High levels of healthcare worker shortage has limited HIV infected
patients access to antiretroviral therapy in lower and middle-income
countries. This occurs most where the burden of HIV disease is greatest
and where access to trained doctors is limited. We wanted to assess if
task shifting of care from doctors to non-doctors provides both high
quality and safe care for all patients requiring antiretroviral
We searched for studies up to March 2014. We found 10 studies, including
4 randomised controlled trials and 6 cohort studies collecting data
from HIV care programmes. All the studies were conducted in Africa in
adults who were followed up for up to one year.
We describe three types of care:
- Doctor versus nurse or clinical officer care for initiation and
maintenance of antiretrovirals
- Doctor versus nurse or clinical officer care for maintenance of
- Doctor versus community health workers for maintenance of
We found high quality evidence from trial data that when nurses
initiated and provided follow-up HIV therapy, there was no difference in
death and lower rates of losses to follow up at one year.
However, lower quality data from two cohort studies suggests that there
may be an increased risk of death in the task shifting group, but no difference in patients lost to follow-up between groups.
We found moderate quality evidence from two trials that when doctors
initiated therapy and nurses provided follow-up, that there was probably
no difference in death or number of patients lost to follow up at one
year. Lower quality evidence from the cohort study showed
that death as well as the number of patients lost to follow-up at one
year may be lower in the group treated by nurses.
Compared to doctor led care, we found moderate quality evidence from a
single trial that when antiretroviral therapy was provided in the
community, by trained field workers, there was probably no difference in
death or losses to follow-up.
Kredo, T.; Adeniyi, F.B.; Bateganya, M.; Pienaar, E.D. Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy. Cochrane Database of Systematic Reviews (2014) (Issue 7) Art. No.: CD007331. [DOI: 10.1002/14651858.CD007331.pub3]
Kredo, T; McCaul, M; Volmink, J. South African Medical Journal 2015;105(8):626-627. DOI:10.7196/SAMJnew.8271
Published 23 September 2015