Integrated Regional Information Networks - September 3, 2009

The study, conducted by the Infectious Diseases Institute (IDI) of Uganda's Makerere University and the Ministry of Health and published in the 23 August edition of Human Resources for Health, found that 64 percent of people who prescribed ART were not doctors.

"Many of these health workers have never received training for this, which means they may make mistakes that could lead to patients developing resistance and other complications," said Ibrahim Lutalo of the IDI, one of the authors of the study. "While their use has allowed for the expansion of ART rollout, there is an urgent need to properly train them."

The study sampled 265 doctors, clinical officers, nurses and midwives in 44 Ugandan health facilities. Of those who reported prescribing ART as part of their duties, 24 percent of doctors, 38 percent of clinical officers and nurses and 49 percent of midwives had no training in initiating patients on ART; even fewer had received training in monitoring patients on ART.

While assessing themselves, 7 percent of doctors who prescribed ART reported their overall knowledge of ART was less than "good", compared with 48 percent of other health workers who prescribed the drugs.

"Task-shifting"

Experts recommend that when resources are limited, "task-shifting" - the redistribution of work usually carried out by doctors to nurses, for example - be used to boost access to ART.

Another recent study found that Ugandan nurses and clinical officers agreed with physicians in deciding whether to initiate antiretroviral therapy in HIV-positive patients, pointing to the potential benefits of task-shifting, particularly in rural areas where doctors are largely unavailable. However, without training for health workers, patients can be exposed to incorrect prescriptions.

"Training initiatives should be an integral part of the support for task-shifting and ensure that ART is used correctly and toxicity or drug-resistance do not reverse the successes to date," the study's authors recommend.

"We also strongly recommend that the government amend its policy to officially allow other health workers to be involved in ART roll-out, provided they are properly trained," Lutalo said. "Task-shifting is already a reality in Uganda - entrenching it in the national policy with training guidelines will ensure people involved have the skills they need."

He added that the IDI had designed a course to equip health workers with the skills they needed to prescribe and monitor ART.

An estimated 170,000 people are enrolled in Uganda's ARV programme; another 130,000 need the drugs but do not have access to them. The country has only one doctor for every 22,000 patients and an overall health worker deficit of up to 80 percent, according to the UN World Health Organization.

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