Published April 23, 2008 in "Trials" (1) an open access article shares a study protocol entitled: "Streamlining tasks and roles to expand treatment and care for HIV: [randomized] controlled trial protocol" Fairal, l, et al.
The South Africa Free State health department has decided to support this trial and to decide whether to implement nurse-led ART [antiretroviral treatment] based on the trials' results. Despite national guidelines, its Provincial Pharmaceutical and Therapeutics committee is legally [authorized] to permit nurses to prescribe Schedule 4 drugs such as antiretrovirals and has done so for intervention clinics in this trial. The National Department of Health and the main patient advocacy group in South Africa, the Treatment Action Campaign also support the trial and are keenly interested in the results. The timing of this trial is thus critical for policy making....
The aim of the trial is to compare the effectiveness of a primary care system based on nurse-led ART with the current system based on doctor -led ART. It is still widely assumed that ART is too difficult and risky to be entrusted to nurses because of drug side effects and resistance. But many eligible patients continue to die because of delays in starting ART. It is likely that with appropriate training and support, nurses can manage most patients effectively, leaving doctors to manage the minority at high risk or with complications....
Background: South African government health services started in 2004 to provide free ART to HIV-infected patients with certain CD4 counts but by 2007 only 1/3 of patients who need ART were receiving it. The major bottleneck is due to reliance on doctors to prescribe ART including starting treatment. Doctors are generally only available in hospitals and large urban health centers whereas most public sector primary care clinics are staffed by nurses.
... a better use of nurses is a compelling way to expand access and avoid delays in starting treatment. If most patients with HIV/AIDS can start and continue ART without doctors' involvement , they could start treatment earlier and thus avoid disease progressing and death.
At present in South Africa, only doctors may prescribe ART in keeping with national guidelines.
(1) http://www.trialsjournal.com/content/pdf/1745-6215-9-21.pdf