Task Shifting for Scale-up of HIV Care: Evaluation of nurse-centered antiretroviral treatment at rural health centers in Rwanda

Shortage of physicians is a barrier in achieving universal access to HIV care and treatment. In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three of the rural primary health centers in Rwanda. The feasibility and effectiveness of this task-shifting model was evaluated using descriptive data. Patients enrolled in HIV care and treatment services from September 2005 to March 2008 were reviewed to assess and the result shows no ineligible patients were started on ART and only one patient received an inappropriate ART prescription. Patient outcomes in this pilot program compared favorably with other ART cohorts in sub-Saharan Africa and with those from a recent evaluation of the national ART program in Rwanda. These findings suggest that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.