A systematic review of task- shifting for HIV treatment and care in Africa

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dc.contributor.authorCallaghan, Mikeen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorSchneider, Helenen_ZA
dc.date.accessioned2015-11-11T11:57:20Z
dc.date.available2015-11-11T11:57:20Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. METHODS: We conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts. RESULTS: We found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement. CONCLUSIONS: Task shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes.en_ZA
dc.identifier.apacitationCallaghan, M., Ford, N., & Schneider, H. (2010). A systematic review of task- shifting for HIV treatment and care in Africa. <i>Human Resources for Health</i>, http://hdl.handle.net/11427/14869en_ZA
dc.identifier.chicagocitationCallaghan, Mike, Nathan Ford, and Helen Schneider "A systematic review of task- shifting for HIV treatment and care in Africa." <i>Human Resources for Health</i> (2010) http://hdl.handle.net/11427/14869en_ZA
dc.identifier.citationCallaghan, M., Ford, N., & Schneider, H. (2010). Review A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health, 8, 8-16.en_ZA
dc.identifier.ris TY - Journal Article AU - Callaghan, Mike AU - Ford, Nathan AU - Schneider, Helen AB - BACKGROUND: Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. METHODS: We conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts. RESULTS: We found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement. CONCLUSIONS: Task shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes. DA - 2010 DB - OpenUCT DO - 10.1186/1478-4491-8-8 DP - University of Cape Town J1 - Human Resources for Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - A systematic review of task- shifting for HIV treatment and care in Africa TI - A systematic review of task- shifting for HIV treatment and care in Africa UR - http://hdl.handle.net/11427/14869 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14869
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4491-8-8
dc.identifier.vancouvercitationCallaghan M, Ford N, Schneider H. A systematic review of task- shifting for HIV treatment and care in Africa. Human Resources for Health. 2010; http://hdl.handle.net/11427/14869.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Callaghan et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceHuman Resources for Healthen_ZA
dc.source.urihttp://www.human-resources-health.com/en_ZA
dc.subject.otherCommunity Care Giveren_ZA
dc.subject.otherPrimary Health Care Teamen_ZA
dc.subject.otherSubstitute Healthen_ZA
dc.subject.otherNon-physician Clinicianen_ZA
dc.subject.otherLay Counselloren_ZA
dc.subject.otherLay Health Workeren_ZA
dc.subject.otherHealth System Goalen_ZA
dc.subject.otherHRH Shortageen_ZA
dc.subject.otherHealth Care Work Shortageen_ZA
dc.subject.otherArt Initiatien_ZA
dc.titleA systematic review of task- shifting for HIV treatment and care in Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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