Nurse-monitored ART found to be as safe, effective as therapy monitored by doctors in South African trial

Jun 18 2010

"HIV drugs can be administered as effectively by nurses as by doctors, a finding that could yield major benefits in the fight against AIDS in Africa," according to a study published online Wednesday in the Lancet, Agence France-Presse reports.

For the trial, which took place in two South African clinics, 812 patients living with HIV were divided into two groups - one group received antiretroviral therapy (ART) monitored by doctors, the other by trained nurses, AFP reports. "A total of 371 patients encountered treatment failure over the 120-week length of the experiment, but the results were similar in both groups - 192 in the nurses group and 179 in the doctors group," AFP writes. "Ten patient deaths occurred among the nurses group compared with 11 among the doctors. There were equally close results among patients who failed to respond to a specific ART combination, fell ill from them or dropped out of the programme" (6/15).

The results of the study support the safety of "task-shifting" HIV treatment from doctors to nurses, which "could help ease a critical shortage of health workers," Reuters writes (Kelland, 6/15). "The findings are important because Africa, the worst-hit continent for AIDS, suffers from a chronic lack of doctors - and health watchdogs have been wondering desperately whether less-trained personnel can be used as substitutes," AFP adds (6/15).

Though the U.N. estimates 33 million people worldwide are living with HIV, "more than half of the 9.5 million people who need AIDS drugs cannot get them" - an issue "compounded by a global shortage of 4.3 million healthcare workers,  Reuters continues (6/15). The healthcare worker shortage recently "prompted the World Health Organisation to propose task-shifting from doctors to lower level healthcare workers," Nursing Times writes (6/16).

"Expansion of ART services is urgently needed in resource-poor countries to achieve universal access targets by 2010, and further expansion will be needed with the start of universal testing and treating strategies," write the authors of the study. "This study therefore lends supports to the strategy of task shifting, and suggests that HIV management by nurses can be safe and effective," the authors add (Sanne et al., 6/16).

"The new study, while approving the 'task-shifting' to nurses, adds that staff still need to be trained to supervise use of these powerful drugs," AFP continues. Additionally, the study found that patients with advanced HIV infection "did somewhat better when monitored by doctors as opposed to nurses."

AFP adds: "The research did not look at the question as to whether nurses performed well in initiating drug treatment. Under South African law, only doctors have the right to prescribe licensed drugs such as ART" (6/15).

"Over recent years, there have been many calls for clinical and operational research to help to better inform policy and guidelines for routine HIV care," write the authors of an accompanying Lancet Comment. "In view of the enormous amount of resources ploughed into the effort to achieve universal access to HIV care, including antiretroviral therapy, it is marvellous to see the results of a practical and innovative study which helps propel the field forward and improves our collective confidence that despite all the obstacles we can succeed," they write (Boyd/Nwizu, 6/16).

Lancet Study Examines Impact Of Gender Inequality, Violence Against Women On New HIV Infections

In related news, the Los Angeles Times' "Booster Shots" blog reports on a separate Lancet study, also published online Wednesday, that explores the relationship between gender inequality and physical and sexual abuse and HIV infection among women living in rural South Africa (Kaplan, 6/16).

For the study, the authors analyzed "data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06," according to the study. "Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively" (Jewkes et al., 6/16).

Based on their findings, the researchers assert that "nearly 14% of the new HIV infections recorded between 2002 and 2006 [in South Africa] could have been avoided," the blog reports (6/16).

In the study, the authors conclude, "Organisations driving HIV prevention agendas for women, particularly UNAIDS and WHO, need to ensure that policies, programmes, and interventions to build gender equity and prevent partner violence are developed and widely implemented. Donors and researchers must invest efforts and resources in developing and testing new interventions" (6/16).

"As we move forward, we should consider that nature and social contexts of epidemics vary and so must interventions," writes the author of an accompanying Lancet editorial that notes the recent U.S. commitment of "$30 million to implement and test prevention programmes for gender-based violence in three African nations" - Tanzania, Mozambique, and the Democratic Republic of Congo -currently receiving PEPFAR funding. "In view of the scale of U.S. efforts over the past decade to combat HIV, and the great potential for HIV prevention associated with reduction of gender-based violence, we must hope that this initial allocation will be followed by far greater investment," the author writes (Silverman, 6/16).