Antiretroviral Treatment

The need to strengthen health-care worker capacity was identified by the Botswana Ministry of Health and confirmed by a training needs assessment conducted in 2001. In response, Botswana embarked on the first phase of a national antiretroviral training program, which this document outlines. [adapted from author]

This article presents information and approaches for estimating human resource needs and identifies approaches and innovations to take into consideration as antiretroviral programs are developed, implemented, and monitored. [from author]

As part of the collaborative to improve the efficiency of HIV service delivery, the authors conducted a baseline assessment of HIV/AIDS provider productivity, efficiency, and engagement in Uganda. [adapted from author]

The focus of this brief is on examining how the lack of availability of trained personnel can constrain the ability of the government of Uganda to meet its strategic goals in scaling up antiretroviral treatment (ART). It utilizes a capacity module tool that estimates human resource requirements for HIV interventions. [from author]

This study documented women’s experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) program. In-depth interviews identified considerable weaknesses within operational HIV service delivery including: shortage in staff and supplies, lack of healthworker knowledge, stigma, and inadequacy of data and information systems for monitoring and evaluation. The analysis suggests that there is great scope for health system change, much of which centers on health personnel capacity and performance. [adapted from author]

This article examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy in Uganda. [from abstract]

This paper we discusses the effect of feedback from current antiretroviral (ART) coverage to future ART human resources need on the sustainability of high levels of ART coverage.

This article reports on a nationwide evaluation by the Mozambican Ministry of Health of the quality of care delivered by non-physician clinicians after a two-week in-service training course emphasizing antiretroviral therapy. [adapted from abstract]

This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. [from abstract]

Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. This article evaluates the effectiveness of nurse-led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. [from abstract]

Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. [from summary]

This article discusses the implications and issues concerning the implementation of nurse-initiated ART treatment - rather than the legal and regulatory frameworks governing nurse prescibing that dominate the current debate on these types of delivery programs. [adapted from author]

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]