Effectiveness of Task Shifting in Improving HIV Antiretroviral Therapy

This report presents a systematic review exploring the effectiveness of task shifting in improving antiretroviral therapy (ART) for HIV patients, particularly within the context of healthcare in Australia. The study investigates how shifting tasks from physicians to nurses and other healthcare professionals can alleviate workload burdens and enhance the efficiency of ART delivery. The methodology involves a comprehensive search strategy using databases like Medline, PubMed, and Google Scholar, employing specific keywords and inclusion/exclusion criteria to identify relevant articles. The results section highlights findings from several key studies, including Pham et al. (2017), Crowley & Mayers (2015), Schmidt et al. (2018), Brown (2018), and Spies et al. (2016), which address the impact of task shifting on patient care, nurse workload, and the overall effectiveness of ART. The report concludes that task shifting is a cost-effective approach that can improve patient outcomes and nursing practices in the treatment of HIV/AIDS, especially in resource-constrained environments. The study also points out the need for further research and consistent monitoring for best results.

Running head: ANTIRETROVIRAL THERAPY
Effectiveness of task shifting in improvement of the antiretroviral therapy as the treatment of
HIV patient
Name of Student:
Name of University:
Author’s Note:

1ANTIRETROVIRAL THERAPY
Table of Contents
Introduction......................................................................................................................................2
Research question............................................................................................................................2
Method.............................................................................................................................................2
Search strategy.............................................................................................................................2
Search criteria..............................................................................................................................3
Inclusion criteria..............................................................................................................................3
Exclusion criteria.............................................................................................................................4
Result...............................................................................................................................................4
Overview of the evidence................................................................................................................6
Conclusion.......................................................................................................................................7
Reference.........................................................................................................................................8

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Introduction
Antiretroviral therapy for the treatment of HIV/AIDS is limited by physical resource and
lack of human power which is the major barrier for implementation of the therapy in Australia.
In health sector of Australia, an approach towards antiretroviral therapy has failed because of the
inefficient health professional which has impacted the health outcome of the HIV patient. In
order search for the remedial action, task shifting can be the option which can lower the burden
of workload and improve their efficiency. Therefore, the main aim of the study to explore the
effectiveness of task shifting in improvement of the antiretroviral therapy for treatment of HIV
patient. The main purpose of the study is to improve the nursing practice involved in the care of
HIV patient in the domain of antiretroviral therapy. The study has done systematic review of the
various studies with objective to address the aim of the research related to success of task
shifting action and improvement in ART therapy for HIV patient.
Research question
How can there be improvement in delivery of ART therapy for the HIV patient in
Australia?
Method
Search strategy
The search strategy aims to find the relevant articles based on the research question with
the use of key terms and health care database (McGowan et al., 2016). The systematic review is
done to give detail information of the aim of the research by employing critical review of
scholarly article published in the database (Ogdie et al. 2015). The literature review is done
utilising the computerised investigation for review as per the aim of the study. The article were

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collected by the process of gathering data and text has were published in grey or peer reviewed
journals. The search of literature has utilize snowball technique that has extended the manual
search for the reference and bibliography of the relevant articles (Hays et al. 2016). The step was
followed by exploring more literature at every stage of examination with aim to find quality
paper. In order to search for the articles following database and search engine were used:
 Medline
 PubMed central
 Google scholar
Search criteria
The key words used for extraction of pertinent articles were “Effectivness OR “use”,;
antiretroviral therapy AND HIV patient; “task shifting“ AND “cost”; “task shifting“ AND
“nurse”; “human resource“ AND “Antiretroviral therapy”; “health care professional“ OR
“Nurse.” .
For enhancing the search method, following steps has been followed:
 There has been used of free text and MeSH accompanied with truncation.
 Search for the catchwords
 Used Boolean operator like AND and OR with key terms.
Inclusion criteria
Following criteria was used to search article based on the aim of the paper:
 The paper addressing the research question based on any appropriate study design.

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 The participant in the study must include Health care professional working in ART
therapy and patient selected must be HIV positive.
 The paper must include task shifting model in health care sector
 The paper selected were no more than 5 years old from 2015 to 2019.
 All paper selected must be of English language.
Exclusion criteria
Following criteria were used to exclude the paper
 Old articles published before 2015 were excluded
 Article of language other than English
 Half text
 Not addressing the aim of the paper
 Paper not involving HIV patient and ART therapy
Result
After searching the articles, total 389 number of article were identified, 200 from Google
scholar, 89 from PubMed and 100 from Medline. The article were screened based on following
sequence for title, abstract, full text and in account with selection criteria. Total 145 paper were
selected which was analysed for quality and out of which only 5 article were based on research
question and in relevant with criteria.

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Medline
89
PubMed
100
Google scholar
200
Records after Duplicates removed=244
Records screened=
145
Records excluded based
(n=100)
Screening
Full-text articles assessed for eligibility
(n=45)
Full text articles
excluded with reasons
(40)
Eligibility Identification
Records identified through database
searching= 389
Studies included =5
(n=6)

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Figure: flow of article through systematic review
Overview of the evidence
In the study of Pham et al. (2017) which is based on RCT, author has discussed about the
requirement of antiretroviral therapy for care of HIV patient. Author has done systematic review
of the paper addressing the research question. In the finding of the study, regular monitoring is
highlighted for effective care of HIV patient. In another finding of the paper the workload of the
nurse has reflected poor care of the HIV patient. Therefor the author has concluded to due
inefficiency of the nurse, they are not able to deliver effective to the patient which has resulted in
poor health outcome. The sample size of the study is low hence need more research.
The finding was supported by Crowley and Mayers (2015) where the author has done
systematic review of the article based on task shifting in HIV treatment in Africa. The author has
found that task shifting is one the effective strategy to reduce the workload of the nurse. Author
has address various challenges in the health care system which include lack of effective health
care system, lack of mentoring, monitoring and evaluation by health care professional. In the
treatment of the HIV by antiretroviral therapy require regular care and observation by nurse
which could be achieved by task shifting of the nurse. The number of studies included were old
which give unreliable result.
In other finding of the Schmidt et al. (2018), author has highlighted about the incidence
of high rate of HIV in Australia, by explaining the pre-exposure prophylaxis (PrEP) as an
intervention to provide HIV prevention. The study has included the ART therapy for treatment,
however given evidence for importance of task shifting have in cost of implication in health care
Included

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system. The author has conducted qualitative study focusing on “Expanded PrEP
Implementation in Communities in New South Wales (EPIC-NSW)” trail model. Author found
that use of nurse-led PrEP has been evident for HIV prevention which can only achieved when
nurse deliver regular monitoring on the patient. Author has also suggested that this can be
achieved method of task shifting. The study design needs more research as limited to one
technique does not address the effect nurse intervention.
In the study of Brown (2018) author has done research on the indigenous nurse initiated
and managed antiretroviral therapy (NIMART) as the mean of treatment of the HIV. The author
has used textual analysis method to access the NIMART report. The study suggested that nurse
workload has been the common issue in the report which has resulted in inefficient care of the
patient. The study has not used any statistical analysis to conclude the result and selection of the
report were random which has the potential of existence of biasness in the study. In the study of
Spies et al. (2016) author has studied on the task shifting effect among the nurse in treatment of
HIV. Author has done literature review and found that task shifting is the best strategy to address
the shortage of human resource in health care system. The study is limited with lack of any data
support which make the finding subject to question.
Conclusion
From the above discussion it can be concluded that task shifting of the nurse and health
care professional is effective in giving care to the patient undergoing antiretroviral therapy and
thus improve the health of the patient and progress the nursing practice. It is the cost effective
approach to address the issue of limited human resource for giving care to HIV patients. As the
finding was related to different counties, its outcome can be applied to any health care system.

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Reference
Brown, A. M. (2018). Accommodating Indigenous Nurse-Initiated and Managed Antiretroviral
Therapy (NIMART) Reporting in a Developing Country Context. Journal of the
Association of Nurses in AIDS Care, 29(2), 220-230.
Crowley, T., & Mayers, P. (2015). Trends in task shifting in HIV treatment in Africa:
Effectiveness, challenges and acceptability to the health professions. African journal of
primary health care & family medicine, 7(1), 1-9.
Hays, D. G., Wood, C., Dahl, H., & Kirk‐Jenkins, A. (2016). Methodological rigor in Journal of
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(2015). Imaging modalities for the classification of gout: systematic literature review and
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Pham, M. D., Romero, L., Parnell, B., Anderson, D. A., Crowe, S. M., & Luchters, S. (2017).
Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a
systematic review. AIDS research and therapy, 14(1), 3.
Schmidt, H. M. A., McIver, R., Houghton, R., Selvey, C., McNulty, A., Varma, R., ... & Holden,
J. (2018). Nurse-led pre-exposure prophylaxis: a non-traditional model to provide HIV

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prevention in a resource-constrained, pragmatic clinical trial. Sexual health, 15(6), 595-
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Spies, L. A., Gray, J., Opollo, J., & Mbalinda, S. (2016). HIV and nurses: a focus group on task
shifting in Uganda. Journal of the Association of Nurses in AIDS Care, 27(3), 312-321.