Can Nurses Replace Doctors for HIV Care?

Nurses as effective as doctors for HIV care

(RxWiki News) Can nurses do the job of a doctor? When it comes to providing HIV care in areas where doctors are in short supply, transferring some duties to nurses might mean major benefits.

According to a new study, nurses caring for HIV patients can be just as effective as care provided for doctors.

The good news is that nurses are more available than doctors to monitor patients, and there may even be additional health benefits to transferring the responsibility of care to them.

"Hard time seeing your doctor? Ask for a nurse."

The study was conducted by the University of East Anglia in the UK, and the University of Cape Town in South Africa. Dr. Max Bachmann of Norwich Medical School at the University of East Anglia, was one of the co-authors.

In a press release, Dr. Bachmann said, "Our findings show that with very little extra training and support nurses can deliver HIV care that is just as safe and effective as that provided by doctors. Indeed, we found that this model of nurse-centred care had a number of important health benefits.”

The trial involved more than 15,000 patients receiving care at antiretroviral therapy (ART) clinics in South Africa's Free State province. The study period lasted over two years.

HIV patients were divided up into two groups, for the first ever study that explored shifting tasks from doctors to nurses on a large scale.

The first group was assigned to a program that provides training to nurses, teaching them how to initiate ART for patients and do follow-up care. The other group continued receiving standard care from doctors.

At the end of the study period, there were very few differences between the two groups in terms of how many patients died, and whether the virus was under control in the still-living patients' bodies.

In the group that was treated by nurses, the researches noted that they had increased white blood cell counts, gained weight, and were more consistent with following the treatment program. The nurses were also better at detecting tuberculosis, which is a common disease for those infected by HIV.

The study is important because there are often a shortage of doctors in the areas hardest hit by AIDS – such as South Africa. There are six million HIV-infected individuals living in South Africa, but it has been estimated that only one in three people who could benefit from drugs are receiving them.

"There is a critical need to improve access to antiretroviral drugs – not only in South Africa but in other low to middle income countries where infection rates are high and doctors are in short supply,” said Dr. Bachmman. “HIV programes worldwide should now consider expanding nurse-centred care, safe in the knowledge that there need not be detrimental effects on patient health or mortality rates if done carefully."

In Western countries like the US, antiretrovirals are much more widely available. Patients typically receive care from doctors who specialize in HIV care, but it's possible that using nurses could bring down the cost of care.

The findings were published in The Lancet in August 2012. The study was funded by UK Medical Research Council, Development Cooperation Ireland, and Canadian International Development Agency.

Review Date: 
August 15, 2012