Limits...
Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.

Hanson S, Thorson A, Rosling H, Ortendahl C, Hanson C, Killewo J, Ekström AM - PLoS ONE (2009)

Bottom Line: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up, assuming that sufficient drugs and supplies are provided by donors.A comparison of our scenario estimations and actual output 2006-2008 indicates that a simple user-friendly dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting staff factor and information on availability of this staff and patient losses.Thus, it is possible to set more achievable targets.

View Article: PubMed Central - PubMed

Affiliation: Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. Stefan.Hanson@ki.se

ABSTRACT

Background: International targets for access to antiretroviral therapy (ART) have over-estimated the capacity of health systems in low-income countries in Sub-Saharan Africa. The WHO target for number on treatment by end 2005 for Tanzania was 10 times higher than actually achieved. The target of the national Care and Treatment Plan (CTP) was also not reached. We aimed at estimating the capacity for ART provision and created five scenarios for ART production given existing resource limitations.

Methods: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up, assuming that sufficient drugs and supplies are provided by donors. We created a simple formula to estimate the number of patients on ART based on availability and productivity of clinical staff, time needed to initiate vs maintain a patient on ART and patient losses using five different scenarios with varying levels of these parameters.

Findings: Our scenario assuming medium productivity (40% higher than that observed in 2002) and medium loss of patients (20% in addition to 15% first-year mortality) coincides with the actual reported number of patients initiated on ART up to 2008, but is considerably below the national CTP target of 90% coverage for 2009, corresponding to 420,000 on ART and 710,000 life-years saved (LY's). Our analysis suggests that a coverage of 40% or 175,000 on treatment and 350,000 LY's saved is more achievable.

Conclusion: A comparison of our scenario estimations and actual output 2006-2008 indicates that a simple user-friendly dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting staff factor and information on availability of this staff and patient losses. Thus, it is possible to set more achievable targets.

Show MeSH
Formula for the calculation of ART output.
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pone-0005294-g003: Formula for the calculation of ART output.

Mentions: We constructed a simple dynamic model to estimate the number of new and post-first-year-patients on ART at the end of each year based on annual availability and productivity of clinicians, and, on the proportion of patients lost to follow-up or death,. The variables in this formula (figure 3) include: first year mortality, age-specific mortality, other patient losses (loss to follow-up), average number of clinicians per facility type, time devoted to HAART, new patients/year, old (post-first-year) patients/year(clinician productivity). The input values of each variable can easily be changed by entering new data into a spread sheet. For our scenarios we only varied patient losses, new patients/year and old patients/year( clinician productivity), but kept the other variables constant.


Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.

Hanson S, Thorson A, Rosling H, Ortendahl C, Hanson C, Killewo J, Ekström AM - PLoS ONE (2009)

Formula for the calculation of ART output.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2667213&req=5

pone-0005294-g003: Formula for the calculation of ART output.
Mentions: We constructed a simple dynamic model to estimate the number of new and post-first-year-patients on ART at the end of each year based on annual availability and productivity of clinicians, and, on the proportion of patients lost to follow-up or death,. The variables in this formula (figure 3) include: first year mortality, age-specific mortality, other patient losses (loss to follow-up), average number of clinicians per facility type, time devoted to HAART, new patients/year, old (post-first-year) patients/year(clinician productivity). The input values of each variable can easily be changed by entering new data into a spread sheet. For our scenarios we only varied patient losses, new patients/year and old patients/year( clinician productivity), but kept the other variables constant.

Bottom Line: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up, assuming that sufficient drugs and supplies are provided by donors.A comparison of our scenario estimations and actual output 2006-2008 indicates that a simple user-friendly dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting staff factor and information on availability of this staff and patient losses.Thus, it is possible to set more achievable targets.

View Article: PubMed Central - PubMed

Affiliation: Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. Stefan.Hanson@ki.se

ABSTRACT

Background: International targets for access to antiretroviral therapy (ART) have over-estimated the capacity of health systems in low-income countries in Sub-Saharan Africa. The WHO target for number on treatment by end 2005 for Tanzania was 10 times higher than actually achieved. The target of the national Care and Treatment Plan (CTP) was also not reached. We aimed at estimating the capacity for ART provision and created five scenarios for ART production given existing resource limitations.

Methods: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up, assuming that sufficient drugs and supplies are provided by donors. We created a simple formula to estimate the number of patients on ART based on availability and productivity of clinical staff, time needed to initiate vs maintain a patient on ART and patient losses using five different scenarios with varying levels of these parameters.

Findings: Our scenario assuming medium productivity (40% higher than that observed in 2002) and medium loss of patients (20% in addition to 15% first-year mortality) coincides with the actual reported number of patients initiated on ART up to 2008, but is considerably below the national CTP target of 90% coverage for 2009, corresponding to 420,000 on ART and 710,000 life-years saved (LY's). Our analysis suggests that a coverage of 40% or 175,000 on treatment and 350,000 LY's saved is more achievable.

Conclusion: A comparison of our scenario estimations and actual output 2006-2008 indicates that a simple user-friendly dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting staff factor and information on availability of this staff and patient losses. Thus, it is possible to set more achievable targets.

Show MeSH