Studies Find Few Differences in Health Outcomes for HIV-Positive Patients Cared for by Nurses Versus Doctors

HIV-positive patients who receive care from trained nurses fare just as well as those who are treated by physicians, according to two studies released at the XVII International AIDS Conference in Mexico City, Reuters reports.

Delegates at the conference this week discussed how shifting some tasks to nurses might help in areas with high levels of HIV/AIDS and physician shortages. Ciaran Humphreys, a public health consultant with the Nuffield Centre for International Health and Development in the United Kingdom said, "It's a partial answer ... but this is a way of helping, particularly in settings where prevalence is so high." Humphreys added that HIV/AIDS "should not be seen as a specialist condition anymore. This is a condition that needs to be managed in primary care as well as in specialist centers when required."

For Humphreys' study in Swaziland, 427 patients were put on antiretroviral regimens in nurse-led clinics, while 150 patients started treatment in hospitals under the care of physicians. The nurses had all been trained to manage HIV/AIDS treatment and side effects.

After a year, patients in both groups were medically stable and had the virus under the same level of control. Humphreys said, "They get holistic care at the local clinic level with people they know and were comfortable with," adding, "More people at the clinics expressed their confidence in the ability to start to manage their own conditions than the people who attended the hospitals with all their doctors and facilities."

In a second, larger study in Mozambique, nurses in two public hospitals cared for 69% of 6,006 patients, while physicians cared for the rest, Reuters reports. The nurses took on more work, including reading laboratory results, identifying those who needed to start antiretrovirals, writing prescriptions and managing treatment of patients, as well as side effects. Both groups showed no difference in their health and viral loads after a year.

Kenneth Sherr of Health Alliance International, who conducted the study, said, "There was comparable level of quality of (nurses) and physicians in terms of HIV care and treatment." According to Sherr, patients under the care of nurses took their drugs more faithfully. "Doctors are managers and see a lot of different types of patients. ... [N]urses are more available and provide the bulk of care," Sherr added.

According to the researchers, questions such as nurses' feelings about the additional duties and whether they needed to shift some of their own duties to other staff members to care for HIV patients, need to be answered (Tan, Reuters, 8/7).

Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City.