World Health Organization

Task shifting for integrated and decentralized HIV treatment

Eyerusalem Negussie, Margaret Streeten, Brian Pazvakavambwa, Amitabh Suthar, Frank Lule, Andrew Ball

WHO – Task Shifting

● Growing number of people require chronic care- high burden settings

● The need for comprehensive care, and ensure continuity of care

● Role of patient education, community involvement and broader support on access, linkage, retention and adherence to treatment

● Limited human resource in most settings

Human resource: availability, mix, skill

Growing number of people require chronic care

WHO – Task shifting

WHO, UNAIDS, UNICEF. 2011. Universal access report

• Significant overlap with high HIV burden

WHO. 2006. Global report

• Health workers tend to concentrate in urban settings

WHO. 2006. Global report

Regulatory framework

Quality assurance, ongoing learning, supportive supervision, professional development

Sustainability

Essential for effective task shifting

WHO – Task shifting

WHO – Task Shifting

Quick assessment: 22 countries national programme managers • 1 country has regulatory framework for non-

medical doctors to provide ART;

1. Task shifting: Rational distribution of tasks among health workers to provide chronic care

WHO – Task shifting

PhysiciansPediatriciansPhysicians

Pediatricians

Medical officers,

GPs*

Medical officers,

GPs*

Clinical officers*Clinical officers*

Midwives,MCH

nurses

Midwives,MCH

nursesTB clinicTB clinic

PLHIV(self-management)

PLHIV(self-management)

Nursing assistants,counselors, "lay" counselors:

PLHIV on clinical team

Nursing assistants,counselors, "lay" counselors:

PLHIV on clinical team

CHW, other community-based practitioners

Community volunteers(PLHIV and others)

CHW, other community-based practitioners

Community volunteers(PLHIV and others)

Family caregiversFamily caregivers

NursesNurses

* "District clinicians" providing outpatient and inpatient care at district hospital, depending on country

Decentralization and task shifting

Clinical teams led by anurse or clinical officer

Primary care level Close to home

Community-based support

District hospital

Central/RegionalHospitals

Community workers- testing, counselling, patient education, triage and weight, retrieve pt chart, screening for TB, provision of cotrimoxazole prophylaxis, ARV pickup spots, support

WHO – Task Shifting

WHO 2013 consolidated guideline • Evidence review on task shifting in HIV care and

treatment – from physicians to non-physician health workers;– Across population group: infants, children,

adolescents and adults, pregnant and postpartum women,

– By different cadres of health workers– ART initiation, ART maintenance in stable patients, in

the management of certain conditions.

Acknowledgement

• National Programme managers of MoH and WHO staff- who facilitated the country survey.