A cluster randomised controlled trial of an educational and organisational intervention to expand antiretroviral treatment access in public-sector primary care clinics in South Africa: the STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) trial

Conditions

HIV/ AIDS Infections and Infestations Unspecified human immunodeficiency virus [HIV] disease

Fairall L, Bachmann MO, Lombard C, Timmerman V, Uebel K, Zwarenstein M, Boulle A, Georgeu D, Colvin CJ, Lewin S, Faris G, Cornick R, Draper B, Tshabalala M, Kotze E, van Vuuren C, Steyn D, Chapman R, Bateman E.

2012-08-15215 citations

10.1016/s0140-6736(12)60730-2

Task shifting and integration of HIV care into primary care in South Africa: the development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention.

Uebel KE, Fairall LR, van Rensburg DH, Mollentze WF, Bachmann MO, Lewin S, Zwarenstein M, Colvin CJ, Georgeu D, Mayers P, Faris GM, Lombard C, Bateman ED.

2011-08-0228 citations

10.1186/1748-5908-6-86

Streamlining tasks and roles to expand treatment and care for HIV: randomised controlled trial protocol.

Fairall LR, Bachmann MO, Zwarenstein MF, Lombard CJ, Uebel K, van Vuuren C, Steyn D, Boulle A, Bateman ED.

2008-04-2320 citations

10.1186/1745-6215-9-21

Interventions

Complex health systems intervention comprising: 1. Clinical algorithm to triage AntiRetroViral (ARV) patients for nurse- or doctor-managed care 2. Educational outreach training to nurses 3. Expande

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: Clinics: All 31 public sector clinics currently offering antiretroviral treatment in the Free State province, South Africa. Patients: Cohort 1: All patients enrolled at the 31 facilities with a CD4 count of 350 cells/ul or less not yet on HAART. Cohort 2: All patients enrolled at the 31 facilities already on HAART for 6 months or longer, and alive and in care at the start of the trial.

Exclusion criteria

Exclusion criteria: Clinics: None Patients: Patients younger than 18 years

Design outcomes

Primary

Measure	Time frame
The following will be analysed at 1 year (interim analysis) and 2 years (final analysis): Cohort 1: Survival Cohort 2: Viral load suppression rates	—

Secondary

Measure	Time frame
The following will be measured at 2 years (or 1 year if the trial should be discontinued): Cohort 1: 1. Viral load suppression rates 2. Duration between enrolment and starting HAART 3. Proportion of patients with CD4 count <=350 who start HAART during the study period 4. Median baseline CD4 count of patients starting HAART 5. Tuberculosis (TB) case detection 6. Screening for TB (sputum tests) 7. Cotrimoxazole prophylaxis provision 8. Changes in CD4 and weight, hospital admissions 9. Number of nurse and doctor visits Cohort 2: 1. Survival 2. Programme retention (the proportion of patients remaining alive and in care) 3. Duration of viraemia prior to switch to second-line treatment 4. TB case detection 5. Screening for TB (sputum tests) 6. Cotrimoxazole prophylaxis provision 7. Changes in CD4 and weight 8. Hospital admissions 9. Number of nurse and doctor visits	—

Measure

Time frame

The following will be measured at 2 years (or 1 year if the trial should be discontinued): Cohort 1: 1. Viral load suppression rates 2. Duration between enrolment and starting HAART 3. Proportion of patients with CD4 count <=350 who start HAART during the study period 4. Median baseline CD4 count of patients starting HAART 5. Tuberculosis (TB) case detection 6. Screening for TB (sputum tests) 7. Cotrimoxazole prophylaxis provision 8. Changes in CD4 and weight, hospital admissions 9. Number of nurse and doctor visits Cohort 2: 1. Survival 2. Programme retention (the proportion of patients remaining alive and in care) 3. Duration of viraemia prior to switch to second-line treatment 4. TB case detection 5. Screening for TB (sputum tests) 6. Cotrimoxazole prophylaxis provision 7. Changes in CD4 and weight 8. Hospital admissions 9. Number of nurse and doctor visits

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Countries

South Africa

Outcome results

None listed