Patient experience and economic impact as a result of task-shifting ART services in Ethiopia

The delivery model of ART services in Ethiopia has shifted from a hospital-based program run by physicians to include a decentralized program at the health center level where services are provided by non-physician clinicians (NPC). By a process known as task-shifting, NPCs are trained on tasks traditionally performed by physicians. This changes the interface of ART care that patients experience. The success of ART treatment is dependent on patient adherence to treatment; therefore, it is critical to understand how task-shifting affects patient perception of services and the opportunity costs for accessing care. Data were collected through exit interviews of ART patients in 61 facilities across 4 regions. Patients available on the day of data collection were approached for interview; at least 10 patients per facility were targeted. The interview covers services received, patient perception of services, travel time to facility, and economic losses as a result of the visit. Results of the analysis will include summary findings of the effect task-shifting ART services had on perceived treatment and opportunity costs of patients. The task-shifting delivery model has contributed to the rapid expansion of ART services in Ethiopia, with a nearly 30-fold increase of number of patients accessing ART between 2005-11. The discussion will focus on whether task-shifting appears to result in greater / lesser / no change in patient perception of care, and the implications for program managers in terms of targeting and tailoring training, and encouraging greater use of task-shifting in more facilities.