Clumeck Nathan
Division of Infectious Diseases, Saint Pierre University Hospital, Brussels, Belgium.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19493. doi: 10.7448/IAS.17.4.19493. eCollection 2014.
ART coverage among HIV-positive population varies, depending on the countries, between 10% (e.g. Indonesia) and 65% (Botswana). Death rates and new HIV infections have been linked to ART coverage. Therefore, streamlining tasks and roles to expand treatment and care and to provide quality and equitable health is an ongoing concern globally. One concept that has been applied to improve the delivery of HIV services is that of task shifting. Defined as the systematic delegation of tasks from doctors to cadre with less training such as nurses or lay workers, task shifting has been used as an effective strategy to address the current healthcare worker shortage in many African countries. A body of literature supports the use of task shifting as a successful approach in delivering healthcare services including HIV testing, counselling and ART treatment. In addition, in a time of economic burden and scare resources, task shifting may also help to relieve the situation. This concern is highlighted in recommendation of WHO to strengthen and expand human capacity among healthcare workers. The major issues that are raised are: How can task shifting be implemented in a way that is sustainable? How can clinical care services be organized to maximize the potential of the task-shifting approach while ensuring safety, efficiency and effectiveness? What preconditions must be met, what are the country-specific factors that will guide decision-making in the implementation of task shifting? In addition, task shifting should be implemented alongside other efforts to increase the numbers of skilled health workers. Quality assurances mechanisms should provide the necessary checks balances to protect both service users and health workers.
艾滋病毒阳性人群中的抗逆转录病毒治疗覆盖率因国家而异，在10%（如印度尼西亚）至65%（博茨瓦纳）之间。死亡率和新的艾滋病毒感染与抗逆转录病毒治疗覆盖率有关。因此，简化任务和职责以扩大治疗和护理范围，并提供高质量和公平的医疗服务，是全球持续关注的问题。一个已被应用于改善艾滋病毒服务提供的概念是任务转移。任务转移被定义为将任务从医生系统地委托给培训较少的人员，如护士或非专业工作人员，在许多非洲国家，任务转移已被用作解决当前医护人员短缺问题的有效策略。大量文献支持将任务转移作为提供包括艾滋病毒检测、咨询和抗逆转录病毒治疗在内的医疗服务的成功方法。此外，在经济负担沉重和资源稀缺的时期，任务转移也可能有助于缓解这种情况。世界卫生组织关于加强和扩大医护人员人力的建议中突出了这一关切。提出的主要问题是：如何以可持续的方式实施任务转移？如何组织临床护理服务，以在确保安全、效率和有效性的同时，最大限度地发挥任务转移方法的潜力？必须满足哪些先决条件，哪些特定国家因素将指导任务转移实施中的决策？此外，任务转移应与增加熟练卫生工作者数量的其他努力同时实施。质量保证机制应提供必要的制衡措施，以保护服务使用者和卫生工作者。
