World Health Organization

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 Human resource: availability, mix, skill • 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

4. WHO – Task shifting Growing number of people require chronic care 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. WHO – Task shifting Essential for effective task shifting • Regulatory framework • Quality assurance, ongoing learning, supportive supervision, professional development • Sustainability

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

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

10. Central/Regional Hospitals Decentralization and task shifting Clinical teams led by a nurse or clinical officer District hospital Primary care level Close to home Community-based support 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.