Nurses and clinical officers (non-physician clinicians, NPCs) are capable of determining when a person should receive antiretroviral therapy (ART) for HIV/AIDS. Researchers writing in BioMed Central's open access journal Human Resources for Health suggest that this should ease the strain on overstretched doctors in sub-Saharan Africa and thereby help increase access to antiretroviral therapy, particularly in rural areas.
Ashwin Vasan, from the University of Michigan and London School of Hygiene & Tropical Medicine, worked with a team of researchers in 12 Ugandan clinics to assess the degree of agreement between NPCs' decisions and those made by fully trained doctors. He said: "Nurses and clinical officers showed moderate to almost perfect agreement with physicians in their final ART recommendations. Considering that the scarcity of physicians in sub-Saharan Africa is constraining access to HIV treatment, particularly in rural clinics staffed only by NPCs, our results could lead to immediate benefits with respect to ART scale-up and decentralization."
This is the first study, either in industrialized or developing countries, to compare clinical decision-making between health care worker cadres in their prescription of ART. It offers the first evidence to support increased investment in task-shifting and training of NPCs to deliver therapy in rural primary care settings.
Speaking about the potential implications of this finding, Vasan said: "Non-physician clinicians at primary care clinics should be trained, supported, and empowered to deliver antiretroviral therapy independently, with the support - but not necessarily the full-time presence - of a physician. As this a pilot, it is important to study this question further, but in the meantime programs should begin providing the necessary training, post-training support and clinical mentoring to NPCs to provide HIV/AIDS care and treatment. This will fill an important gap, particularly in rural areas, where physicians are relatively scarce, and yet where the majority of the poor reside."
- Ashwin Vasan, Nathan Kenya-Mugisha, Kwonjune J Seung, Marion Achieng, Patrick Banura, Frank Lule, Megan Beems, Jim Todd and Elizabeth Madraa. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda. Human Resources for Health, 2009; 7 (1): 75 DOI: 10.1186/1478-4491-7-75
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