title: Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
abstract: BACKGROUND
  Evidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may not be readily adopted in another. This study used an implementation research approach to assist policy makers and other stakeholders to assess the acceptability and feasibility of task shifting in the Namibian context.
  
  
  METHODS
  The Namibian Ministry of Health and Social Services implemented a Task Shifting Demonstration Project (TSDP) at 9 sites at different levels of the health system. Six months after implementation, a mixed methods evaluation was conducted. Seventy semi-structured interviews were conducted with patients, managers, doctors and nurses directly involved with the TSDP. Physician-evaluators observed and compared health service provision between doctors and nurses for 40 patients (80 observations), documenting performance in agreement with the national guidelines on 13 clinical care indicators.
  
  
  RESULTS
  Doctors, nurses, and patients interviewed believed task shifting would improve access to and quality of HIV services. Doctors and nurses both reported an increase in nurses' skills as a result of the project. Observation data showed doctors and nurses were in considerable agreement (>80%) with each other on all dimensions of HIV care and ≥90% on eight dimensions. To ensure success of national scale-up of the task shifting model, challenges involving infrastructure, on-going mentoring, and nursing scope of practice should be anticipated and addressed.
  
  
  CONCLUSIONS
  In combination with findings from other studies in the region, data from the TSDP provided critical and timely information to the Namibian Ministry of Health and Social Services, thus helping to move evidence into action. Small-scale implementation research projects enable stakeholders to learn by doing, and provide an opportunity to test and modify the intervention before expansion.
authors.affiliation: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Malley
authors.affiliation: International Training and Education Center for Health, University of Washington, Windhoek, Namibia.
authors.forename: Lily
authors.initials: L
authors.lastname: Asrat
authors.affiliation: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Ndapewa
authors.initials: N
authors.lastname: Hamunime
authors.affiliation: International Training and Education Center for Health, University of Washington, Windhoek, Namibia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Stephanus
authors.affiliation: International Training and Education Center for Health, University of Washington, Windhoek, Namibia.
authors.forename: Laura
authors.initials: L
authors.lastname: Brandt
authors.affiliation: International Training and Education Center for Health, University of Washington, Windhoek, Namibia.
authors.forename: Deqa
authors.initials: D
authors.lastname: Ali
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Francina
authors.initials: F
authors.lastname: Kaindjee-Tjituka
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Salomo
authors.initials: S
authors.lastname: Natanael
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Justice
authors.initials: J
authors.lastname: Gweshe
authors.affiliation: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Caryl
authors.initials: C
authors.lastname: Feldacker
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Ella
authors.initials: E
authors.lastname: Shihepo
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006761:Hospitals; D006801:Humans; D009276:Namibia; D009726:Nurses / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D000078329:Workforce
chemical_list: D044966:Anti-Retroviral Agents