A systematic review of task- shifting for HIV treatment and care in Africa

Abstract

BackgroundShortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings.MethodsWe conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts.ResultsWe found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement.ConclusionsTask shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes.

The Enabling Effect of Food Assistance in Improving Adherence and/or Treatment Completion for Antiretroviral Therapy and Tuberculosis Treatment: A Literature Review

“…1), this could mean performing tasks that are typically done in more medical environments (i.e. task shifting, [40]), for instance, assessing and tracking malnourished clients by lay community health workers (CHWs) trained for specific tasks or establishing nutrition support centers for PLHIV equipped to distribute therapeutic or supplementary foods, eligibility for which is decided by the clinician based on adherence and nutritional status. For health systems, the linkages with communities could be collaborating on the above-mentioned shift of tasks as well as referring PLHIV to HIV sensitive or HIV specific safety nets (e.g., resilience building, livelihood support) and linking them to programs for prevention of mother to child transmission and sexual and reproductive health programs implemented in the community.…”

Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade

“…These new service delivery models have the ultimate goals of increased treatment capacity and sustainable quality HIV service delivery in a cost-effective manner related to the resources available. The new models go beyond the traditional clinic-based, physician centered delivery of HIV services with changes and novel interventions to personnel with task shifting, service delivery locations into the community, modifying ART clinic follow-up appointment spacing and reducing criteria that limits enrollment into ART [89][90][91].…”

Shining a Light on Task-Shifting Policy: Exploring opportunities for adaptability in non-communicable disease management programmes in Uganda

“…[14][15][16] These issues have significantly affected the delivery of healthcare services in Uganda and highlight the need for the implementation and development of policies that consider both an efficient and effective use of existing human resources through planned resource allocation. 8,10,17,18 The WHO recommends task-shifting as a national strategy to combat the health human resource crisis and to aid in the implementation of national NCD management programmes. 8,10,11,13,[17][18][19] This article examines task-shifting policy in Uganda within the current political and economic context.…”