title: Task-shifting in HIV care: a case study of nurse-centered community-based care in Rural Haiti.
abstract: BACKGROUND
  At least 36 countries are suffering from severe shortages of healthcare workers and this crisis of human resources in developing countries is a major obstacle to scale-up of HIV care. We performed a case study to evaluate a health service delivery model where a task-shifting approach to HIV care had been undertaken with tasks shifted from doctors to nurses and community health workers in rural Haiti.
  
  
  METHODS
  Data were collected using mixed quantitative and qualitative methods at three clinics in rural Haiti. Distribution of tasks for HIV services delivery; types of tasks performed by different cadres of healthcare workers; HIV program outcomes; access to HIV care and acceptability of the model to staff were measured.
  
  
  RESULTS
  A shift of tasks occurred from doctors to nurses and to community health workers compared to a traditional doctor-based model of care. Nurses performed most HIV-related tasks except initiation of TB therapy for smear-negative suspects with HIV. Community health workers were involved in over half of HIV-related tasks. HIV services were rapidly scaled-up in the areas served; loss to follow-up of patients living with HIV was less than 5% at 24 months and staff were satisfied with the model of care.
  
  
  CONCLUSIONS
  Task-shifting using a community-based, nurse-centered model of HIV care in rural Haiti is an effective model for scale-up of HIV services with good clinical and program outcomes. Community health workers can provide essential health services that are otherwise unavailable particularly in rural, poor areas.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Ivers
authors.forename: Jean-Gregory
authors.initials: JG
authors.lastname: Jerome
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cullen
authors.forename: Wesler
authors.initials: W
authors.lastname: Lambert
authors.forename: Francesca
authors.initials: F
authors.lastname: Celletti
authors.forename: Badara
authors.initials: B
authors.lastname: Samb
mesh_terms: D003150:Community Health Workers; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D015658:HIV Infections; D006205:Haiti; D006801:Humans; D009726:Nurses; D010820:Physicians