support of nurses is critical for effective implementation of the revised World
Health Organization (WHO) HIV treatment guidelines, MaryAnn Vitiello and Suzanne
Willard state in a letter published in the August 2010 online edition of AIDS.
are nurses who work in countries which receive US PEPFAR support, and they are affiliated
with the International Training and Education
Center on Health (I-TECH)
and the Elizabeth Glaser Pediatric AIDS Foundation respectively.
a well-informed and highly skilled nursing workforce is considered essential
for all national health care systems, in reality it just doesn’t happen, note
are on the front lines of care, represent the largest group of health care
workers and have the most interaction with women and children, highlight the
and understanding the training and support needs of those who interact with
women and children affected by HIV – nurses (as well as clinical officers,
midwives, physicians and the community)-
is vital to ensuring the successful implementation of the guidelines, and
an integral part of a comprehensive approach to the prevention of
mother-to-child transmission, Vitiello and Willard note.
are proven leaders in HIV treatment and care, often under the most trying of
circumstances, and nurses in both resource-rich and resource-poor settings
continue to adapt standards and practices to meet the needs of their patients,
say the authors.
the United States,
Vitiello and Willard note, a team approach to HIV care and treatment is
favoured with nurses playing a key treatment role. Task-shifting in areas of
severe health worker shortages and increasing demand for treatment and care continues
to prove successful; nurses have taken on many duties previously undertaken by
doctors including prescribing antiretrovirals.
authors make six key recommendations to help ensure nurses have the necessary
tools, in accordance with the new guidelines, to provide client-centred HIV prevention,
treatment and care as part of their daily practice.
- Nurses at the teaching
level must have a complete understanding of the new guidelines and provide
their students with the necessary practical information. Pre-service
education should focus on a systems-based approach so nurses are able to
develop and run programmes that provide consistent and continuous access
to HIV-related services as well as the pharmacologic and physiological
aspects of HIV.
- WHO and programme
implementers should work with nursing organisations to identify gaps in
healthcare systems and make the necessary changes to integrate and link
services. In particular, so that children’s and women’s access to HIV
treatment is not limited by vertical programmes.
- Delivering HIV services
at antenatal care (ANC) clinics will ensure women get timely treatment and
care. This also provides an opportunity to establish a long-term
relationship with an HIV-positive mother and so support good adherence.
The authors suggest either a nurse in the HIV programme working closely
with ANC through mentorship, or preferably she/he has a presence at the
ANC clinic according to the need.
- The provision of
cross-training of ANC and HIV service providers through in-service
education and mentoring will promote a team approach to care.
- Advocacy at the national
level by nursing associations, including the International Council of
Nurses for nurses to receive the necessary training to put the guidelines
into practice is needed.
- A team-based,
collaborative approach is key to mentorship programmes. “Management of HIV
disease is complex not only because of antiretroviral treatment regimens,
but also because of the psychological and social implications of the
disease, especially in regard to stigma” the authors stress.
authors conclude “application of the recommendations offered here in the
regions of the world most deeply affected by HIV and AIDS will take us a step
closer to securing optimum health for all those living with HIV, and will
enhance global efforts to decrease mother-to-child transmission and protect the
health of mothers and children living with HIV.”