A systematic review of task- shifting for HIV treatment and care in Africa.
AffiliationDepartment of Anthropology, University of Toronto, Canada. firstname.lastname@example.org.
MetadataShow full item record
JournalHuman Resources for Health
AbstractBACKGROUND: Shortages 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. METHODS: We 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. RESULTS: We 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. CONCLUSIONS: Task 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 effectiveness and cost implications of task-shifting in the delivery of antiretroviral therapy to HIV-infected patients: a systematic review.
- Authors: Mdege ND, Chindove S, Ali S
- Issue date: 2013 May
- Perspectives of key stakeholders regarding task shifting of care for HIV patients in Mozambique: a qualitative interview-based study with Ministry of Health leaders, clinicians, and donors.
- Authors: Rustagi AS, Manjate RM, Gloyd S, John-Stewart G, Micek M, Gimbel S, Sherr K
- Issue date: 2015 Apr 1
- Task shifting of HIV management from doctors to nurses in Africa: clinical outcomes and evidence on nurse self-efficacy and job satisfaction.
- Authors: Iwu EN, Holzemer WL
- Issue date: 2014 Jan
- Global surgical and anaesthetic task shifting: a systematic literature review and survey.
- Authors: Federspiel F, Mukhopadhyay S, Milsom P, Scott JW, Riesel JN, Meara JG
- Issue date: 2015 Apr 27
- Health workforce skill mix and task shifting in low income countries: a review of recent evidence.
- Authors: Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A
- Issue date: 2011 Jan 11