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Task-shifting of HIV care to nurses: sucesses, but problems to watch out for
Theo Smart, 2011-07-21 09:10:00
“A nurse-led service can deliver ART care as effectively as a doctor-driven one, and even improves quality of care, but this pragmatic trial did not result in increased access to ART,” said Lara Fairall of the University of Cape Town. She was describing the results of the STRETCH study, a cluster-based randomised controlled study of nurse-managed and initiated antiretroviral therapy (ART) presented at the sixth International AIDS Society conference, held in Rome this week.
Another presentation in the session suggested non-physician health workers could be mobilised to respond to AIDS in prevention services – notably male circumcision.
Meanwhile, an observational cohort study presented by Dr Megan McGuire of Epicentre, a public health research unit of Médecins Sans Frontières, suggested that HIV-care provided by nurses in Malawi was superior to that provided by clinical officers. However, as McGuire herself pointed, the clinical officers primarily managed the sickest patients with the mosst advanced disease. This was not an entirely fair comparison.
All these reports recommended task-shifting HIV care to nurses at the primary healthcare level. But the session also highlighted the tension at the conference between those lobbying for a quick shift to task-shifting and decentralisation in order to reach goals for universal access to HIV treatment, versus those warning that task-shifting may not be an overnight solution to the crisis in human resources for health care. Rather, there are indicators suggesting programmes must be aware that there can be gaps and problems in the transition for doctor-based to task-shifted care.
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