Nurse Task Shifting for Antiretroviral Treatment Services in Namibia: Implementation Research to Move Evidence into Action

Abstract

BackgroundEvidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may not be readily adopted in another. This study used an implementation research approach to assist policy makers and other stakeholders to assess the acceptability and feasibility of task shifting in the Namibian context.MethodsThe Namibian Ministry of Health and Social Services implemented a Task Shifting Demonstration Project (TSDP) at 9 sites at different levels of the health system. Six months after implementation, a mixed methods evaluation was conducted. Seventy semi-structured interviews were conducted with patients, managers, doctors and nurses directly involved with the TSDP. Physician-evaluators observed and compared health service provision between doctors and nurses for 40 patients (80 observations), documenting performance in agreement with the national guidelines on 13 clinical care indicators.ResultsDoctors, nurses, and patients interviewed believed task shifting would improve access to and quality of HIV services. Doctors and nurses both reported an increase in nurses’ skills as a result of the project. Observation data showed doctors and nurses were in considerable agreement (>80%) with each other on all dimensions of HIV care and ≥90% on eight dimensions. To ensure success of national scale-up of the task shifting model, challenges involving infrastructure, on-going mentoring, and nursing scope of practice should be anticipated and addressed.ConclusionIn combination with findings from other studies in the region, data from the TSDP provided critical and timely information to the Namibian Ministry of Health and Social Services, thus helping to move evidence into action. Small-scale implementation research projects enable stakeholders to learn by doing, and provide an opportunity to test and modify the intervention before expansion.

Economic Analysis of ART Task Shifting in Limited Resource Setting Using Econometric Model: Ethiopia Case Study

“…The study found a 15% lower cost of visit and 16% lower length of visit for ART patients treated by nurses and health officers, as compared with the physicians. The findings from the econometric model support the recent debate on task shifting (Zachariah et al 2009, O'Malley et al 2014, Edge 2008 health care delivery to the least costly health worker and who is capable of reliably performing this task. This micro-economic analysis strengthens recent findings on antiretroviral task-shifting in Namibia and Botswana which highlighted the relevance of task shifting in improving access, service quality and skills enhancement (O'Malley et al 2014, Monyatsi et al 2013.…”

“…Previous studies in Sub-Saharan Africa countries, including Ethiopia, have reviewed the relationship between task performance, access and task shifting (Gessessew et al 2011, O'Malley et al 2014, however, there is limited knowledge on the economic significance associated with ART task shifting for policy makers. More importantly, there is a paucity of evidence on the application of micro-econometric modeling to ART task-shifting.…”

Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review

“…Task shifting has been shown to be effective in improving maternal health care provision for patients in LMICs, most notably in the administration of ARV therapy [ 113 , 114 ], non-communicable disease management [ 115 – 117 ], and mental health care [ 118 ]. Task shifting interventions involve equipping a cadre of staff in the health care system with the appropriate skills to provide services that would otherwise be provided by higher cadre providers, who are often scarce.…”

Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation

“…Strengthening the capacity of rural healthcare agents and medical personnel was essential: the former undertook monitoring of medication adherence and ADRs, whereas the in situ participation of physicians was restricted to treatment indication, clinical exams and improved ADR management. In remote areas of Africa, transference of treatment initiation and monitoring of HIV patients to local nurses improved the access to and quality of health care and cost-effectiveness of integrated interventions [ 51 , 52 ]. Benznidazole was available at the time of our program and timely provision was carefully planned, but these usually are major issues elsewhere.…”