Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

Abstract

sub-Saharan Africa is home to almost three-quarters of all individuals living with HIV/AIDS in the world. Yet, sub-Saharan Africa also has one of the most severe shortages of trained medical and behavioral health care workers in the world to tackle the needs of the huge epidemic. This gap between HIV-related treatment needs and staff resources has presented the need for “task shifting” or “task sharing,” defined as delegating tasks to less specialized health care workers, and/or considering ways of sharing tasks across a clinical team. Task shifting has been a key implementation strategy for increasing access to antiretroviral therapy (ART) to treat HIV/AIDS across sub-Saharan Africa. For behavioral medicine, task shifting can be used for the delivery of behavioral health interventions for HIV medication adherence and co-occurring mental health problems. In this chapter, we aim to demonstrate how the efforts to use task shifting for rolling out ART programs in sub-Saharan Africa can inform behavioral medicine task shifting efforts to expand access to evidence-based ART adherence counseling and mental health interventions in HIV care in sub-Saharan Africa. We focus specifically on examples of task shifting cognitive behavioral therapy (CBT) for ART adherence, depression, and substance use among individuals living with HIV/AIDS in sub-Saharan Africa. Although there have been few examples to date of task shifting CBT in the context of HIV care in sub-Saharan Africa, we use these promising early examples to inform future considerations for adapting and implementing CBT using a task shifting model in this population.