Nurses can boost access to antiretroviral therapy

Wednesday June 16th, 2010

It is safe and effective for nurses to monitor antiretroviral therapy for HIV patients, experts state today.

This approach could help ease the shortage of health care workers in many regions while expanding access to antiretroviral therapy, say Professor Ian Sanne of the University of the Witwatersrand, Johannesburg, South Africa, and colleagues.

In the Lancet, they report on a study of expanded access to antiretroviral therapy in resource-poor settings. They say this "is dependent on task shifting from doctors to other health care providers".

The team randomly assigned 812 HIV-positive patients in South Africa to nurse or doctor management. Just under half of patients in both groups experienced "treatment failure".

There was no significant difference between the groups in risk of treatment failure. Over an average follow-up of 120 weeks, rates of death, virological failure, toxicity failure, and drop-out were similar in nurse and doctor groups.

The researchers write: "Nurse-monitored antiretroviral therapy is non-inferior to doctor-monitored therapy. Findings from this study lend support to task shifting to appropriately trained nurses, and suggest that HIV management by nurses can be safe and effective even for those starting therapy with advanced HIV infection."

Such "task-shifting" is recommended by the World Health Organisation in order to meet universal access targets.

Dr Mark Boyd of St Vincent's Hospital, Sydney, Australia, writes in a commentary: "In view of the enormous amount of resources ploughed into the effort to achieve universal access to HIV care, including antiretroviral therapy, it is marvellous to see the results of a practical and innovative study which helps propel the field forward and improves our collective confidence that despite all the obstacles we can succeed."

Sanne, I. et al. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. The Lancet, published online June 16, 2010.

Boyd, M. A. and Nwizu, C. A. Operational research in HIV priority areas: the African way. The Lancet, published online June 16, 2010.

Tags: Africa | Australia | Flu & Viruses | Nursing & Midwifery

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