Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.

<h4>Background</h4>Evidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may...

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Autores principales:	Gabrielle O'Malley, Lily Asrat, Anjali Sharma, Ndapewa Hamunime, Yvonne Stephanus, Laura Brandt, Deqa Ali, Francina Kaindjee-Tjituka, Salomo Natanael, Justice Gweshe, Caryl Feldacker, Ella Shihepo
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f197be400da64b25853b2d81167e86d6
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spelling	oai:doaj.org-article:f197be400da64b25853b2d81167e86d62021-11-18T08:27:34ZNurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.1932-620310.1371/journal.pone.0092014https://doaj.org/article/f197be400da64b25853b2d81167e86d62014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24642894/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Evidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may not be readily adopted in another. This study used an implementation research approach to assist policy makers and other stakeholders to assess the acceptability and feasibility of task shifting in the Namibian context.<h4>Methods</h4>The Namibian Ministry of Health and Social Services implemented a Task Shifting Demonstration Project (TSDP) at 9 sites at different levels of the health system. Six months after implementation, a mixed methods evaluation was conducted. Seventy semi-structured interviews were conducted with patients, managers, doctors and nurses directly involved with the TSDP. Physician-evaluators observed and compared health service provision between doctors and nurses for 40 patients (80 observations), documenting performance in agreement with the national guidelines on 13 clinical care indicators.<h4>Results</h4>Doctors, nurses, and patients interviewed believed task shifting would improve access to and quality of HIV services. Doctors and nurses both reported an increase in nurses' skills as a result of the project. Observation data showed doctors and nurses were in considerable agreement (>80%) with each other on all dimensions of HIV care and ≥90% on eight dimensions. To ensure success of national scale-up of the task shifting model, challenges involving infrastructure, on-going mentoring, and nursing scope of practice should be anticipated and addressed.<h4>Conclusion</h4>In combination with findings from other studies in the region, data from the TSDP provided critical and timely information to the Namibian Ministry of Health and Social Services, thus helping to move evidence into action. Small-scale implementation research projects enable stakeholders to learn by doing, and provide an opportunity to test and modify the intervention before expansion.Gabrielle O'MalleyLily AsratAnjali SharmaNdapewa HamunimeYvonne StephanusLaura BrandtDeqa AliFrancina Kaindjee-TjitukaSalomo NatanaelJustice GwesheCaryl FeldackerElla ShihepoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e92014 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gabrielle O'Malley Lily Asrat Anjali Sharma Ndapewa Hamunime Yvonne Stephanus Laura Brandt Deqa Ali Francina Kaindjee-Tjituka Salomo Natanael Justice Gweshe Caryl Feldacker Ella Shihepo Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
description	<h4>Background</h4>Evidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may not be readily adopted in another. This study used an implementation research approach to assist policy makers and other stakeholders to assess the acceptability and feasibility of task shifting in the Namibian context.<h4>Methods</h4>The Namibian Ministry of Health and Social Services implemented a Task Shifting Demonstration Project (TSDP) at 9 sites at different levels of the health system. Six months after implementation, a mixed methods evaluation was conducted. Seventy semi-structured interviews were conducted with patients, managers, doctors and nurses directly involved with the TSDP. Physician-evaluators observed and compared health service provision between doctors and nurses for 40 patients (80 observations), documenting performance in agreement with the national guidelines on 13 clinical care indicators.<h4>Results</h4>Doctors, nurses, and patients interviewed believed task shifting would improve access to and quality of HIV services. Doctors and nurses both reported an increase in nurses' skills as a result of the project. Observation data showed doctors and nurses were in considerable agreement (>80%) with each other on all dimensions of HIV care and ≥90% on eight dimensions. To ensure success of national scale-up of the task shifting model, challenges involving infrastructure, on-going mentoring, and nursing scope of practice should be anticipated and addressed.<h4>Conclusion</h4>In combination with findings from other studies in the region, data from the TSDP provided critical and timely information to the Namibian Ministry of Health and Social Services, thus helping to move evidence into action. Small-scale implementation research projects enable stakeholders to learn by doing, and provide an opportunity to test and modify the intervention before expansion.
format	article
author	Gabrielle O'Malley Lily Asrat Anjali Sharma Ndapewa Hamunime Yvonne Stephanus Laura Brandt Deqa Ali Francina Kaindjee-Tjituka Salomo Natanael Justice Gweshe Caryl Feldacker Ella Shihepo
author_facet	Gabrielle O'Malley Lily Asrat Anjali Sharma Ndapewa Hamunime Yvonne Stephanus Laura Brandt Deqa Ali Francina Kaindjee-Tjituka Salomo Natanael Justice Gweshe Caryl Feldacker Ella Shihepo
author_sort	Gabrielle O'Malley
title	Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
title_short	Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
title_full	Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
title_fullStr	Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
title_full_unstemmed	Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.
title_sort	nurse task shifting for antiretroviral treatment services in namibia: implementation research to move evidence into action.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/f197be400da64b25853b2d81167e86d6
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Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action.

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