HIV patients fare just as well with nurses: studies

By Tan Ee Lyn

MEXICO CITY (Reuters) - HIV patients under the care and management of trained nurses fared just as well as patients treated by doctors, if not better, according to two studies that demonstrate ways to replace scarce doctors in Africa.

Areas hard hit by the AIDS virus often suffer a shortage of doctors and some of the discussion at an international AIDS conference in Mexico City this week focused on how this could be partially answered by "task-shifting," or transferring some of the responsibilities of doctors to nurses.

In both studies, nurses stepped adequately into the shoes of doctors when managing HIV patients being given drug treatment.

"It's a partial answer ... but this is a way of helping, particularly in settings where prevalence is so high," Ciaran Humphreys, a public health consultant with the Nuffield Centre for International Health and Development in Britain, said in an interview.

The AIDS virus infects 33 million people globally, according to the United Nations AIDS agency UNAIDS. Two-thirds are in Africa, in some of the poorest countries with little medical infrastructure.

But properly given, cocktails of HIV drugs can keep patients alive, healthy and working, the many are now combined into easy-to-take single pills.

"This should not be seen as a specialist condition any more. This is a condition that needs to be managed in primary care as well as in specialist centers when required," Humphreys said.

SCARCE RESOURCES

Researchers in both studies agreed that questions needed to be answered, such as whether nurses were happy with the extra workload and if they needed to pass off their own work to other hospital staff.

Many experts have been complaining for years about a shortage of trained medical experts in developing countries. Nurses are often in short supply, as are trained technicians.

In Humphrey's study in Swaziland in southern Africa, 427 patients started HIV treatment in nurse-led clinics, while 150 patients started therapy in hospitals under the care of doctors.

The nurses had all been trained to manage HIV drug treatment as well as side-effects.

After a year, patients in both groups were medically stable and had the virus under the same level of control, but those who visited the clinics seemed more confident.

"They get holistic care at the local clinic level with people they know and were comfortable with," Humphreys said.

"More people at the clinics expressed their confidence in the ability to start to manage their own conditions than the people who attended the hospitals with all their doctors and facilities."