Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.     

Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique

Background  

A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new chronic disease services for people with the acquired immunodeficiency syndrome (AIDS).     

Population movements and the spread of HIV/AIDS in Mozambique

This article demonstrates how the spread of HIV/AIDS in Mozambique may gave been affected by internal and external population movements which, in turn, contributed to the pronounced regional differences in adult HIV prevalence among the three regions of the country observed today. Further population movement may put certain individuals at higher risk of HIV infection but, even if these movements were to stop, in the absence of effective interventions to prevent new infections, HIV prevalence would remain high and perhaps continue to rise. The current regional differences in HIV prevalence and duration of the epidemic present different challenges for the development and implementation of prevention and mitigation services.     

Gender, religious involvement, and HIV/AIDS prevention in Mozambique

Using survey and semi-structured interview data collected in various religious congregations in urban and rural areas of Mozambique, this study analyzes how gender differences in perceptions of HIV/AIDS and preventive behavior are mediated by religious involvement. Logistic regression is employed to examine the effects of gender and of the interactions between gender and type of denomination--"mainline" (Catholic and Presbyterian) or "healing" (Assembly of God, Zionist, and Apostolic)--on female and male members' exposure to HIV/AIDS-related prevention messages, knowledge and perception of risks, and practice of prevention. The analysis detects women's disadvantage on several measures of knowledge and prevention but also suggests that gender differences are less pronounced among members of "mainline" churches. The semi-structured interview data further highlight how gender differences are shaped in different religious environments. Although the potential of faith-based institutions in combating the HIV/AIDS pandemic is undeniable, policy-makers need to heed important differences among these institutions when devising ways to harness this potential.     

艾滋病防治绩效评价工作开展的SWOT分析

文章采用SWOT分析法对现阶段我国开展艾滋病防治绩效评价工作的优势、劣势、机会和威胁进行了系统的分析,并根据分析结果对我国开展艾滋病防治绩效评价工作提出一些发展策略,为顺利开展艾滋病防治绩效评价工作提供政策建议.     

HIV/AIDS and home-based health care

This paper highlights the socio-economic impacts of HIV/AIDS on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.     

Battling AIDS in America: an evaluation of the National HIV/AIDS Strategy

Thirty years ago, the Centers for Disease Control and Prevention reported the first cases of AIDS in the United States. Since then, more than half a million Americans have died of AIDS, and 1.1 million people are currently living with HIV in the United States. In an attempt to reinvigorate the domestic response to the HIV epidemic, the Obama administration developed and released the National HIV/AIDS Strategy for the United States (NHAS). The NHAS has 3 focus areas: reducing new infections, improving access to care and health outcomes, and reducing HIV-related disparities. With ambitious five-year targets set for each goal, the NHAS requires significant fiscal investment to achieve its desired impact on the domestic HIV epidemic.     

Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya,Malawi and Tanzania

Background

This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya.

Methods

Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA.

Results

Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff.Factors significantly associated with increased productivity were: 1) located at a regional or private/mission hospital compared to a district hospital (OR = 8.26; 95 % CI 2.89 – 23.81); 2) 3 or more nurses in the eye unit (OR = 8.69; 95% CI 3.27-23.15); 3) 3 or more cataract surgical sets (OR = 3.26; 95% CI 1.48-7.16); 4) a separate eye theatre (OR = 5.41; 95% CI 2.15-13.65); 5) a surgical outreach program (OR = 4.44; 95% CI 1.88-10.52); and 6) providing transport for patients to hospital (OR = 6.39; 95% CI 2.62-15.59). The associations were similar for baseline and follow-up assessments. Attrition during the 3 years occurred in 13 surgeons (10.3%) and was due to retirement or promotion to administration.

Conclusions

High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.

     

HIV/AIDS and long-term care: A state perspective

Long-term care services for people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) were fostered in New York State by passage of HIV-specific regulations that set program standards and authorized reimbursement rates sufficient to support these standards. A rapid expansion of HIV-specific capacity has occurred. Demographic and selected clinical characteristics of the populations in AIDS residential health care facilities and AIDS adult day health care programs in New York State are presented. Aspects of the service models for these two program types that have changed to meet new needs are discussed. Ms. Chorost is from the Chronic Care Section, Division of HIV Health Care, AIDS Institute; Dr. Chesnut is from the Information Systems Office of the AIDS Institute.     

Self-care and HIV/AIDS patients: nursing care systematization

This research aimed at systematizing nursing care to HIV/aids patients in view of Orem's Self-care Deficit Nursing Theory, using the convergent-care method and the Self-Care Nursing Process. Subjects were thirteen HIV/AIDS patients attended at a non-governmental organization in Fortaleza/CE, Brazil. We used interview techniques, physical examination, observation and information records, with a structured instrument, addressing requisites related to universal self-care, development and health alterations. Self-care deficits corresponded to nineteen nursing diagnoses, named according to NANDA's Taxonomy II, ten of which were based on the requisites for universal self-care, five on the requisites for self-care related to development and four on the requisites for self-care related to health deviations. In care planning, goals were established and the system and health methods were selected, prioritizing support-education actions in order to engage HIV/aids patients in self-care.     

Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years

Background  

The burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon.     

医务人员艾滋病病毒职业暴露

根据国务院防治艾滋病工作委员会办公室、卫生部、联合国艾滋病中国专题组联合发布的<2007年中国艾滋病防治联合评估报告>,截至2007年底,我国现存艾滋病病毒(HIV)感染者和病人约70万,其中艾滋病病人8.5万人.2007年,新发HIV感染者5万,因艾滋病死亡2万人.随着国家政策的倾斜,医疗卫生服务的可及性以及艾滋病感染者和患者就诊意识的提高,医务人员与他们的接触越来越多.     

Legal and ethical issues in HIV / AIDS care

People in India, including foreigners, can be forced to submit their blood for HIV testing at the discretion of a health officer. Once tested, no statute exists to protect the confidentiality of that medical information. Section 51 of the Goa Public Health Act and local municipal laws provide for the notification of AIDS cases. There are presently 67 AIDS surveillance centers in India. No statute obliges doctors to treat people with HIV. However, once treatment is started, the doctor is obliged to continue treatment to ensure that the patient does not die, with treatment being administered only with the patient's consent. No statute exists which requires the HIV testing of employees in the workplace or prisoners. Only defense personnel are being routinely tested for HIV. Furthermore, there are no specific criminal offenses for transmitting HIV and no policies regarding HIV-infected employees. Preventive measures are contained in local municipal laws, local public health laws, and the Epidemic Diseases Act, and vaccine and drug trials are conducted under the Drugs and Cosmetics Act.