Since the early 1990s, PIH and its sister organization in Haiti, Zanmi Lasante (PIH/ZL), have delivered high-quality care to thousands of HIV patients by sharing – or task-shifting – responsibilities among a limited number of doctors and a much larger population of specially trained nurses and community health workers.
This model eases the burden on physicians and results in healthier patients according to an article in the May 2011 edition of the journal PLoS ONE, “Task-Shifting in HIV Care.”
The article – co-authored by Dr. Louise Ivers, PIH’s Senior Health and Policy Advisor, and colleagues from PIH/ZL, Harvard Medical School and the World Health Organization – maps how staff shared responsibilities at three PIH/ZL clinics during a six-month period in 2007.
How PIH/ZL’s approach differs
While doctors exclusively perform 64 percent of HIV-related tasks in traditional clinical settings, PIH/ZL doctors exclusively perform only 2 percent. This means that nurses and community health workers (CHWs) either partially or fully participated in 98 percent of the 135 HIV-related tasks included in a patient’s treatment plan.
In fact, CHWs perform over 50 percent of HIV-related responsibilities, many of which take place in the patient’s home.
The study finds a direct link between task-shifting and high adherence rates.
For example, just over 95 percent of PIH/ZL patients living with HIV still adhere to their antiretroviral treatment after two years.
These numbers far surpass those found in comparable regions of Sub-Sahara Africa, where “the best retention rate was 90 percent at 24 months and the average retention rate was 60 percent.”
Prior to working to with HIV patients, nurses and CHWs are properly trained in tasks traditionally performed by doctors and therefore pose no danger to the patient.
Proving what PIH/ZL staff have long known
By sharing responsibilities with CHWs, physicians and nurses have more time to focus on tasks that require advanced training, such as monitoring test results and making major treatment decisions. Employing CHWs ensures that patients have regular, if not daily, one-on-one contact with care providers.
The task-shifting model also allows for the rapid and effective introduction of services in new regions.
Between October 2002 and October 2007, PIH/ZL scaled up HIV care to the entire Central Department of Haiti (population 550,000) using the task-shifting model of care. The organization enrolled 11,114 people living with HIV and started 3,763 patients on antiretroviral therapy. At the time of the study’s completion, there were no waiting lists for treatment.
PIH/ZL’s task-shifting model serves as an example to health care organizations in other developing countries.
“The number of individuals requiring HIV treatment and care far surpasses the current capacity of most health care systems in the developing world,” according to the article. “At least 36 countries are suffering from severe shortages of health care workers and this crisis of human resources in developing countries is a major obstacle to scale-up of HIV care.”
Task-shifting offers a long-term solution to the shortage of HIV doctors in developing countries.