Task shifting of HIV management from doctors to nurses in Africa: clinical outcomes and evidence on nurse self-efficacy and job satisfaction.

With 24% global disease burden and 3% global health workforce, the World Health Organization (WHO) designates the African region a critical workforce shortage area. Task shifting is a WHO-recommended strategy for countries with severe health worker shortages. It involves redistribution of healthcare tasks to make efficient use of available workers. Severe physician shortages, increasing HIV disease burden, and the need for improved access to antiretroviral treatment (ART) posed serious challenges for Africa. Shifting ART management from physicians to nurses was adopted by many countries to increase access to treatment. Growing evidence from Africa supports this model of care but little is known about its impact on African nurses. A PubMed literature search was conducted for most recent task-shifting studies in Africa between January 2009 and August 2012. Thirty-four studies were identified but 11 met criteria for "task shifting from physicians to nurses in HIV settings." The methodologies and findings related to patient outcome, nurses' perceived self-efficacy, and job satisfaction were summarized. Patient outcomes were measured in 10 of the studies and all demonstrated comparable results. Seven of eight studies showed no difference in mortality while five found better retention and lower client loss to follow-up in nurse-managed groups. Four studies showed that nurses built on existing nursing and HIV knowledge; improved HIV and other disease management skills; and had increased comfort levels with using treatment guidelines. Results of job satisfaction from three studies showed that nurses expressed "feelings of emotional rewards, accomplishment, prestige, and improved morale." In six studies, nurse-managed care was acceptable to patients in five studies, nurses in two studies, and majority of physicians and program managers in one study. Nurse-managed care had comparable outcomes and retained more patients but only two studies "directly" assessed nurses' perceptions. Research exploring nurses' response, self-efficacy, and job satisfaction are critically to sustainability.