Task-Shifting Strategies in HIV Care Delivery
Summary
Task shifting in HIV care encompasses the systematic delegation of clinical and support functions from highly specialised health professionals to cadres with shorter training and narrower scopes of practice. This approach has emerged as a pragmatic solution to chronic shortages of physicians and nurses, particularly in low- and middle-income countries. By authorising nurses, midwives, trained lay counsellors and other community-based workers to undertake tasks such as HIV testing, antiretroviral therapy (ART) initiation and routine monitoring, health systems can extend coverage, reduce waiting times and improve continuity of care. Key elements of successful task-shifting programmes include tailored clinical guidelines, structured training and mentorship, clear regulatory frameworks, and mechanisms for quality assurance. Task shifting has been applied across the HIV care cascade—from community-based testing and linkage to care, through nurse-led ART initiation (often termed NIMART), to adherence support and retention activities conducted by lay health workers. While evidence indicates high levels of patient satisfaction, comparable clinical outcomes and cost-effectiveness relative to physician-centred models, challenges remain in ensuring sustainable funding, protecting professional roles and maintaining adequate supervision and supply chains.
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Task-Shifting Strategies in HIV Care Delivery publication trend
The graph below shows the total number of articles in task-shifting strategies in hiv care delivery across all publications each year (not limited to Nature Index journals).
Technical terms
Task shifting: The deliberate reassignment of tasks from higher-trained to lower-trained health cadres, with the aim of optimising use of human resources.
Lay health worker: A community-based individual trained to perform specific health tasks (e.g., HIV testing, counselling) but without formal clinical qualifications.
Nurse-initiated antiretroviral therapy (NIMART): A model in which trained nurses assess eligibility for, prescribe and monitor ART according to standardised protocols.
Antiretroviral therapy (ART): The lifelong combination of drugs used to suppress HIV replication, preserve immune function and prevent disease progression.
Care cascade: The sequence of steps in HIV care—from diagnosis, linkage to treatment, retention in care, through to viral suppression.
References
- Registered nurses’ experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal. BMC Nursing (2024).
- Does a youth intern programme strengthen HIV service delivery in South Africa? An interrupted time‐series analysis. Journal of the International AIDS Society (2023).
- A systematic review of task- shifting for HIV treatment and care in Africa. Human Resources for Health (2010).
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