KIGALI, 26 February 2010 (PLUSNEWS) - Rwandan nurses will soon be authorized to start HIV-positive patients on life-prolonging antiretroviral treatment (ART), a move Ministry of Health officials say will speed up the rollout of ART in the East African nation.
"Task-shifting will reduce the number of cases requiring the presence of a doctor, thereby reducing the number of treatment-eligible patients that have not initiated ART because they have to wait for the doctor's visit," Aimable Mbituyumuremyi from TRAC Plus, the Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, told IRIN/PlusNews.
At present, starting on ARVs requires a medical consultation and prescription from a physician. Nurses are responsible for regular patient follow-up and can refill existing ARV prescriptions. Physicians are generally based at district hospitals and visit health centres once a week.
According to officials from TRAC-Plus and the Ministry of Health, the new programme aims to train two nurses from every health centre offering HIV services. By the end of May, 600 nurses will be trained on the theoretical and practical aspects of ART prescription. Training will be followed by a three-month mentorship period, where physicians from district hospitals will conduct follow-up visits to each health centre to guide nurses on patient management.
By September the nurses will be authorized to prescribe ART in uncomplicated cases requiring first-line drugs.
Cases with significant complications that may require second-line ART will continue to be referred to physicians. Doctors and supervisors from the district hospitals will continue to monitor nurses during their quarterly formative supervision visits to health centres.
A 2009 study http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000163 by the NGO, Family Health International, and the Ministry of Health, evaluating nurse-centred ART in rural health centres in Rwanda found that nurses could "effectively and safely prescribe ART when given adequate training, mentoring, and support".
Rwanda suffers from a severe shortage of health workers; according to the UN World Health Organization http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf, the country has approximately one physician per 10,000 population and four nurses and midwives per 10,000, compared with 13 physicians per 10,000 globally and 32 physicians per 10,000 in the European region.
The country's limited number of health workers has been put under enormous stress by the rapid scale-up of ART. According to TRAC, clients on ART increased from approximately 34,000 at end-2006 to more than 75,000 at end-2009 - an increase of 120 percent - while the number of health centres providing ART increased from 133 to 252 during the same period.
The latest Rwanda National Strategic Plan for HIV/AIDS aims to have all health facilities in Rwanda able to provide a full package of HIV services, including ART, by 2012; it also intends to put 90 percent of eligible patients on HIV treatment. The plan envisages task-shifting as critical to achieving these goals.
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