Integrating public health research trials into health systems in Africa: Individual or cluster randomisation?

摘要

Health services in Africa have a very severe shortage of doctors and nurses with fewer than 10 doctors per 100 000 population in several countries (World Health Organization 2006), and access to health services is difficult for many patients because of high transport costs (Govindasamy et al. 2012). Despite these constraints, and the limited experience in delivering chronic care in Africa, antiretroviral therapy (ART) has been scaled up rapidly and about 8 million people are now on treatment (World Health Organization 2013a). In most countries, the HIV services are delivered as stand-alone vertical programmes (Munderi et al. 2012).