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Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda

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Listed:
  • Fabienne Shumbusho
  • Johan van Griensven
  • David Lowrance
  • Innocent Turate
  • Mark A Weaver
  • Jessica Price
  • Agnes Binagwaho

Abstract

Fabienne Shumbusho and colleagues evaluate a task-shifting model of nurse-centered antiretroviral treatment prescribing in rural primary health centers in Rwanda and find that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.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 (

Suggested Citation

  • Fabienne Shumbusho & Johan van Griensven & David Lowrance & Innocent Turate & Mark A Weaver & Jessica Price & Agnes Binagwaho, 2009. "Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda," PLOS Medicine, Public Library of Science, vol. 6(10), pages 1-12, October.
    • Handle: RePEc:plo:pmed00:1000163
    DOI: 10.1371/journal.pmed.1000163
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    Cited by:

    1. Sarang Deo & Stephanie M Topp & Ariel Garcia & Mallory Soldner & Kezban Yagci Sokat & Julien Chipukuma & Chibesa S Wamulume & Stewart E Reid & Julie Swann, 2012. "Modeling the Impact of Integrating HIV and Outpatient Health Services on Patient Waiting Times in an Urban Health Clinic in Zambia," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-9, April.
    2. Stephanie M Topp & Julien M Chipukuma & Mark Giganti & Linah K Mwango & Like M Chiko & Bushimbwa Tambatamba-Chapula & Chibesa S Wamulume & Stewart Reid, 2010. "Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia," PLOS ONE, Public Library of Science, vol. 5(7), pages 1-11, July.

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