Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia
Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia
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DOI：
10.1186/1472-6963-9-5
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发表时间：
2009-01-09
影响因子：
2.8
通讯作者：
Reid, Stewart E.
中科院分区：
文献类型：
--
作者：
Morris, Mary B.;Chapula, Bushimbwa Tambatamba;Reid, Stewart E.
世界卫生组织提倡任务转移，将临床护理职能从专业化程度较高的卫生工作者下放给专业化程度较低的卫生工作者，以此作为实现联合国千年发展目标的一项战略。然而，在撒哈拉以南非洲，由于面临普遍的人力资源危机，抗逆转录病毒疗法服务迅速扩大，但却缺乏描述任务转移的文献。作为在赞比亚卢萨卡扩大抗逆转录病毒治疗服务的一部分，我们在现有的卫生服务提供者和社区工作者中实施了一项全面的任务转移计划。培训从针对专门技能的教学课程开始。之后是一个密集的实践指导期，在独立工作之前，提供者与培训师配对。我们使用每个站点的临床护理质量的关键指标提供持续的质量评估。每季度与诊所工作人员一起审查计划绩效。当发现问题时，诊所工作人员设计和实施具体的干预措施，以解决目标领域。从2005年到2007年，我们培训了516名成人艾滋病毒治疗的医疗服务提供者; 270名儿童艾滋病毒治疗; 341名坚持咨询; 91名专科护士“分诊”课程，93名强化临床指导计划。持续的质量评估表明，尽管患者数量迅速增长，但临床护理质量指标有所改善。我们的任务转移战略旨在满足当前卫生保健工作者的需求，并维持ART的规模扩大活动。虽然这一办法取得了成功，但还迫切需要长期解决人力资源危机，以扩大提供者的数量，减缓工作人员向该区域外迁移的速度。
The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.