SOUTH AFRICA: Study backs nurse-monitored HIV treatment


JOHANNESBURG - A South African study suggests that nurses are able to manage patients on antiretroviral (ARV) therapy as effectively as doctors, supporting the case for "task-shifting" in HIV treatment.

The study, published in the Lancet on 16 June, divided 812 HIV patients into two groups - one of which received ARV therapy from doctors, the other from nurses. Both the nurses and doctors were inexperienced in ARV management and received similar training from clinicians who were also on call during the duration of the study to answer questions.

After 120 weeks, the patients managed by nurses were no more likely to have been lost to follow-up, to have failed treatment or to have died than those under a doctor's care.

"Nurses didn't prescribe the medication but they managed every other aspect, [including] drug interactions, illness and adherence," explained the co-author, Catherine Orrell, of the Desmond Tutu HIV Centre at South Africa's University of Cape Town. "I'm hoping it will add some confidence in nurses' abilities, which I think has been lacking a bit in the debate [about task-shifting]."

South Africa recently revised its national treatment guidelines to recommend earlier initiation of ARV therapy for HIV-positive pregnant women, infants and tuberculosis patients. The government also launched a national voluntary HIV testing and counselling (VCT) campaign in April, which aims to test 15 million people by 2011. The potential upsurge in people needing ARV treatment in a country with 18 percent HIV prevalence amongst adults has made calls for task-shifting in the management of HIV more urgent.

Although South Africa's national HIV strategic plan recommends allowing nurses to manage ARV treatment and the new treatment guidelines list implementing nurse-initiated treatment as a goal, current legislation mandates that only doctors may prescribe licensed drugs. Prominent AIDS groups and NGOs, including Médecins Sans Frontières and the Southern African HIV Clinicians Society, have already called on the government to change the existing legislation to allow nurses to initiate therapy and relieve bottlenecks caused by the shortage of doctors working in the public sector.

"With treating larger numbers of people and certainly with treating more people at higher CD4 counts, there is a need to expand the number of [health] staff available," Orrell told IRIN/PlusNews. "Hopefully, this study puts us one step closer to nurse-initiated treatment."

(Source:Plus News)