Nurses 'critical link' in implementing new WHO HIV guidelines

Active 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.

 The authors 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.

 While 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 the authors.

Nurses 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 authors.

Recognising 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.

Nurses 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.

In 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.

The 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.

1. 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.
2. 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.
3. 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.
4. The provision of cross-training of ANC and HIV service providers through in-service education and mentoring will promote a team approach to care.
5. 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.
6. 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.

The 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.”