjopen-2016-015072.
The original publication is available at https://bmjopen.bmj.com/
The original publication is available at https://bmjopen.bmj.com/
Keywords
Antiretroviral therapy, HIV infections, Medical personnel
Citation
Mbeye, N. M. et al. 2017. Shifting tasks from pharmacy to non-pharmacy personnel for providing antiretroviral therapy to people living with HIV: a systematic review and meta-analysis. BMJ Open, 7(8):e015072. doi:10.1136/bmjopen-2016-015072.