Abstract
BackgroundTo increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives. This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy training needs among clinicians to whom tasks have shifted.MethodsThe Infectious Diseases Institute, in collaboration with the Ugandan Ministry of Health, surveyed health professionals and heads of antiretroviral therapy clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed, previous human immunodeficiency virus training, and self-assessment of knowledge of human immunodeficiency virus and antiretroviral therapy. Heads of the antiretroviral therapy clinics reported on clinic characteristics.ResultsThirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) who worked in accredited antiretroviral therapy clinics reported that they prescribed this therapy (p < 0.001). Sixty-four percent of the people who prescribed antiretroviral therapy were not doctors. Among professionals who prescribed it, 76% of doctors, 62% of clinical officers, 62% of nurses and 51% of midwives were trained in initiating patients on antiretroviral therapy (p = 0.457); 73%, 46%, 50% and 23%, respectively, were trained in monitoring patients on the therapy (p = 0.017). Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good (p = 0.001).ConclusionTraining initiatives should be an integral part of the support for task shifting and ensure that antiretroviral therapy is used correctly and that toxicity or drug resistance do not reverse accomplishments to date.
Highlights
To increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives
World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS) and United Nations Children's Fund (UNICEF) recently estimated that 2.12 million people have access to anti-retroviral therapy (ART) in sub-Saharan Africa, or 30% of people with human immunodeficiency virus (HIV) living there who need ART [1]
Criteria for a health facility to be accredited to provide ART in Uganda included that a minimum number of health professionals were qualified with experience in HIV/acquired immune deficiency syndrome (AIDS) management [20], but the staff of the ART clinics may have changed over time
Summary
To increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives. WHO, UNAIDS and UNICEF recently estimated that 2.12 million people have access to ART in sub-Saharan Africa, or 30% of people with HIV living there who need ART [1]. These accomplishments required training of health professionals, among other efforts to strengthen health systems. Several experts recommend "task shifting" from doctors to clinical officers and nurses [6,7,8,9] or from clinicians to community health workers [8,9,10]. According to WHO, task shifting is the rational redistribution of tasks among health workforce teams:
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