Nurses are fundamentally important in the delivery of good healthcare to patients. A recent study highlights just how significant a nurse's role can be in providing medical care. There is now research backing up the claim that nurses are able to manage patients on antiretroviral (ARV) therapy as effectively as doctors, which supports the idea that healthcare facilities should "task-shift" in HIV treatment.
The South African study, which was published in the Lancet, follows recent investigation into the treatment of HIV by the government. The study divided 812 HIV positive patients into two groups.
One group received ARV therapy from doctors and the other group received their treatment from nurses. Both doctors and nurses participating in the study were inexperienced in ARV management, but underwent similar training from clinicians. These clinicians were on call during the duration of the study to answer any questions the doctors and nurses had.
The study found that patients received equal care from both nurses and doctors. After 120 weeks, the patients being treated by nurses were no more likely to have been lost to follow-up, to have failed treatment, or to have died than the patients being treated by doctors. Co-author of the study, Catherine Orrell, associated with the Desmond Tutu HIV Centre at South Africa's University of Cape Town hopes that the findings will be useful in the debate about task-shifting.
?Nurses didn?t prescribe the medication but they managed every other aspect, [including] drug interactions, illness and adherence,? she said. ?I?m hoping it will add some confidence in nurses? abilities, which I think has been lacking a bit in the debate.?
South Africa is currently tackling the problem of HIV in an effort to arrest its 18 percent infection rate amongst adults. The rise in the prevalence of this disease has incited calls for task-shifting in the management of HIV. It recently revised its national treatment guidelines, which now recommend earlier initiation of ARV therapy for HIV-positive pregnant women, infants, and tuberculosis patients. The South African government has also been operating a national voluntary HIV testing and
counseling (VCT) campaign for the last few months, the goal of which is to test 15 million people for HIV by 2011.
South Africa's national HIV strategic plan recommends that nurses be allowed to manage ARV treatment and the new treatment guidelines suggests the implementation of nurse-initiated treatment.
Currently, however, only doctors may legally prescribe licensed drugs in South Africa. This might change if prominent AIDS groups and NGOs get their way. Groups including Médecins Sans Frontières and the Southern African HIV Clinicians Society, have asked the government to change this legislation to allow nurses to initiate therapy and relieve bottlenecks that are happening because of a shortage of doctors in the public sector.