Task Shifting

High HIV Testing Uptake and Linkage to Care in a Novel Program of Home-Based HIV Counseling and Testing with Facilitated Referral in KwaZulu-Natal, South Africa

This study piloted home-based counseling and testing with point-of-care CD4 count testing and follow-up visits from lay counselors to facilitate linkage of HIV-infected persons to local HIV clinics and uptake of antiretroviral treatment in rural KwaZulu-Natal, South Africa. [adapted from abstract]

Noninferiority of a Task-Shifting HIV Care and Treatment Model Using Peer Counselors and Nurses Among Ugandan Women Initiated on ART: Evidence From a Randomized Trial

The objective of this study was to assess the non-inferiority of a task-shifting HIV treatment model relying on peer counselors and nurses compared with a physician-centered model among HIV-1-positive women initiated on antiretroviral therapy (ART) at a prevention of mother-to-child transmission clinic in Mulago Hospital, Uganda. [from abstract]

Using Verbal Autopsy to Ascertain Perinatal Cause of Death: Are Trained Non-Physicians Adequate?

This initiative’s objective was to develop a standardized verbal autopsy training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death by physicians and non-physicians. [from abstract]

Case Study: Does Training of Private Networks of Family Planning Clinicians in Urban Pakistan Affect Service Utilization?

This study aimed to determine whether training of providers participating in franchise clinic networks is associated with increased family planning service use among low-income urban families in Pakistan.

Contribution of Physician Assistants in Primary Care: A Systematic Review

Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as physician assistants. This systematic review aimed to appraise the evidence of the contribution of these workers within primary care relevant to the UK or similar systems. [adapted from abstract]

Evolving Role of Health Care Aides in the Long-Term Care and Home and Community Care Sectors in Canada

This study attempts to gather information on health care aides, a cadre that constitutes a significant component of the health care labor force providing home and community care in Canada, to fill gaps in basic information about this component of the workforce including motivations, retention, and adequacy of their training. [adapted from author]

How Do Retired Paramedics Fit into Remote, Rural Emergency Departments?

This article argues that paramedics’ skills, education and experience enable them to become useful physician assistants who may relieve much of the doctors’ burden, allowing physicians in remote hospitals to concentrate on genuine medical duties; but the objection of doctors’ and nurses’ professional organizations constitute a substantial obstacle to this solution. [adapted from abstract]

Effectiveness of Nurse Case Management Compared with Usual Care in Cancer Patients at a Single Medical Center in Taiwan: A Quasi-Experimental Study

The aim of this study is to evaluate the effectiveness of care quality in cancer patients using a nurse case management model. [adapted from abstract]

Results from a Study Using Misoprostol for Management of Incomplete Abortion in Vietnamese Hospitals: Implications for Task Shifting

This study sought to assess whether sublingual misoprostol could effectively evacuate the uterus after incomplete abortion and to confirm its applicability for use by lower level clinicians. [adapted from abstract]

NIMART Rollout to Primary Healthcare Facilities Increases Access to Antiretrovirals in Johannesburg: An Interrupted Time Series Analysis

In this study, decentralisation of anitretroviral treatement (ART) initiation by professional nurses through the Nurse Initiatied Management of Antiretroviral Treatment (NIMART) program was shown to increase ART uptake and reduce workloadat referral facilities, enabling them to concentrate on complicated cases. [adapted from author]

Systematic Review Evaluating the Impact of Task Shifting on Access to Antiretroviral Therapy in Sub-Saharan Africa

This review evaluates whether task shifting of ART initiation and management from physicians to nurses increases access to antiretroviral therapy, the primary purpose cited for the implementation of task shifting policies. [from introduction]

Evaluation of a Well-Established Task-Shifting Initiative: The Lay Counselor Cadre in Botswana

This study examined the Botswana lay counselor cadre, a task shifting initiative, to explore effectiveness and contribution to the health workforce. [from abstract]

Combating Global Health Worker Shortages: Task Shifting and Sharing May Provide One Solution

This article discusses the options of task shifting and task sharing to boost access to healthcare in the face of the global health worker shortage. [adapted from author]

Provision of Injectable Contraceptives in Ethiopia through Community-Based Reproductive Health Agents

The objective of this study was to determine if, with appropriate training, volunteers known as community-based reproductive health agents can administer injectable contraceptives to women in a rural region of Ethiopia with the same effectiveness, safety and acceptability as health extension workers. [from author]

Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions through Task Shifting

The objective of this guidance is to issue evidence-based recommendations to facilitate universal access to key, effective maternal and newborn interventions through the optimization of health worker roles. [from summary]

How to Keep ART Patients in Long-Term Care: ART Adherence Club Report and Toolkit

This toolkit is simple model that allows patient groups to collect pre-packed, two-month supplies of treatment from lay health workers either at the clinic or outside of the clinic - whether at a local library or at a fellow patients home. Antiretroviral treatment (ART) adherence clubs give stable adherent HIV patients easier access to their treatment, while unclogging clinics and freeing up scarce nurses and doctors to manage new or at-risk HIV patients. [from publisher]

Increasing Access to Safe Abortion Services through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants

This study attempted to determine the best way to implement new strategies of medical abortion and increase safety and access using auxiliary nurse midwives trained as skilled birth attendants [adapted from author].

Cameroon Mid-Level Providers Offer a Promising Public Health Dentistry Model

This study reviewed Cameroon’s experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. The authors anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon. [adapted from abstract]

Economic Evaluation of a Task-Shifting Intervention for Common Mental Disorders in India

The present study evaluates the cost–effectiveness and cost–utility of a trial task shifting approach to mental health services with the hope that the additional resources needed to train, pay and supervise the lay health workers used in the task-shifting approach to the primary care of common mental disorders would promote recovery and reduced disability in a more cost–effective manner than more conventional care. [adapted from author]

Will Clinical Associates be Effective for South Africa

This article outlines a program in South Africa that has developed an innovative mid-level medical worker model that can contribute substantively to the development of quality district-level health care and examines the priorities for expanding and sustaining the program going forward. [adapted from author]

Private Sector Drug Shops in Integrated Community Case Management of Malaria, Pneumonia, and Diarrhea in Children in Uganda

This study sought to determine appropriateness of treatment of common childhood illnesses at private sector drug shops in two rural districts of Uganda. [adapted from abstract]

Experiences, Opportunities and Challenges of Implementing Task Shifting in Underserved Remote Settings: The Case of Kongwa District, Central Tanzania

The aim of this was to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, and to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. [adapted from abstract]

Stakeholder Perceptions of a Nurse Led Walk-In Centre

This study aimed to ascertain the views of key stakeholders on the introduction of a nurse led primary care walk-in center in a rural region of Australia that aimed to fulfill an unmet health care need in the community due to the shortage of general practitioners, meet projected demand for health care services and relieve pressure on the hospital system. [adapted from abstract[

Community-Based Blood Pressure Measurement by Non-Health Workers Using Electronic Devices: A Validation Study

Qualified health workers are expensive and often unavailable for blood pressure screening. In a poor, urban community the authors compared blood pressure measurements taken by non-health workers using electronic devices against qualified health workers. [from abstract]

Policy and Programmatic Implications of Task Shifting in Uganda: A Case Study

Uganda has a severe health worker shortage and a high demand for health care services. This study aimed to assess the policy and programmatic implications of task shifting in Uganda. [from abstract]

Using Primary Health Care (PHC) Workers and Key Informants for Community Based Detection of Blindness in Children in Southern Malawi

The current study compared the effectiveness of trained health surveillance assistants versus trained volunteer key informants in identifying blind children in southern Malawi. [from abstract]

Are Dutch Patients Willing to be Seen by a Physician Assistant Instead of a Medical Doctor?

The objective of this study was to assess the willingness of Dutch patients to be treated by a physician assistant or a medical doctor under various time constraints and semi-urgent medical scenarios to determine the patients’ perspectives on using physician assistants as a means to bridge the growing gap between the supply and demand of medical services. [adapted from abstract]

Task Shifting in Maternal and Newborn Care: A Non-Inferiority Study Examining Delegation of Antenatal Counseling to Lay Nurse Aides Supported by Job Aids in Benin

Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. [from abstract]

Treatment Outcomes and Cost-Effectiveness of Shifting Management of Stable ART Patients to Nurses in South Africa: An Observational Cohort

This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health care facility in Johannesburg, South Africa. [from abstract]

Economic Evaluation of Task-Shifting Approaches to the Dispensing of Anti-Retroviral Therapy

The study aims to compare two task-shifting approaches to the dispensing of anti-retroviral therapy (ART): indirectly supervised pharmacist’s assistants and nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. [adapted from abstract]