Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea

Philips, Mit; Zachariah, Rony; Venis, Sarah

doi:10.1016/s0140-6736(08)60307-4

Cited by 118 publications

(119 citation statements)

References 14 publications

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“…57 In addition to task shifting, the crumbling health systems of sub-Saharan Africa badly need an increased human resource pool that is flexible, motivated and able to respond to the increasing disease burden and the changing landscape of public health needs. What is demanded of the medical profession is flexible pragmatism to safeguard both quality and safety and to prioritize patient needs above those of the profession.…”

Section: Discussionmentioning

confidence: 99%

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Zachariah

Ford

Philips

et al. 2009

Transactions of the Royal Society of Tropical Medicine and Hygi

330

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Section: Discussionmentioning

confidence: 99%

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Zachariah

Ford

Philips

et al. 2009

Transactions of the Royal Society of Tropical Medicine and Hygi

330

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“…Government wages are low and NAs working in the public Finally, while task shifting should be seen as a necessary part of scaling up essential surgical services, this does not remove the need for specialists [28], and efforts must also be made to increase the number of anesthesiologists working in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

Ten Years of Experience Training Non‐Physician Anesthesia Providers in Haiti

et al. 2009

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Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource‐limited countries. Often non‐physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non‐existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post‐hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non‐physician anesthetists is a feasible and important way to scale up surgical services resource limited settings.

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“…Panel 4 summarises the key challenges and approaches to scaling up of these three interventions on the basis of the authors' fi eld experiences. [112][113][114][115] Care for HIV-associated tuberculosis in the general health system…”

Section: Comprehensive Hiv Carementioning

confidence: 99%

“…• Incorporate HIV testing early into diagnosis and registration of tuberculosis 90,91 • Provide infrastructure and rooms for HIV testing in tuberculosis wards and clinics • Use provider-initiated HIV testing and counselling 90,91 • Consider task shifting to trained lay counsellors 41,112 • Monitor consumption and establish a procurement and supply system through existing tuberculosis systems deliver chronic care to patients with non-communicable diseases such as diabetes, hypertension, and asthma. 121…”

Section: Practical Considerations and Ways Forwardmentioning

confidence: 99%

The HIV-associated tuberculosis epidemic—when will we act?

et al. 2010

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Journal LancetRights Reproduced on this site with permission of Elsevier Ltd. Please see [url] Tuberculosis 3The HIV-associated tuberculosis epidemic-when will we act? Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in aff ected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensifi ed tuberculosis case fi nding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be eff ective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.

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Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea

Cited by 118 publications

References 14 publications

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Ten Years of Experience Training Non‐Physician Anesthesia Providers in Haiti

The HIV-associated tuberculosis epidemic—when will we act?

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