Let the Trained Nurses Run the ART Centers !?

[Guest guest]

[This article provide evidence and data to support the idea of Task Shifting.

Trained Nurses could manage ART Centers. NACO must initiate a pilot study to

assess the feacibility of Nurse run ART centers in India?]

Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered

Antiretroviral Treatment at Rural Health Centers in Rwanda

Fabienne Shumbusho1*, Johan van Griensven1, Lowrance2, Innocent Turate1,

Mark A. Weaver3, Price1, Agnes Binagwaho4

1 Family Health International, Kigali, Rwanda, 2 TRACPlus - Center for

Infectious Disease Control, Kigali, Rwanda, 3 Family Health International,

Durham, North Carolina, United States of America, 4 Rwanda National AIDS Control

Commission, Kigali, Rwanda

Abstract

Background

The shortage of human resources for health, and in particular physicians, is one

of the major barriers to achieve universal access to HIV care and treatment. In

September 2005, a pilot program of nurse-centered antiretroviral treatment (ART)

prescription was launched in three rural primary health centers in Rwanda. We

retrospectively evaluated the feasibility and effectiveness of this

task-shifting model using descriptive data.

Methods and Findings

Medical records of 1,076 patients enrolled in HIV care and treatment services

from September 2005 to March 2008 were reviewed to assess: (i) compliance with

national guidelines for ART eligibility and prescription, and patient monitoring

and (ii) key outcomes, such as retention, body weight, and CD4 cell count change

at 6, 12, 18, and 24 mo after ART initiation. Of these, no ineligible patients

were started on ART and only one patient received an inappropriate ART

prescription. Of the 435 patients who initiated ART, the vast majority had

adherence and side effects assessed at each clinic visit (89% and 84%,

respectively). By March 2008, 390 (90%) patients were alive on ART, 29 (7%) had

died, one (<1%) was lost to follow-up, and none had stopped treatment. Patient

retention was about 92% by 12 mo and 91% by 24 mo. Depending on initial stage of

disease, mean CD4 cell count increased between 97 and 128 cells/µl in the first

6 mo after treatment initiation and between 79 and 129 cells/µl from 6 to 24 mo

of treatment. Mean weight increased significantly in the first 6 mo, between 1.8

and 4.3 kg, with no significant increases from 6 to 24 mo.

Conclusions

Patient outcomes in our pilot program compared favorably with other ART cohorts

in sub-Saharan Africa and with those from a recent evaluation of the national

ART program in Rwanda.

These findings suggest that nurses can effectively and safely prescribe ART when

given adequate training, mentoring, and support.

Citation: Shumbusho F, van Griensven J, Lowrance D, Turate I, Weaver MA, et al.

(2009) Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered

Antiretroviral Treatment at Rural Health Centers in Rwanda. PLoS Med 6(10):

e1000163. doi:10.1371/journal.pmed.1000163

Academic Editor: Feeley, Boston University, United States of America

Received: February 13, 2009; Accepted: September 3, 2009; Published: October 13,

2009

Copyright: © 2009 Shumbusho et al. This is an open-access article distributed

under the terms of the Creative Commons Attribution License, which permits

unrestricted use, distribution, and reproduction in any medium, provided the

original author and source are credited.

Funding: Costs for the study were supported under USAID grant no.

696-A-00-06-00097-00 to Family Health International. The funders had no role in

study design, data collection and analysis, decision to publish, or preparation

of the manuscript.

Competing interests: The authors have declared that no competing interests

exist.

Abbreviations: 3TC, lamivudine; ART, antiretroviral treatment; AZT, zidovudine;

d4T, stavudine; EFV, efavirenz; FHI, Family Health International; IQR,

interquartile range; LTFU, lost to follow-up; MD, medical doctor; NVP,

nevirapine; PHC, primary health center

* E-mail: Fabiennes@...

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000163