title: From medical rationing to rationalizing the use of human resources for AIDS care and treatment in Africa: a case for task shifting.
abstract: With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient care is effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable.
authors.affiliation: Family Health International, Kigali, Rwanda. jprice@fhi.org
authors.forename: Jessica
authors.initials: J
authors.lastname: Price
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000628:therapy*; D000349:Africa; D019380:Anti-HIV Agents / Q000008:administration & dosage; D011307:Drug Prescriptions; D015276:Health Care Rationing / Q000941:ethics / Q000639:trends*; D006282:Health Personnel / Q000193:education / Q000639:trends; D006291:Health Policy / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends*; D006280:Health Workforce / Q000592:standards / Q000639:trends*; D006801:Humans; D020380:Needs Assessment; D010819:Physician's Role
chemical_list: D019380:Anti-HIV Agents