Skip to main content
Log in

Commentary: Scaling up HIV treatment in resource-limited countries: The challenge of staff shortages

  • Commentary
  • Published:
Journal of Public Health Policy Aims and scope Submit manuscript

Abstract

Scaling up antiretroviral therapy (ART) in resource-limited countries is a major challenge for health professionals and program managers due to the large number of patients and the severe shortage of health-care workers. The estimated number of patients in those settings requiring ART in 2009 was 14.6 million, of whom 64 per cent were not yet treated. The World Health Organization estimates that there is an overall deficit of more than 4 million physicians, nurses, midwives, and support workers for achieving the essential health interventions and the Millennium Development Goals (including the scaling up of HIV care). Strengthening the health systems through education, job-specific training, recruitment, and retention of health-care workers is imperative. In the meantime, task shifting is a key element of the response to the staff shortages, but further innovative models of care delivery are needed.Article JPHP.2011.4, available at http://www.palgrave-journals.com/jphp/, relates to this Commentary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2

References

  • Adedimeji, A., Malokota, O. and Manafa, O. (2011) Implementing antiretroviral therapy programs in resource-constrained settings: Lessons from Monze, Zambia. Journal of Public Health Policy, advance online publication 24 February, doi: 10.1057/palgrave.jphp.2011.4.

  • Laurent, C. et al (2002) The Senegalese government's highly active antiretroviral therapy initiative: An 18-month follow-up study. AIDS 16 (10): 1363–1370.

    Article  Google Scholar 

  • Desclaux, A. et al (2003) Access to antiretroviral drugs and AIDS management in Senegal. AIDS 17 (Suppl 3): S95–S101.

    Article  Google Scholar 

  • Weidle, P.J. et al (2002) Assessment of a pilot antiretroviral drug therapy programme in Uganda: Patients’ response, survival, and drug resistance. Lancet 360 (9326): 34–40.

    Article  Google Scholar 

  • Djomand, G. et al (2003) Virologic and immunologic outcomes and programmatic challenges of an antiretroviral treatment pilot project in Abidjan, Côte d’Ivoire. AIDS 17 (suppl 3): S5–S15.

    Article  Google Scholar 

  • Galvao, J. (2002) Access to antiretroviral drugs in Brazil. Lancet 360 (9348): 1862–1865.

    Article  Google Scholar 

  • World Health Organization. (2003) Treating 3 million by 2005: Making it happen: The WHO strategy, http://www.who.int/3by5/publications/documents/en/3by5StrategyMakingItHappen.pdf, accessed 19 January 2011.

  • World Health Organization. (2010) Towards Universal Access. Scaling Up Priority HIV/AIDS Interventions in the Health Sector. Progress report 2010, http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf, accessed 13 October 2010.

  • World Health Organization. (2006) Towards universal access by 2010. How WHO is working with countries to scale-up HIV prevention, treatment, care and support, http://www.who.int/hiv/toronto2006/towardsuniversalaccess.pdf, accessed 5 January 2011.

  • UNAIDS. (2010) Global Report: UNAIDS Report on the Global AIDS Epidemic 2010, http://www.unaids.org/documents/20101123_GlobalReport_em.pdf, accessed 1 December 2010.

  • Kober, K. and Van Damme, W. (2004) Scaling up access to antiretroviral treatment in southern Africa: Who will do the job? Lancet 364 (9428): 103–107.

    Article  Google Scholar 

  • World Health Organization. (2006) Working together for health, http://www.who.int/whr/2006/whr06_en.pdf, accessed 14 January 2011.

  • Gilks, C.F. et al (2006) The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet 368 (9534): 505–510.

    Article  Google Scholar 

  • Brinkhof, M.W. et al (2008) Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ 86 (7): 559–567.

    Article  Google Scholar 

  • WHO UNAIDS PEPFAR. (2008) Task shifting: Rational redistribution of tasks among health workforce teams. Global recommendations and guidelines, http://www.who.int/healthsystems/TTR-TaskShifting.pdf, accessed 9 January 2011.

  • Bedelu, M., Ford, N., Hilderbrand, K. and Reuter, H. (2007) Implementing antiretroviral therapy in rural communities: The Lusikisiki model of decentralized HIV/AIDS care. Journal of Infectious Diseases 196 (Suppl 3): S464–S468.

    Article  Google Scholar 

  • Shumbusho, F. et al (2009) Task shifting for scale-up of HIV care: Evaluation of nurse-centered antiretroviral treatment at rural health centers in Rwanda. PLoS Medicine 6 (10): e1000163.

    Article  Google Scholar 

  • Stringer, J.S. et al (2006) Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: Feasibility and early outcomes. Journal of the American Medical Association 296 (7): 782–793.

    Article  Google Scholar 

  • Coetzee, D. et al (2004) Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS 18 (6): 887–895.

    Article  Google Scholar 

  • Bemelmans, M. et al (2010) Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care. Tropical Medicine & International Health 15 (12): 1413–1420.

    Article  Google Scholar 

  • Miles, K., Clutterbuck, D.J., Seitio, O., Sebego, M. and Riley, A. (2007) Antiretroviral treatment roll-out in a resource-constrained setting: Capitalizing on nursing resources in Botswana. Bull World Health Organ 85 (7): 555–560.

    Article  Google Scholar 

  • Severe, P. et al (2005) Antiretroviral therapy in a thousand patients with AIDS in Haiti. New England Journal of Medicine 353 (22): 2325–2334.

    Article  Google Scholar 

  • Callaghan, M., Ford, N. and Schneider, H. (2010) A systematic review of task-shifting for HIV treatment and care in Africa. Human Resources for Health 8: 8.

    Article  Google Scholar 

  • Sanne, I. et al (2010) Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): A randomised non-inferiority trial. Lancet 376 (9734): 33–40.

    Article  Google Scholar 

  • Jaffar, S. et al (2009) Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: A cluster-randomised equivalence trial. Lancet 374 (9707): 2080–2089.

    Article  Google Scholar 

  • Ferradini, L. et al (2006) Scaling up of highly active antiretroviral therapy in a rural district of Malawi: An effectiveness assessment. Lancet 367 (9519): 1335–1342.

    Article  Google Scholar 

  • Koenig, S.P., Leandre, F. and Farmer, P.E. (2004) Scaling-up HIV treatment programmes in resource-limited settings: The rural Haiti experience. AIDS 18 (Suppl 3): S21–S25.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laurent, C. Commentary: Scaling up HIV treatment in resource-limited countries: The challenge of staff shortages. J Public Health Pol 32, 211–218 (2011). https://doi.org/10.1057/jphp.2011.8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/jphp.2011.8

Keywords

Navigation