title: Trends in task shifting in HIV treatment in Africa: Effectiveness, challenges and acceptability to the health professions.
abstract: BACKGROUND
  Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new, it acquires new relevance in the context of current healthcare delivery.
  
  
  OBJECTIVE
  To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes, challenges identified in practice and the acceptability of this strategy to the health professions.
  
  
  METHODS
  Electronic databases were searched for studies published in English between January 2009 and December 2014. Keywords such as 'task shifting', 'HIV treatment', 'human resources' and 'health professions' were used.
  
  
  RESULTS
  Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring, absent regulatory frameworks, a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised.
  
  
  CONCLUSIONS
  Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges.
authors.affiliation: Department of Interdisciplinary Health Sciences, Stellenbosch University. tcrowley@sun.ac.za.
authors.forename: Talitha
authors.initials: T
authors.lastname: Crowley
authors.forename: Pat
authors.initials: P
authors.lastname: Mayers
mesh_terms: D000349:Africa; D019380:Anti-HIV Agents / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D032022:Delegation, Professional / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans
chemical_list: D019380:Anti-HIV Agents