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

<h4>Background</h4>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...

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Autores principales:	Stefan Hanson, Anna Thorson, Hans Rosling, Claes Ortendahl, Claudia Hanson, Japhet Killewo, Anna Mia Ekström
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2009
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d6ef31b9366b42ca9fd0cd04588e7e4e
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spelling	oai:doaj.org-article:d6ef31b9366b42ca9fd0cd04588e7e4e2021-11-25T06:16:06ZEstimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.1932-620310.1371/journal.pone.0005294https://doaj.org/article/d6ef31b9366b42ca9fd0cd04588e7e4e2009-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19381270/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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.<h4>Conclusion</h4>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.Stefan HansonAnna ThorsonHans RoslingClaes OrtendahlClaudia HansonJaphet KillewoAnna Mia EkströmPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 4, Iss 4, p e5294 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stefan Hanson Anna Thorson Hans Rosling Claes Ortendahl Claudia Hanson Japhet Killewo Anna Mia Ekström Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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.<h4>Conclusion</h4>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.
format	article
author	Stefan Hanson Anna Thorson Hans Rosling Claes Ortendahl Claudia Hanson Japhet Killewo Anna Mia Ekström
author_facet	Stefan Hanson Anna Thorson Hans Rosling Claes Ortendahl Claudia Hanson Japhet Killewo Anna Mia Ekström
author_sort	Stefan Hanson
title	Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
title_short	Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
title_full	Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
title_fullStr	Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
title_full_unstemmed	Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.
title_sort	estimating the capacity for art provision in tanzania with the use of data on staff productivity and patient losses.
publisher	Public Library of Science (PLoS)
publishDate	2009
url	https://doaj.org/article/d6ef31b9366b42ca9fd0cd04588e7e4e
work_keys_str_mv	AT stefanhanson estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT annathorson estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT hansrosling estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT claesortendahl estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT claudiahanson estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT japhetkillewo estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses AT annamiaekstrom estimatingthecapacityforartprovisionintanzaniawiththeuseofdataonstaffproductivityandpatientlosses
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Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses.

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