1. World Health Organization

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

3. 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

4. Growing number of people require chronic care WHO – Task shifting WHO, UNAIDS, UNICEF. 2011. Universal access report

5. Significant overlap with high HIV burden WHO. 2006. Global report

6. Health workers tend to concentrate in urban settings WHO. 2006. Global report

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

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

9. 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

10. 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

11. 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.

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