Family Health International, Kigali, Rwanda.
Dev World Bioeth. 2010 Aug;10(2):99-103. doi: 10.1111/j.1471-8847.2010.00281.x. Epub 2010 Apr 26.
With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient care is effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable.
在全球范围内，致力于在资源匮乏的环境中扩大艾滋病护理和治疗，为非洲一些受艾滋病影响最严重的国家提供服务。现在，获得抗逆转录病毒治疗已不再是扩大治疗范围的主要障碍。缺乏经过培训的医疗保健人员来启动治疗和管理患者，这是向所有有需要的患者提供救生治疗的更具挑战性的障碍。以医生为中心的治疗政策强调了这一挑战。尽管有证据表明，将护士为中心的艾滋病患者护理任务转移是有效的，可以缓解目前阻碍治疗扩大的严重医生短缺问题，但支持任务转移护理模式的政治承诺和政策行动一直缓慢甚至缺乏。本文回顾了支持在非洲将艾滋病治疗任务转移的证据，并认为，政策持续不作为相当于不合理的医疗资源配给，因此在道德上是站不住脚的。
