Antiretroviral Treatment

This successful program highlights how improving HIV care strengthened the primary health care system and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor supported testing and counselling, adherence and case management. [from abstract]

In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three rural primary health centers in Rwanda. We retrospectively evaluated the feasibility and effectiveness of this task-shifting model using descriptive data. [from abstract]

In Mozambique, a country with a high HIV burden and a staggering workforce deficit, the Ministry of Health looked to past experience in workforce expansion to rapidly build ART delivery capacity, including reliance on existing nonphysician clinicians (NPC) to prescribe ART and dramatically increasing the output of NPC training. [from abstract]

Lower-income countries face severe health worker shortages. Recent evidence suggests that this problem can be mitigated by task-shifting or delegation of aspects of health care to less specialized health workers. We estimated the potential impact of task shifting on costs of antiretroviral therapy and physician supply in Uganda. [from abstract]

Access to HIV treatment in sub-Saharan Africa is constrained by the scarcity of physicians as they are the only providers legally allowed to initiate antiretroviral therapy in HIV-positive patients. This particularly impacts rural clinics staffed entirely by non-physician health workers. This article presents a pilot study from Uganda assessing agreement between non-physician clinicians and physicians regarding their decisions regarding the initiation of antiretroviral therapy. [adapted from abstract]

In resource-limited settings, serious healthcare worker shortages that contribute to weak health systems exist alongside the drive to scale up ART and other HIV services to reach those in need. The global health community thus needs to reassess current delivery models and pilot new ones that could expand needed healthcare and be more cost effective, while preserving the quality of services. This book provides a roadmap for conceptualizing and initiating the expansion of the nursing scope of practice to include ART prescription and management. [adapted from author]

This technical paper analyzes the equity issues in HIV/AIDS health sector responses
in Malawi, including access to ART. [from executive summary]

This report describes field experiences with task shifting in Lusaka, Zambia, where a large public-sector ART program has enrolled over 71,000 HIV-infected adults and children across 19 program sites. It advocates a comprehensive, three-pronged approach to task-shifting that comprises training, on-site clinical mentoring, and continuous quality assurance. A structured approach is important so that clinical care is not compromised when clinical duties are initially shifted to less specialized health professionals. [from introduction]

Currently, a wide variety of community health workers are active in many antiretroviral treatment delivery sites. This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. [from abstract]

East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University established a network of academic institutions to build capacity for pharmaceutical management in the East African region. The initiative includes institutions from Uganda, Tanzania, Kenya and Rwanda and aims to improve access to safe, effective and quality-assured medicines for the treatment of HIV/AIDS, TB and Malaria through spearheading in-country capacity.

The objective of this study was to investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects. [from summary]

Zambia, like many of the countries heavily affected by HIV and AIDS in southern Africa, also faces a shortage of human resources for health. The country receives significant amounts of funding from GHIs for the large-scale provision of antiretroviral treatment through the public and private sector. This paper examines the impact of GHIs on human resources for ART roll-out in Zambia, at national level, in one province and two districts. [from abstract]

This paper examines the impact of Global Health Initiatives on human resources for antiretroviral treatment roll-out in Zambia at a national level, in one province and two districts. [adapted from abstract]

In the space of just a few years, close to 300,000 people with HIV have been put onto ART in Ethiopia and Malawi - two of the countries most severely affected by the human resources for health crisis. But while some might suggest that such a rapid scale-up could only have come at the expense of other general health services, Ethiopia and Malawi performed this remarkable feat using HIV/AIDS funding and technical support to launch ambitious and comprehensive human resource plans to strengthen their health sectors overall. [from author]

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

Task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff. [from author]

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic. An assessment of health-care worker availability in the region against health system needs for that area reveals stark gaps. This article details the contributing reasons for health-care worker shortages, as well as the effect of these shortages on antiretroviral therapy (ART) for HIV-infected patients. [from abstract]

This article focuses on professional nurses in a study of patterns of planning, recruitment, training and task allocation associated with an expanding antiretroviral program in the districts of Free State. [from abstract]

This study details the costs and personnel requirements for the provision of antiretroviral therapy (ART) to patients with AIDS in Haiti. [from abstract]

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

One of the most significant challenges in fighting the AIDS epidemic in Southern Africa is securing the health care workforce to deliver care in settings where the manpower is already in short supply. The authors produced a demand-driven staffing model based on treatment protocols for HIV-positive patients that adhere to Mozambican guidelines.

Twelve percent of the adult population in Malawi is estimated to be HIV infected and 15% to 20% of these are in need of life saving antiretroviral therapy. Using data on the total number of patients on highly active antiretroviral treatment (HAART) and estimates of the number of health professionals required to deliver HAART, researchers set out to determine the human resources requirements for HAART scale-up in Malawi. Results show that the human resources requirements are significant and that Malawi is using far fewer human resources than would be expected based on past studies. [adapted

Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. [from abstract]

As strides are made in the prevention and treatment of HIV, it is important to take advantage of opportunities to expand and integrate reproductive health services. Integration is an approach that uses a client visit as an opportunity to address other health and social needs beyond those that prompted the current health visit.

This is a guideline to replicate and scale-up a human resources promising practice documented by the Capacity Project for outsourcing human resources services (HRS) to obtain a rapid increase and deployment of the health workforce, making HIV services available in a short period of time, especially in underserved areas.

This guideline is for human resources planners and managers in the health sector and sets out the steps required to extend the health workforce by incorporating lay workers (field officers), especially in the delivery of antiretroviral therapy (ART) to home-based clients.

The main objections to the use of [antiretroviral therapies] in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere.

This news article presents a study in Uganda that found HIV-positive Ugandans are twice as likely to quit antiretroviral therapy (ART) if they also use traditional herbal medicine. It suggests that the integration of traditional healers into modern medical practice needs to be handled more cautiously and that rather than shunning traditional healers, the solution is to work closely with them. [adapted from author]

The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilization thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV. [from abstract]

Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints. [from abstract]