Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia
Open accessAbstract
The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.
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In dermatology, unlike in HIV or obstetrics, there are few examples of task shifting in resource-poor settings.
“In the field of dermatology, unlike in HIV or obstetrics (53–56), there are few examples of task shifting in resource-poor settings”
From Global Burden of Skin Disease: Inequities and Innovations (2017) · cites this paper as [55]
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- Authors
- Morris, M. B., Chapula, B. T., Chi, B. H., Mwango, A., Chi, H. F., Mwanza, J., Manda, H., Bolton, C., Pankratz, D. S., Stringer, J. S., & Reid, S. E.
- Affiliations
- Centre for Infectious Disease Research in Zambia (ZM)
- Ministry of Health (ZM)
- Corresponding author
- Reid, Stewart E
- Venue
- BMC Health Services Research
- Published
- 2009-01-09
- Volume
- 9
- Issue
- 1
- Pages
- 5-5
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2628658
- OpenAlex
- W2076775397
- Cited by
- 166
- References
- 11
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 13 · 2016: 13 · 2015: 16 · 2014: 17 · 2013: 21 · 2012: 17
- FWCI
- 25.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Elizabeth Glaser Pediatric AIDS Foundation
- National Institutes of Health (P30-AI- 027767, 2007061, AI027767)
- Centers for Disease Control and Prevention
- U.S. Public Health Service (U62/CCU12354)
- National Institute of Allergy and Infectious Diseases (K23 AI 01411, P30AI027767)
- Fogarty International Center (K01-TW06670, K01TW006670)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
- Keywords
- task shifting, HIV antiretroviral therapy, ART scale-up, health workforce shortage, clinical mentorship, health professions education, pediatric HIV treatment, adherence counseling, Lusaka, Zambia
- MeSH terms
- Delivery of Health Care, Health Workforce, Health Services Accessibility, Humans, Staff Development, Zambia, HIV Infections, Models, Organizational, Efficiency, Organizational, Total Quality Management, Anti-Retroviral Agents
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