For more than 20 years since HIV/Aids was first identified in south western Uganda around 1985, access to treatment for this ailment was for only the privileged few.
Even when medicines such as AZT became available 10 years later in 1996, only a select few Ugandans such as top government officials and high- income individuals could afford them.
At the time, only a handful of elite clinics such as the Joint Clinical Research Centre (JCRC), could offer any relief for people living with HIV.
This because only a small number of patients were able to pay exclusive fees for HIV services, care was almost entirely provided by medical doctors.
Many Ugandans living with HIV often died premature deaths as the virus ravaged their lives with no medicines to treat the virus.
Then a game-changer happened in Uganda in June 2004. The US government through the PEPFAR initiative provided substantial external aid to enable the provision of free anti-retroviral therapy (ART) at national and regional referral hospitals across Uganda.
But then, the ‘medicines without doctors’ predicament emerged as the new challenge. From the 2,700 who were enrolled on treatment in 2004 alone, there are currently 1.2 million Ugandans accessing anti-retroviral therapy (ART).
The giant leap in the number of those accessing treatment could not have been possible without task shifting from medical doctors to less-specialised cadres such as nurses and midwives. Task shifting to nurses was, however, done informally without a guiding policy framework. There is still no such policy to date.
As we commemorate 2020 as the International Year of the Nurse and Midwife, we reflect on findings from a study we conducted across Uganda that revealed the true extent of task shifting to nurses in HIV care.
We found that across the nearly 200 hospitals, we visited across Uganda’s 10 sub-regions, 93% of them permitted nurses to initiate and manage ART.
Our study reveals for the first time that nurses have the highest representation in the leadership and governance of HIV clinics across Uganda. This trend was more pronounced in rural areas, but was fairly even across both rural and urban settings.
The facility managers perceived nurses to be a more dependable cadre as they ‘tend to stick around for years.’ There was a common perception that ‘higher grade’ cadres such as young doctors tend to leave for further training and better paying jobs. Because of the shortage of doctors, nurses were depended upon as the backbone of HIV service delivery in HIV clinics countrywide.
Nurses were empowered to be ‘all-rounders’ in HIV care right from testing to ensuring viral suppression.
We were told that nurses can do ‘big things’ if they receive regular trainings and supportive supervision. Over the past decade several studies have demonstrated the non-inferiority of nurse-managed HIV care and treatment.
Although the dramatic expansion in access to HIV treatment revealed the competence of nurses in managing more advanced roles in HIV management, task shifting to nurses is still not yet formally recognised by policy. The official ‘scope of practice’ of nurses has not been revised to reflect the extension in their roles in HIV service delivery.