Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana

Abstract

Problem As programmes to deliver antiretroviral therapy (ART) are implemented in resource-constrained settings, the problem becomes not how these programmes are going to be financed but who will be responsible for delivering and sustaining them. Approach Physician-led models of HIV treatment and care that have evolved in industrialized countries are not replicable in settings with a high prevalence of HIV infection and limited access to medical staff. Therefore, models of care need to make better use of available human resources. Local setting Using Botswana as an example, we discuss how nurses are underutilized in long-term clinical management of patients requiring ART. Relevant changes We argue that for ART-delivery programmes to be sustainable, nurses will need to provide a level of clinical care for patients receiving this therapy, including prescribing ART and managing common adverse effects. Lessons learned Practicalities involved in scaling up nurse-led models of ART delivery include overcoming political and professional barriers, identifying educational requirements, agreeing on the limitations of nursing practice, developing clear referral pathways between medical and nursing personnel, and developing mechanisms to monitor and supervise practice. Operational research is required to demonstrate that such models are safe, effective and sustainable.

Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea

“…Furthermore, although medical doctors are commonly perceived as the guardians of technical quality, a clinical approach isolated from the community is not ideal. The involvement of other cadres 11 and communities in support and care [12][13][14] brings benefi ts by increasing coverage and improving overall outcomes. 11,13 Patients, health staff , and policy makers need to be involved in setting measurable targets and indicators for what they deem to be an acceptable level of quality of care.…”

What is needed for taking emergency obstetric and neonatal programmes to scale?

“…Conditions for scale up described in the literature include establishing clear policy and implementation networks between state and non-state sectors [3,34], consideration of task shifting in order to meet the human-resource demands of providing the desired service [35,36], appropriate contextual application of existing and emerging evidence [3,37], and advocacy for the outcome amongst healthcare professionals [38]. Once there is robust evidence to support the use of a particular tool or package in an implementation programme, the feasibility of scale up should be ascertained [3].…”

Task-shifting of HIV/AIDS services down the professional ladder: Current status in Ethiopia and lessons from other African countries

“…Experiences in Zambia and Botswana illustrated that shifting the task of ART initiation to nurses has the potential to improve ART coverage (5,6), and the CD4 Nurse Intervention in…”

“…However, there was no empirical evidence that demonstrated that the nurses could perform as safe, accountable and acceptable practitioners. Therefore, controlled trials and formative research are needed to provide empirical data on the benefits and risks of this strategy compared to traditional models (6). Task shifting might also have consequences such as imposing new responsibilities on some staff and removing tasks from others (2).…”