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Nurses in Africa know when to start antiretroviral treatment

August 19, 2009

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."
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Notes to Editors

1. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda
Ashwin Vasan, Nathan Kenya-Mugisha, Kwonjune J Seung, Marion Achieng, Patrick Banura, Frank Lule, Megan Beems, Jim Todd and Elizabeth Madraa
Human Resources for Health
(in press)

During embargo, article available here: http://www.human-resources-health.com/imedia/1293009671254088_article.pdf?random=780799

After the embargo, article available at journal website: http://www.human-resources-health.com/

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

Article citation and URL available on request at press@biomedcentral.com on the day of publication

2. Human Resources for Health is an open access, peer-reviewed, online journal covering all aspects of planning, producing and managing the health workforce - all those who provide health services worldwide.

3. BioMed Central (http://www.biomedcentral.com/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

4. In conjunction with BioMed Central, Retrovirology is hosting Frontiers of Retrovirology - Complex Retroviruses, retroelements and their hosts conference in Montpellier, France, September 21 to 23, 2009. This conference will bring together leading human retrovirus researchers to review current progress and to chart future challenges.

BioMed Central

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