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South Africa: Nurses Ease HIV Burden of Doctors
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Business Day (Johannesburg)
8 August 2008
Posted to the web 8 August 2008
Tamar Kahn
Mexico City
Training nurses to treat HIV patients can help alleviate the load on doctors without compromising their quality of care, according to several African studies presented this week at the 17th International AIDS Conference.
Only about 30% of the world's HIV sufferers are getting treatment, and the rising number of patients who have started therapy, are increasing the burden on already strained healthcare staff in many parts of world. This increases the likelihood of healthcare workers not being able to devote enough time to patients and leads to long queues and inadequate medical care.
In SA for example, many rural hospitals can't get enough general and specialist doctors. In rural areas there are often as few as three doctors for every 100 000 patients -- five times lower than the urban rate. By contrast, the US has 550 doctors per 100000 patients.
One strategy being explored in many parts of the world, particularly in rural areas where doctors are scarce, is to train nurses and counsellors to provide much of the supervision HIV patients require.
In Kenya for example, the Express Care clinic programme has employed clinical officers to take on many tasks usually performed by doctors and has broken down some of the traditional divisions of labour, between categories of healthcare worker. Clinical officers are trained to a level beyond that attained by a nurse, but below a doctor's.
HIV patients can make "one-stop" visits, with all immediate needs met by the nurse, clinical officer or doctor they consulted that day, instead of having to queue repeatedly f or services of various practitioners.
For example, nurses refilled patient prescriptions for antiretrovirals, provided they had no complications requiring more specialised attention, a task traditionally performed only by a doctor.
"There has been a 50% reduction in risk of death and loss (in HIV patients on treatment), to follow up," said the programme's Rose Kosgei. The Academic Model for the Prevention and Treatment of HIV developed Express Care.
Haiti's Partners in Health programme, which trained community healthcare workers for HIV-positive patients, led to dramatically improved efficiency of rural clinics. Louise Ivers of Harvard Medical School said some of the clinics had been almost nonfunctional, with 10 to 15 visits a day, drug shortages and staff absenteeism.
Clinics now saw to the needs of 200-300 patients a day, more than 50000 people were tested for HIV each year, and more than 3000 HIV-positive patients were getting treatment, she told delegates.
"In 2004, not a single patient missed a dose despite the political instability," she said, referring to the coup that ended former president Jean-Bertrand Aristide's rule. She said staff who got additional training were given bigger salaries.
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"We did not just load tasks on to them, but tried to ensure adequate compensation."
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