Task-Shifting to Address HIV Care Needs: The Nurse-Visit Programme

Task-shifting is the process of delegation where tasks are moved, where appropriate, to other cadres of health workers. Following the WHO Conference in 2008, global recommendations and guidelines on task-sifting were developed as an international call for urgent improvement of health systems and particularly strengthening of human resources for health. Although task- shifting gained international prominence in 2008, task-shifting had already started taking place at IDI as early as 2006, to address the overwhelming numbers of patients during antiretroviral therapy (ART) rollout in the clinic.

Nurses are empowered to review patients, so that medical officers can concentrate on treatment and clinical care. To ensure quality of care, the nurses are trained on clinical assessment of patients, identification of drug toxicities, management of opportunistic infections and drug interactions. The nurses have been able to keep abreast with developments in clinical care through continuous nursing education (CNE), a weekly nurse training programme at IDI. Through the weekly CNEs, nurses are updated on various areas such as: general health care, HIV/AIDS, case sharing and clinical skills of patient management. IDI has established standard operating procedures (SOPs)/ guidelines on how patients should be channelled and be reviewed by nurses or doctors.

The team of nurses at IDI has confidently taken on clinical roles that enable them to review patients, through the ‘Nurse Visit' Programme. Nurses are now able to prescribe treatment for opportunistic infections; identify toxicities such as lipodystrophy and peripheral neuropathy; and identify treatment failure with the help of routine lab tests among other things. At IDI, nurses have been able to shift some of their own tasks to the ‘Expert Friends’, who have taken on tasks that were originally meant for nurses, on a voluntary basis, to enable nurses to concentrate on offering quality care to the ‘Friends’ who attend the clinic. Some of these tasks include measuring weight and height of the patients and transferring of files. The ‘Friends’ are trained in basic patient care management and counselling to provide quality care to other patients.

The Pharmacy Refill Programme

The pharmacy refill programme was originally conceived as an efficient and cost effective way of decongesting the IDI Clinic. At the time, it was observed that not all the patients that visited the clinic each day, needed to see a clinician. The clinician workload was too high for both the doctors and nurses because of the high demand for HIV Care. The Pharmacy Refill Programme was then created to cater for this group of ‘Friends’ that were deemed clinically stable. This group includes ‘Friends’ on antiretroviral therapy (ART) and those on cotrimoxazole prophylaxis.

In order to ease implementation of the programme and identification of potential clients, it was necessary to create a separate pharmacy window to serve patients- “The Pharmacy Refill Window”. ‘Friends’ on ART pick up their medicines on a monthly basis, and see a clinician only once in three months. Patients on cotrimoxazole prophylaxis only see the clinician once in six months, and pick up their medicine once every three months, at the Refill Window. The Refill Window was first opened in 2006, and currently serves about a third of the general clinic population.