In 2008, the World Health Organisation International Conference on Task Shifting recommended that countries should consider a task-shifting approach where access to HIV and other health services are constrained by health worker shortages [Article Reference]. In addition, strategies are needed that will empower health workers with skills to deliver a comprehensive quality health service to those infected with HIV. South Africa has the world’s highest HIV/AIDS burden, as well as a shortage of skilled health workers. Its national guidelines recommend that antiretroviral treatment (ART) be provided by doctors, although primary care is mainly provided by nurses.
STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) was developed to support the integration and decentralisation of HIV services, including re-prescription and antiretroviral treatment initiation in selected adults by nurses. Based on PALSA PLUS, it was implemented in selected primary care facilities in the Free State province.
STRETCH is being evaluated by means of a pragmatic cluster randomised controlled trial using 31 primary care clinics in the Free State. The two primary outcomes are mortality among patients waiting for antiretroviral treatment (to evaluate effect on treatment access) and viral load suppression rates among those receiving treatment (to evaluate effect on quality of care). Data collection started in September 2007 and the results will be available in the second half of 2010
Since 2008 this intervention has also been piloted as a health program in the Western Cape province in South Africa and and we will also be able to report on the successes and challenges of this type of health system intervention.
We believe that the STRETCH trial will provide valuable recommendations for high quality HIV and ART care and the expansion of ART access at the level of primary health care [Article Reference].
Funding has been made available for the STRETCH trial from Irish Aid, the Canadian International Development Agency and the British Medical Research Council.
“Nurses who are consulting are coming back to me that they feel so confident seeing patients now because of the training of PALSA PLUS guideline, directing them towards proper care and treatment of clients. Also, the key messages helping them remember and communication skills helping them never to forget why they are nurses.” PALSA PLUS trainer