World Health Organization

Task shifting for integrated and decentralized HIV treatment Eyerusalem Negussie, Margaret Streeten, Brian Pazvakavambwa, Amitabh Suthar, Frank Lule, Andrew Ball

WHO – Task Shifting ●Growing number of people require chronic care- high burden settings ●The need for comprehensive care, and ensure continuity of care ●Role of patient education, community involvement and broader support on access, linkage, retention and adherence to treatment ●Limited human resource in most settings Human resource: availability, mix, skill

Growing number of people require chronic care WHO – Task shifting WHO, UNAIDS, UNICEF Universal access report

Significant overlap with high HIV burden WHO Global report

Health workers tend to concentrate in urban settings WHO Global report

 Regulatory framework  Quality assurance, ongoing learning, supportive supervision, professional development  Sustainability Essential for effective task shifting WHO – Task shifting

WHO – Task Shifting Quick assessment: 22 countries national programme managers 1 country has regulatory framework for non- medical doctors to provide ART;

1. Task shifting: Rational distribution of tasks among health workers to provide chronic care WHO – Task shifting Physicians Pediatricians Physicians Pediatricians Medical officers, GPs* Medical officers, GPs* Clinical officers* Clinical officers* Midwives, MCH nurses Midwives, MCH nurses TB clinic PLHIV (self-management) PLHIV (self-management) Nursing assistants, counselors, "lay" counselors: PLHIV on clinical team Nursing assistants, counselors, "lay" counselors: PLHIV on clinical team CHW, other community- based practitioners Community volunteers (PLHIV and others) CHW, other community- based practitioners Community volunteers (PLHIV and others) Family caregivers Nurses * "District clinicians" providing outpatient and inpatient care at district hospital, depending on country

Decentralization and task shifting Clinical teams led by a nurse or clinical officer Primary care level Close to home Community-based support District hospital Central/Regional Hospitals Community workers- testing, counselling, patient education, triage and weight, retrieve pt chart, screening for TB, provision of cotrimoxazole prophylaxis, ARV pickup spots, support

WHO – Task Shifting WHO 2013 consolidated guideline Evidence review on task shifting in HIV care and treatment – from physicians to non-physician health workers; – Across population group: infants, children, adolescents and adults, pregnant and postpartum women, – By different cadres of health workers – ART initiation, ART maintenance in stable patients, in the management of certain conditions.

Acknowledgement National Programme managers of MoH and WHO staff- who facilitated the country survey.